June 2004 Archives

What sleep I got today wasn't all that great. I got to nap for a little while during the morning before my wife and middle daughter had to go to rehearsal for their dance performance tomorrow. I was left home with the oldest and youngest. If the combination was different I could have gone back to sleep for some more time. My middle daughter is the responsible one, the 6 going on 16 child. I know that I can trust her to watch out for whichever other sister is home and wake me if they need something. My oldest is just too impulsive and my youngest is just too young. Sleep was just not going to happen until my wife got home again.

That happened around 1500 and I managed to crash for another couple of hours giving me a respectably scant amount of sleep but still enough to muddle through on.

The medic that left suddenly last night will not be working tonight so we had to rearrange the schedule and I will be working Medic 1 tonight. I had hoped that I would be able to swap into Medic 6 and have a chance to get a nap but that just didn't work.

The night tonight and the day tomorrow are going to be very interesting from a sleep perspective.

It was a pretty good night even though I spent a lot of time on the road. Early in the shift we had to take Medic 2 off line when the paramedic working had a family emergency that required his immediate attention. The pages started going out right away to find coverage, and kept going out for over an hour. It was frustrating for me since the paramedic that needed to be covered has always been willing to come in on short notice to cover for other people. It's a shame that nobody would return the favor. I know that if I had been home I would have been willing to work, he's done it for me (and most of the rest of us as well), the least he could expect was the same treatment .

In the end it was about three hours that we were down a unit. Medic 3 and I were constantly on the move with lots of calls coming in during that time. We finally had coverage from a new medic that had just finished his orientation. When I say just finished, I mean he had to stop at the ED and finish the last item on his list as he was driving in.

About a half hour before he was due to be in to take over I was sent to a call far on the border of Medic 2's area, an area that we cover that is actually in a neighbouring county, for a MVC, possible rollover on the interstate. After about 10 minutes responding the fire department reported no injuries and cancelled all responding EMS. I was between exits and still had to travel a couple of miles further to turn around. On the way back I had just crossed the river and back into my county when the call came in for chest pain at the northern edge of my regular territory. Medic 3 was already on a call and no other paramedics were available from surrounding areas to cover this call so I had to go. Coming from the southern end of Medic 2's area I knew it was going to be about a 25 minute response. I was pretty unhappy about the whole situation but there was nothing that I could do about it.

26 minutes later I pulled up to the scene just as the ambulance was closing the back doors to leave. I grabbed my gear and hopped in the side door and found an 80ish male whole looked absolutely grey, dripping with sweat, and clearly in agony. The patient complained of a sudden onset of chest pain and difficulty breathing shortly before calling 911. He said that the 10 out of 10 pain was radiating from the center of his chest to his neck and that it was unchanged when he moved or I palpated his chest or belly. I did a quick 12 lead ECG which was not helpful, not normal but not showing anything clearly bad. The ambulance had already given him aspirin. I told the ambulance to give me a smooth ride but not to waste any time. While I started his line he got a single dose of nitroglycerin under his tongue.

It helped, his chest pain went completely away but now he was complaining of 8 out of 10 upper abdominal pain, continued nausea and shortness of breath and now some dizziness. Well, if my blood pressure dropped quickly to the 60's I'd probably be dizzy too. We laid him flat and raised his legs and his pressure came up but only a little. I opened the IV wide to give him some fluid and try to bring his blood pressure back up. It didn't work and he still looked pretty awful and started vomiting.

I was very glad that we were really close to the ED by now because he continued to look worse and worse.

He got more IV's in the ED, another 12 lead ECG with both left and right sided leads and didn't respond to the additional fluid he was receiving. He got a quick chest x-ray and sent for a CT scan of his chest. The results were pretty impressive. His aorta, one of the major blood vessels in the chest had developed a dissection (a leak between the layers of the blood vessel) that had swelled up to almost 4 cm and ran from the aortic arch (top of the aorta) down to his diaphragm. This was not a good finding, if the dissecting area ruptured it would without a doubt be fatal.

The surgeon came down to the ED and examined the x-rays and CT scan and said that he couldn't do the necessary surgery here because of the extent and location of the dissection. He would need to be transfered to a larger hospital with a cardiothoracic surgeon and the proper equipment. The staff called hospital after hospital and each one said that they would be happy to take the patient except that they had no ICU beds for him to take. Finally one hospital said they had a surgeon and an ICU bed for him and the next battle started, finding a way to get him to a hospital almost an hour away.

Air seemed like a good candidate but both of our local helicopters were already on missions and we would have to wait 40 minutes for a mutual aid helicopter. None of the docs wanted to wait so they called for ground transport. It ended up taking the 40 minutes we would have waited to get the helicopter and then some to get the ambulance to the ED and the patient ready to travel.

I have to say that I would not have been happy transporting this patient that far by ground. This patient had what was essentially a "ticking time bomb" in his chest that could "go off" at any time. If the dissection ruptured during the transport the patient would be very, very dead and there would be absolutely nothing that the crew would be able to do. I always found those situations scary and frustrating.

Fortunately the patient survived the transport and made it to the OR. Even if the surgery is successful he is definitely not out of the woods yet. This is very major surgery and frequently the elderly don't recover well from surgery this extensive.

As I drove home I really felt ambivalent about my treatment of this patient. I mean, I treated the patient properly and even the ED doc thought that with the way he presented my decisions were reasonable. I just felt a little uncomfortable with my transport decision. A nagging voice in the back of my head kept saying that I should have transported him to the larger hospital 20 minutes north of the scene instead of 10 minutes back to the community hospital where I work. I reasoned that if it had been a cardiac problem he would be in a facility that could do a cardiac cath, bypass, or whatever else needed to be done. If it was what it ended up being he would be in a hospital with the capability to do the surgery he needed and since he would already be a patient they would just have to find him an ICU bed for when, or if, he survived the surgery.

I know I made sound judgments but I feel like I was thinking "in the box" instead of out of it.

Total calls for the night: 7
1 BLS downgrade
1 ALS turned over to the ALS ambulance
1 ALS transport
2 Cancelled
2 Cover assignments

Milage for the night: 108

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

It was interesting trying to shoehorn the transportation needs of all three kids into a single afternoon. Still, everybody got to where they needed to be and did what they needed to do and my oldest had a wonderful time at a pizza party with her Brownie troop (even though she had to have salad instead of pizza). I am very relieved that she had a good time and her anxiety and lack of social skills didn't interfere too much.

All of my kids were happy to see their "grandma" even though it meant that they probably were not going to get to see their mom or me very much tonight. That was also a nice change since usually at least one of them makes it known that they want their mom and will accept no substitutes.

It will be nice to see my wife at the hospital, we might even get a chance to talk for a few minutes without being interrupted.

Not a bad night, not extremely busy, but I got to see some patients and do some calls. The only downside to the entire night was that we have a new communications glitch. One of the towns that we respond to most in this area changed their operating frequency to one that we don't have programmed into our radios. This makes it difficult to coordinate responses, intercepts, and get any information about what is happening on scene. I'm hoping that this will not be a problem for too long but who knows.

None of my calls were all that complex or challenging. Everything was pretty routine which was fine with me. I managed to get finish my paperwork on time and catch up on my email.

I'm looking forward to getting home to sleep. Because of some scheduling conflicts between my wife and I we both ended up working tonight so my mother is coming to spend the night and watch the kids while we are both at work. I'll also have to chauffeur my oldest to a bunch of activities she has planned with the Brownies.

Total calls for the night: 6
1 Cancelled enroute
1 BLS transport
2 ALS transports
1 BLS downgrade
1 Cover assignment

Milage for the night: 67

CD for the night: "Volcano" by Jimmy Buffett

First night back, as usual I am looking forward to being back at work. Especially working Medic 2. A lot of my colleagues don't care for working Medic 2 for one reason or another. I don't mind it, I find that I get much more work done and in general it is a less frustrating station to work. I have been starting to get frustrated with Medic 1 (the other station I work regularly) because I seem to spend a lot of time on the road but actually end up transporting very few patients. So many times I am either responding from farther away and end up either not able to intercept with the ambulance or getting cancelled. I also end up turning over patients to the ALS ambulance that I would prefer to ride in on if we had more units on the road. I know that turning some of these patients over to the paramedic on the ambulance helps our availability but sometimes I just want to see patients rather than spend my night driving around.

The whole reason I changed my road trip from today to yesterday was the amount of things that needed to get done today and that I would have had to miss if I had gone.

The most important thing that I wanted to do today, and would have regretted missing, was to go to my 6 year old daughters "Authors Tea" for her 1st grade class at school. The kids have spent several weeks writing and illustrating stories in class, designing and creating the covers, binding them, and practicing reading them aloud. You would think that it would be difficult to sit through 20 kids each haltingly reading their story but when it finally comes time for my daughter to read I totally forget the kids that have gone before and will come after and just enjoy watching her perform. She so clearly enjoys performing that it made me happy to watch her.

After the "Tea" (unfortunately there was no tea, only punch) my youngest and I went on to do errands and work around the house. OK, so I did the errands and worked around the house and my youngest played, watched some TV, and napped. Trips to the bank, the car wash, the grocery store, and the cleaners trekking my middle daughter to dance rehearsal, while fairly mundane for me, were great fun for her kept her pretty happy all day.

As is often true, if my kids are happy, I'm pretty happy and today was no different and while I was more than ready for them to head for bed tonight it was still a good day. Even my oldest had less than usual anxiety and was able to stay focused on her homework and interact pretty nicely with her sisters. The only thing that threw her tonight was when the computer that the kids use started buzzing and smoking. My assessment? Dead, very dead, but then it was an almost 8 year old iMac and didn't owe us anything. Eventually we'll have to find a replacement but I'll have to sell some more stuff on eBay before we can afford to do that. In the meantime the kids will have to share with my wife and I. That should be interesting.

OK, I admit it, this was a crazy trip for me to take. I was on the road by 0500 and back home about 10 hours later. In between I drove close to 400 miles round trip, listened to 5 different CDs, completed a dozen errands, found 5 geocaches in three different states and almost didn't come home.

I had an early lunch sitting below the lighthouse in Eastham, Massachusetts gazing our across the sea and watching some seals play just off shore. I was relaxed, I was happy, and I most definitely did not want to go home and with a view like this I was tempted not to.

But I did and I made it home in time to meet the school bus, pick up my projector and testing materials for the class I was teaching tonight.

I taught 20 EMT's and firefighters tonight, mostly about the use of epinephrine by non-paramedic personnel. For the most part it's a pretty boring thing for me to teach because I have taught it so much over the past few years I do it completely from memory, not even looking at the slides. What makes it a little more interesting is the practical teaching and the interesting scenarios that the students always come up with. Some of the "what if" questions are very thought provoking.

So it's 2200 now and I am thoroughly exhausted. Not exhausted enough to stop looking at my calendar to try and find another time that I can head back to spend some time by the sea, relax, and dream of a simpler life.

I changed my plans for today. I was going to take a road trip to Cape Cod tomorrow to do some errands that can only be done up there as well as taking the opportunity to relax for a while when I am there. Looking at my families obligations for tomorrow it is clear to me that if I wait for Wednesday it just won't happen. So here I sit, at 0430, loading everything that I will need for a day trip to Cape Cod. I feel a little crazy for doing this since I know that I need to be back in time to get my kids off the bus but the errands need to get done and I really need to get out of the house even if it is just for a matter of hours.

A little craziness is a good thing.

The sights and sounds of the beaches of Normandy must have been awe inspiring and enough to strike fear into most sane men. I can't say with any certainty that I would have been able to conquer my fears and been able to actually step off the landing craft into the frigid water and faced the fire that was ahead. What I can say with certainty is that I feel deeply indebted to the men and women that made the landings possible. These citizen-soldiers are truly our "greatest generation" and their stories and sacrifices cannot and should not be forgotten.

After my last shift with almost no calls tonight was better but still not very challenging. Lots of cover assignments, I probably spent 8 hours away from the ED covering for Medic 2 and Medic 3 while they transported patients out of the area. I was dispatched to two actual emergencies and was cancelled on one when I pulled up and downgraded to BLS on the other.

Somehow I feel odd saying that it wasn't enough but I really wanted something that would make me have to think about it.

Total calls for the night: 8
1 BLS downgrade
1 Cancelled upon arrival
6 Cover assignments

Total milage for the night: 178

CD for the night: "Meet me in Margaritaville" by Jimmy Buffett (Disk 1 & 2)

I slept well today and was awake a few minutes before my alarm went off to get the kids off the bus. It gave me a chance to sort through the mail and wake up before my older two daughters whirled in like hurricaines.

My middle daughter was out to go play with one of her friends almost as soon as she got in. She is becoming quit the social butterfly and I am rapidly beginning to dread the teenage years. My oldest wanted to go with her but handled it well when I said that she couldn't. She settled in to play some games on the computer while I got my uniform ready for the night.

I didn't get much of a chance to see my wife this when she got home. I had promised to supply some items to be used as prizes at an upcomiong Geocaching event next weekend and had to meet up with the guy who was collecting them. I haven't met too many of my geocaching colleagues but I have really liked the few that I have met. I dropped of the goods and we agreed to meet later in the month and go caching together. I wish I could attend the event but I will be working for the entire weekend.

I'm hoping tonight will be a little more active than last night was. As much as I hate it when it is slow, I hate it even more when there is nothign to keep my mind active.

Strange night, aside from a single cover assignment and some errands moving equipment around Medic 1 did not get dispatched to a single call. By 0230 it was getting tought to stay alert. Awake was easy, actually alert was another story.

I did manage to get some reading done and some work on a presentation I have to give next week but other than that it was not a very productive night.

Total calls for the night: 1 Cover Assignment

Milage for the night: 57 miles

CD for the night" "The Complex" by Blue Man Group

Still nothing after my interviews. I hate the not knowing but I'm back to work tonight so that will keep my mind off of it.

This will be my first shift since our Selective Spinal Immobilization protocol went into effect. It highlights just what a dinosaur I am, I am not 100% comfortable with the whole idea. I agree with the concept but it's hard to go against 24 years of immobilizing everybody. As with all things, I will get used to this too.

So I went to my interview this morning. It was really long and left me feeling uncertain on how things actually went. One of the interviewers was the same doctor I had met with a couple of weeks ago, the other I had never met before. While the first interview had been an enjoyable experience this one was almost painful. The second doctor seemed cold, somewhat aloof, and bordering on hostile making it very uncomfortable. It was also unsettling to have someone else's resume on the table throughout the entire meeting. It may have had nothing to do with what I was there for but it was still unsettling.

I know that my perception may be tainted by my own nervousness and I may simply be allowing my anxiety and confusion to get the best of me. Since the first part of the meeting had been with the Human Resources department and I was brought up to speed on benefits and that sort of thing I naturally (or unnaturally) assumed that the content of the meeting was going to be different than it was and that an offer was going to be put on the table.

There is nothing for me to do now except to just wait. I hate waiting.

I have slept for almost 12 hours (not all at once) since I got home yesterday and it felt pretty darned good to do it. I up, I'm awake and I'm ready to face the day. I'm a little nervous since I have to go for another interview today for an administrative job but I also excited as well. I am hopeful that things will go well for me today.