c1: (Star of Life)
In the ER last night for a last-minute four hour shift.

Missed an IV last night in a patient who had tough veins. The nurse gave it two tries (the department maximum before calling someone else) so it fell to the paramedic; a guy I work with regularly. He broke a light sweat, but got the stick in the end. Given the tough time, I don't feel bad for missing my attempt. Indeed, all my recent misses have preceded a nurse missing her attempt, so at least anecdotal evidence that I'm not missing the easy sticks. All the same, missing a stick means an unnecessary hole was made, pain inflicted, and that's not a good feeling. Some discussion with the medic followed; he reminded me that getting good is a process, and it'll just take time and practice. (Scary is that he advocates learning with the lights out, so you can go by feel. He's a bit mad, but in a good way.) 

Later in the evening, got the patient of a lifetime: gigantic pipes running just below the skin. I wouldn't have minded a more challenging patient, but it did make me feel better to get one for the night just the same. And the two kiddos in tow were sweet; one intently playing with some colouring sheets and crayons, both well behaved.

Did a couple more challenging IV medication pushes; mainly challenging for the number, necessity for flushes in between, and sending them in over a defined period of time (about a minute). Worked with a nurse just a few years out of school, so she was great as far as knowing basically exactly what I need from my rotations at this point.

Also got in an assessment of a charming baby who's chief complaint was "crying excessively", and indeed, he presented as mainly inconsolable for a short bit, but for reasons unknown, quieted down while we were examining him. Lung/airway assessment was made easy by his cries -- you don't do that in the absence of good lungs moving good air through a good airway, and he was doing so like a champ. At least on that score, the kiddo was the model of health. It's an exception, where I'm more relaxed *because* the patient is making a lot of noise. A silent baby (NB: unless sleeping) is a scary baby.
c1: (Star of Life)
Yesterday, I got two more sticks. Being the day before T-day, the ER was understandably quiet: frustrating, because there's that checklist thing. But I did get two small things.

One was when the cardiac patient came in, and the nurse told me "we need an IV fast, so you need to tell me if you're going to get it, or if you need me to do it." Moments later, I watched my fingers practically shoot the cannula* into the vein on the first shot. Somehow, everything came together, although there was a point when I remember telling myself to push the cannula forward faster than I'd been doing, but about as fast as I'd been watching the nurses do it. Boom, there goes the dynamite.

Two was the number of intra-muscular and subcutaneous injections I gave; rare, but they have a place. Easy, because you're just playing darts with the patient as the dart board. But there are a few things to practice there.

Did a couple patient assessments, but was unsatisfied with them. Reflected on that at work later in the evening, and came up with a better way, that I'll be trying tomorrow night. It's another example of where the words in the book part ways with reality. (The damn advice from the book to start IVs at a 45 degree angle being one of the more acute annoyances on that front.) A doctor laughed at me a little when I asked about ascultating lung sounds from the chest instead of just the back; apparently this should have been obvious, yet the book stresses the back is the best place. Hmmm... book says one thing, doctor standing in front of me says another. *Shakes head* 

Saw a patient I'd treated last week, and was happy to hear the kind words she had about my care. Nice when that happens.

Got to see the classic allergic reaction to penicillin. It's one thing to see a patient covered in spots in the textbook, but seeing it in person was pretty wild. No acute distress, though she was itching like mad -- we gave her stuff to calm that down, and she now knows not to get *cillin meds until she's seen a specialist about the reaction.

Made a few beds, did a few other chores, endeared myself to the ER staff a little more. It's the little things, from me as well as from them.

*IV needles come in two parts: the needle, and a plastic cannula that covers it over. The whole thing goes into the vein, but once you're just in the vein, you pull out the needle and advance the cannula further. It's the cannula that stays in the patient, through which the fluids and medications flow into the body. The needle itself is spring loaded, so when you're in the vein, you push a button, which retracts the needle into a "safer" plastic sheath so you don't poke yourself inadvertently. (This was a major cause of unprotected patient care provider exposures, hence the spring loaded needles.) 
c1: (Star of Life)
I was in surgery for about 8 hours yesterday; my last case was supposed to have been at 13.30, but didn't even get wheeled into the OR until 14.00. Fortunately, my boss was understanding.

I went to the OR rotation with a certain amount of trepidation. There is a culture of surgeons and OR nurses being of a mindset, and indeed, some had prepped us by saying OR rotations typically suck, because before long you're being barked at by the surgeon or someone. The inverse proved to be my case. (Since this has been happening a lot lately, I'm wondering when my luck will run out.) 

The hospital uses a combination of (MD) anesthesiologists and (RN) nurse anesthetists. They were all a pleasure to work with; the doctor was particularly interested in working with me on my posture, and repeatedly complimented me on effectively ventilating the patient. (On the posture thing, if good mechanics are followed, ventilations become pretty effortless.) 

It was frustrating that I got scheduled during the week of Thanksgiving: no-one wants to go to t-day dinner while recovering from surgery. As a result, I got all of four of my required ten check-offs. I'm scheduled for next Friday as well, as a result. On the other hand, there was a bit of downtime to chat with the doctors and nurses about how I'm doing, what I can do better, and the like. They were all happy to share their accumulated wisdom.

Started the day by changing into scrubs, including booties and the funny hat. Face masks required in all operating theatres. From my end, nothing was sterile. I'd walk in with the patient and at least a nurse (sometimes the anesthesiologist) and they'd do some prep work -- getting the patient to shuffle onto the operating table, and so on -- and then Mrs. Sandman would sprinkle some of her magic pixie dust. Usually Propofol, which would suppress the patient's respiratory drive, though there were a couple others used at times.

At this point, I'd go to work, but it was funny. We'd have given the patient 100% oxygen, and by and large the patients were in good health, so time got stretched out a lot. We had time for the doctor to point out airway issues in the patient or whatever, for what seemed an eternity, and the patient's O2 saturation would still be pegged at about 100%. But then I'd insert an airway, and start ventilating the patient, and the magic of watching the chest rise, the patient keeping nice and pink, and so on, before the doctor would jump in and insert a breathing tube of some sort for more definitive airway management. In contrast to performing CPR when seconds aren't squandered, this seemed almost like a walk in the park. Lots of time to take in feedback and make adjustments to form and technique. (Also a big focus on keeping my eyes away from the waveform capnography, because while it's an amazing tool for assessing the effectiveness of ventilations, one might not always have it in the field, so it's important to know what good chest rise looks like.) 

(Meanwhile, the surgeon was standing to one side, maybe reviewing her notes or something, maybe watching approvingly. The weird thing was that our end was decidedly "dirty", and the surgeon's area was sterile, but walking into the room, it was almost like any other room at the hospital, excepting that we were all wearing masks, hoods, and booties. Computer over in the corner (complete with printer -- which seems like a serious mess waiting to happen) other odd stuff here and there, and then this over-riding sense that you shouldn't touch anything. And yet more dissonance from the fact that we were just in exam gloves, not sterile gloves... odd.)

It's intoxicating stuff, doing that. Watching the chest rise and fall due solely to my interventions was nothing short of magic.

More soon

Nov. 21st, 2014 11:27 pm
c1: (Star of Life)
Third day of ER clinical rotations.
Got two more IV sticks, including one in a dark skinned person (makes it harder to visualize the vein), who had scar tissue basically from wrists to shoulders, that *everyone* in the ED was saying I'd never get. "Everyone has an impossible time getting one with that person. But you should at least try." in the tone of "...even though you're going to blow it." I'm pretty happy I got that one, though I was literally sweating over that one. (I was drenched by the time I got back to the nurse's station.) 
The second one came a lot easier, and I think I'm starting to turn the corner.

Toured the OR (during which (and I found out later) I missed out on two more IV opportunities) and got my orientation on what I'll be doing on Monday. Short form: bring my A game.

Exhausted. Bed now.
c1: (Star of Life)
Got two IV starts in real live human beings who weren't the model of health. This was after blowing two attempts on an elderly lady with tough veins. The two I got required a certain amount of psychological heavy lifting, but the nurses saw to it that I got that encouragement and coaching. As a group, they're all trying hard to see us reach the finish line. I don't think any of them are so far removed from their own days as students that they've forgotten the pressure. Indeed, one of the doctors was relating his thoughts on the matter: "yeah, IVs are a pain." 

Mind blown: saw (most decidedly did *not* administer) TPA get administered to a patient. TPA= Tissue Plasminogen Activator, AKA "clot buster." If you've had a stroke or a heart attack, this is the "liquid plumbr" they shoot through your veins to smash the clot.
Trouble is, it busts clots.
So you chuck this into someone, but they've got a clot somewhere that's actually doing something positive for the patient, and next thing you know, your patient is bleeding from every hole in his/her body that you didn't realize was there. Including some you won't find out about until too late. You don't give TPA rashly; in fact, there were two nurses drawing it up with no side conversations, each checking the other's math, and so on. Oh, and there was a consult with the doctors at Mass General beforehand.
Cool thing is: it busts clots.
So much in medicine takes a long time to see. In this case, a woman with obvious stroke signs, notably slurred speech, was talking much more clearly within the hour. No kidding. Not quite perfectly, but certainly "hot damn, that stuff worked quick!"

Paradigm shift: patient came in and needed IV fluid. I didn't go near this one, as her vasculature was that of a frail old woman. Nurse A. tries twice and fails. We're all busy getting this patient wired for sound and then nurse B. comes in to try the IV. And here's where the magic happened.
She quietly takes a stool and sits by the patient's head, her head not much higher. "Hello, love. I'm going to give you an IV so we can make you feel better." And her voice is soft and empathetic and full of love. She reaches out and touches this woman's face, then strokes her hair, adjusts her pillow, and pulls the blanket up to her chin. The woman smiled warmly, with more than a slight bit of contentment and approval.

I asked her later how she got that obviously difficult IV, and she confessed it was "a wing and a prayer". But something about her voice that dropped the collective blood pressure in the room by several points probably helped, too.
The two IV starts that I ended up getting were done with her voice playing in my head, and me sitting on a stool, at the patient's level. (And OK, the phlebotomist coaching me on the last one didn't hurt either.) 

I'm working on establishing a happy place I can go to when I have to start IVs. Practically everyone has been telling me it's 99% mental, and only 1% physical; probably every concert pianist would say the same thing, as would every starting pitcher in the MLB.
c1: (Star of Life)
Sunday night, I went to bed wishing I could, just for once, get off the "I only need to make it past tomorrow" treadmill.

Friday night was the usual -- come home from work, do last minute things before racing to bed, and hopefully get enough sleep before class Saturday morning. Saturday, class as usual (got poked again -- unsuccessfully -- by another student, but when I returned the favour, I successfully got the ante-cubital vein, which was cool) and then on duty Saturday night.

Sunday I actually had a bit of downtime. Went to the MC Escher show at the Currier. This turned out to be rather more of a major showing of his work than I'd expected. There were things there that I never knew he did, and for all the time I've spent in art history classes, I'm disappointed that nothing touched on his immense canon enough to reveal he was much more of an artist than his popular work would suggest. (And to anyone thinking of going: Go. Thank me later.) 

Sunday night was hectic, because I'd not planned in enough time to accommodate cooking lunch for work for the week, plus other sundry things. Monday morning was the start of clinical rotations at the hospital, so this tossed a wrench into things. Usually the things I was stuck doing Sunday are things I don't worry about until Monday morning, so this sucked.

And then there was Monday. I went to bed Sunday night dreading clinicals. The early feedback from students who started theirs wasn't inspiring. Tales of nurses who were less than accommodating were the topic of the day, so as I drove in on a grey morning that could only be described as British, I was filled with the wrong kind of anticipation.

Boy, that was dumb. I'm hoping the bad tales are the outlier, because I had a great time. I was on my feet for seven hours, which caught up with me later that night at work, but the nurses and the doctors on duty yesterday were friendly, and indeed, one of the doctors was constantly carving out moments where he would quiz me on something, then explain the things I was missing. Usually these things were somewhat outside of my scope of practice (really, we're not thinking about the seventh cranial nerve all that much) but in the larger picture, having this knowledge will give me a better sense of what's happening behind what I'm seeing in my patient. (Again with the subtle but long term benefits of the massive A&P barrage of a lecture a couple months ago.) He gave me the gift of tasking me with researching the effects of bilirubin on the body when normal functions aren't working right. Something tells me that there's a compelling reason why he picked the liver. ER doctors are like that.

It's official: I've crossed the line into pushing drugs. Probably the most interesting was the morphine, which is decidedly *out* of my protocol (but the physical act of assembling and squeezing the syringe was OK.) A royal downer was blowing an IV attempt by going in at too high of an angle, but in truth the guy's veins were challenging to say the least. It would have been worse had it been my 20th start instead of my third, but there it is. Though giving a PO medication would have counted, the nurses took special care to involve me on any medication administration that involved a needle, so I got a couple of those checked off the list.

There was a lot of concentrated patient care. A lot of humanity in one room. Humbling was the elderly patient who was expressing that she wanted comfort, not a cure -- her body was betraying her, and she clearly didn't feel the need to press the issue. Inspiring was the guy who's body was betraying him, and yet he soldiered on, even though he was also asking the same question for himself as the other one was answering for herself. I think as a provider, I got a lot from that seven hours, and I may see if I can return afterward on a regular basis.

Monday at the ER was good for me on so many levels. For a short while, I could forget about being on that treadmill. One question that I asked of myself and have yet to answer is what I'd do if I had grad school to do over again. This journey back into EMS has certainly awakened a part of me that I'd suppressed for a long time. I've pretty much acknowledged that teaching, while it was fun, isn't a part of my life right now, and it isn't the part of my life that I thought it would be five years ago. What piece of the puzzle is emergency medicine, and where does it fit? 

One thing is for sure: I'd like to get off the treadmill sometime soon.
c1: (Star of Life)
This weekend was exhausting. While there were spoons to be had, many more were spent. Monday, I was still paying back spoons I borrowed to get through to the end of Sunday. Really, it was that kind of weekend. Not bad, per se, just abnormally intense. (As in, far beyond usual levels of type A intensity.) 

Saturday morning was spent in lecture. Pretty normal. Saturday afternoon was spent in practical sessions. Lesson of the day was IV starts in real live human beings. And oh, look... there is a classroom full of real live human beings. "Everyone pair up." 

On the back of my hand is the remains of a 20 gauge hole that one of my classmates put there. I'm usually pretty good with getting stuck, but what started eating through my supply of spoons was the fact that this time, it was an 18 year old -- who had just gotten her EMT license around the beginning of summer -- doing the sticking. If it had been the course instructor, who's a seasoned paramedic, I might have used up *a* spoon, instead of around 12. Needless to say, this was unexpected.
Said instructor kept asking me, with some sense of urgency in his voice, if I was OK. Indeed I was, but it was planting myself firmly in my happy place that kept me OK, and maintaining that happy place took about one spoon every 10-12 seconds. I don't know what she was doing, but I've never had an IV site burn before. Usually a small pinch, then just a tiny dull ache that's almost completely ignorable. We're onto doing ER rotations now, so all her future sticks will be in other people. I hope by the time she gets her 25th IV placed, she'll have fixed up her technique.
(I feel compelled to edit this a bit, to add: Yes, this made the spoons meter run quite a bit faster, but the reality of the weekend was that the meter was running fast from Friday night (preparing for the test) until Sunday night when I finally could say "I'm done." Also, the instructor sounded urgent, though I would find out with subsequent students, he was pretty much no less concerned. I think everyone was "feeling the love.")

My turn.

Her skin was the colour of milk, and her veins were somewhat deep. The tourniquet improved the contrast slightly, but not much. I did get the vein (inside mid forearm) on the first try, but not without sweating for it a little. On penetrating the skin, all sight of the vein disappeared, so I had to finish the cannulation effectively blindly. Drew back some blood into the syringe with little effort, then flushed the line with 20 cc's of saline. She took a selfie of my handiwork. (Debating whether to post it, though I'm inclined to just keep it in my files.) Plus side: she declared that she was fairly needle-phobic, and yet didn't say anything hurt. I was pretty happy about that.

Saturday night, I was on duty. Two calls. I'm out of stage three of field training, and have my emergency vehicle operator certification in hand. Drove the first call, which was pleasant. Had a partner up front coaching a bit -- how the truck handles in turns, operating the radio, etc. The console with the lights and sirens is almost entirely electronic, which is a far cry from how things were "back in the day". There is an utter lack of mechanical switches, so knowing how to navigate the menus is something I'm going to have to internalize to the point of automaticity.
Had the pleasure of working with a colleague whom I don't get to work with as often as I'd like. He's a great guy, very friendly, and has done everything he can to make my time in field training go smoothly.*
Call #1 came in while we were at Demoulas getting stuff for dinner. Thankfully the other crew took the basket and dealt with it while we ran off. Call #2 came in at an ungodly hour, and left me with a scant few hours of sleep for the night before waking with the dawn to get cleaned up for class on Sunday morning.

Sunday, the instructor started out with "OK, you guys are all toast, so I'm going to try to get us out of here a little early." We did about 4-5 hours of lecture and another hour on scope of practice; working on the spinal injury clearance protocols. (How to determine that spinal injury is unlikely in the face of a mechanism of injury that would have triggered automatic spinal immobilization in a less enlightened time.) 
We did indeed get out a bit early, but I was still running on fumes at that point. (A day later, and I'm still feeling wiped out.)

Double Plus Good: I got a 92 on exam #3; this follows a similar grade on exam #2. I'd have to check, but I think I got around the same on exam #1. Not sure what that means numerically WRT overall average, but it relieved some stress.

Also good: ER and OR rotations are scheduled through the first week of December. Surprisingly, the coordinator put me up for two OR rotations, when we were only supposed to go through one. I'm pretty happy about that, although that might change: I've been warned that the OR attracts a very specific kind of personality, which can be seen as abrasive to most people. It's not at all unheard of for them to be extremely uninviting to outsiders, especially students.

* I can remember being on a call several weeks ago, and things were going OK. But he showed up and asked "how are things going?" and I thought "well, they were going fine before you showed up, but now they're going even better." 

Frustration

Nov. 2nd, 2014 09:10 pm
c1: (Star of Life)
Last night, we were making plans for dinner. I'd already eaten, so this wasn't of much interest to me. However, wanting to be a good spirit, I suggested "home baked" cookies from the supermarket. (Note, these would be the pre-packed cookies from the freezer section. Decent, but not my home-made cookies that take a lot more time.) 
Get back to the station, and fire up the stove. Cookies on the baking sheet, in the oven, three minutes in...
...and the tones drop.
Crap. Take them out, turn off the oven. Put on mask and cape, and go save the day.

Got back and fired up the oven. Left one of the other guys in charge while I had a discussion with the field training coordinator. (Things are going well, there are a few things left to deal with, and I'll be out of field training soon.)

Needless to say, he had one thing to do -- wait until they were golden brown, and then take them out. Thankfully, we didn't need to call the fire department, but they were only barely on this side of edible.

*Sigh*

Plan next time is to make cookies *before* heading to the station; alternately, show up 20 minutes early to guarantee fresh baked goodness.
c1: (Star of Life)
We carry epi-pens; both adult and child sized. (Kiddos get half the dose.) Everyone at my service has standing orders to use them when needed; there's no question of whether the practitioner is a basic EMT or a paramedic, it's in our scope of practice at all levels.
So they're neat in how they work (both mechanically and on the body*) but I'd never actually seen one do its thing, nor have I ever used one in the field. In class yesterday, that got corrected to a certain degree.
No kidding, we set up a target and used a paper coffee cup to trigger the firing mechanism. If you don't know, it's about the size of a large magic marker, and you press the end into the patient's thigh, whereupon a mechanism shoots a spring-loaded needle into the patient, injecting the person with epinephrine intra-muscularly. So I pressed the gizmo into the end of the paper cup, and from about 5 feet away (wow!) doused the target with the juice. (The cops in the class were giving me some friendly grief about "aiming for centre of mass", "get a good sight picture", and so on. They're good guys, and fun to be with.) We were using "real" epi-pens that were out of their expiration dates, so this was as good as the real thing.
One guy in class has felt the "wrath" of the 'pen's needle. It's not particularly small, needing to be able to penetrate clothing, so it shoots out about 1/2-3/4 of an inch. In his case, this was unpleasant, but far more pleasant than the anaphylaxis he was experiencing at the time.

No shift on the trucks last night -- third week of the month is an unscheduled week.

*Epi doesn't work forever, so we were reminded that the patient may want to decline transport, but we should try to convince the patient otherwise; some allergens can have a drawn-out affect on the body, or even bi-phasic, and just because we shot them once or twice with epi doesn't mean they're out of the woods. Ideally, they get monitored in the ER for a good four hours or so just in case they experience a recurrence of symptoms.
We were also cautioned about the trigger: a non-trivial number of practitioners have shot themselves in the thumb, with "entertaining" results. "How's that shot of epinephrine doing for you?" 
c1: (Star of Life)
Last night was a largely uneventful shift. Hit the sack (literally*) about 23.00, and slept mostly unmolested until about 6, when my alarm went off, fell asleep again until 7.30 when I got up. It's nice that if your dorm door is shut, you're left alone to finish sleeping. (We do station chores before bed to facilitate this.) 

Of note was a fairly routine interfacility transfer (urgent care to hospital) of a cancer patient. Since my mother had cancer,* it's a fairly personal issue for me, and this one hit home. The patient in question was actually doing fine, despite having a very advanced form of one of the more terrible cancers out there -- somehow, surviving was a reality for this person, and given the totality of the circumstances, the person was doing quite well indeed. Anyone who was otherwise the model of health could have had the same acute condition as this patient (that is, sans cancer) and been transported exactly the same.

But that being said, I don't have direct familial experience with 99.999% of the fatal diseases out there. That patient with CHF who's on death's door, surrounded by a dozen teary-eyed children? I'm pretty dispassionate -- empathetic, sure, but the empathy comes from a very distinct part of me. Cancer? I was pretty amazed at how squarely that one hit me between the eyes. I did fine during the call (and I think the patient's overall state of non-urgency helped a lot) but I spent some time reflecting on my feelings during the drive back to the station. (Every hospital is a minimum of 20-30 minutes drive.) 

20 years ago, before my grandparents all died and my parents had cancer, practicing was largely without emotional burdens because distancing myself from my patients was simple. The worst thump I got (apart from a 4 month old baby who died of SIDS) was performing CPR on a patient who was 1 year younger than I was at the time. Even then, the kid had played his cards pretty recklessly (he got lit up on booze and thought a high-speed motorcycle ride was a prudent decision) so I had that working in my favour.

I think moving forward I will remain "fine" but it's something that made me think about personal vulnerability. This was a reminder to remain on guard against dancing too close to the flame without appropriate protection in place. A lot more of my patients are going to look more like people I know.
c1: (The Black Fire Engine)
1. Those who can extrapolate from incomplete data.

*Thoughtfully written in binary, because there are 10 kind of people in the world where binary is concerned, too.
c1: (Default)
Today was the first day of new job. It was pretty cool -- 69.4 degrees F to be precise, at 40% RH. I know this because the fancy recording thermometer/hygrometer sits on a shelf behind my desk. Step one before measuring anything is to let it sit on a shelf for awhile and equalize.
Met with HR to start; got issued the usual stuff, W4 form, etc. Got a new pair of shoes with steel toes. They actually look casual enough for non-work wear. (And nice that I get to wear out shoes on the company dime. That's something off my budget.) 
Health insurance is the same as at old company, which is nice. Minimal paper shuffling there.

In comparison to old job, the first day was structured. Not so much that it was overwhelmingly stuffy, but to the point where I never felt lost, or that I should know something about how to log in, or use the phone, or whatever. Indeed, there's a checklist for things that I and my supervisor/coworkers have to do for each of the first four days. At old job, they basically told me where "my" (shared) desk was, and that I could do Solidworks tutorials until I was blue in the face, or until someone was un-busy enough to train me on whatever they felt was relevant. In short, disconcerting, because I did a whole lot of nothing (except try to look busy) for the first week or so. Sub Optimal.
New job isn't leaving me to feel lost like that, which is a pleasant change. Also, in contrast to old job, when they talked about hustling me up the pay (and responsibility) ladder during the interview process, new job didn't stop that patter on the first day like they did at old job -- HR specifically brought that up during the morning paper-pushing. IOW, it really feels like they do value my potential. To that end, I officially have a performance review/salary adjustment before the end of the year, and another one at 6 months and the customary 1 year. Given the amount of structure everywhere else, I can believe that they're actually serious about this. (It doesn't hurt that numerous people I've met who were former employees there have attested to this already.) 

On structure: the company is huge on Six Sigma, 5S, and a lot of the rest of lean manufacturing. No kidding, I saw plenty of tool racks with outlines drawn on them, and you can't walk 5 steps without seeing at least a dozen signs plastered all over the walls and hanging from the ceilings. Nothing is left to interpretation.

On training: coworkers have told me about training they've been sent to, including to Brown & Sharpe/Hexagon Metrology in Rhode Island. I'd be thrilled to get sent there; when I was in college, I got sent there to get some parts measured by their contract services department, and was amazed by their facility. But it underscores that the company is willing to invest in training.
c1: (Star of Life)
This weekend was the town's pumpkin festival. I was on duty for part of it.
Saturday night, we had a truck on either side of the town square, and the paramedic interceptor on one side. The director had his interceptor on the other side, making up coverage. As far as the festival, things were low key: people come to enjoy themselves, and generally, that doesn't include ambulance rides and tours of the emergency room. We hung out at the old ambulance bay, supporting the guys selling ducks for the benefit duck race happening on Sunday. Proceeds fill the coffers of our training budget so we can bring in really cool guest speakers. (Saturday morning for A-EMT class, we had a midwife talk to us about field management of OB complications.)
Nice side note was getting dinner at the firehouse. They had pulled two of the trucks out and filled the bays with tables and chairs, and laid out a gigantic spread. There's nothing like firehouse cooking. I can't say it's anything special, per se, in terms of food, but the camaraderie can't be beat.
Did a call before midnight; somewhat minor motor vehicle crash that yielded no patients. Got to bed at around 23.30, and then at around 4am, we got a pre-alert call for a possible MVA, unknown injuries. The dispatch centre calls us on the radio if they're getting something that might require our services, but details are still being hashed out. It's a nice courtesy because it gives us a chance to visit the head, finish eating, get dressed, etc. before the tones drop and we have to beat feet.

For the uninitiated, "tones drop" means something like this:
http://www.emergencyfans.com/sounds/1stctfir2.mp3
Each town has its own tones, and there are automated systems in the building that activate things. So in the station, we have automatic red lights that come on in the kitchen and dorm rooms. The only thing we don't have is Hank Stanley saying "Station 51 KMG365".

The pre-alert was just the courtesy call, so none of the bells and whistles had gone off, but I automatically sat up, shoved my feet into my boots, and had them tied and was ready to go when the radio announced that no, it wasn't anything after all and we could stand down. It took me about 30 seconds to sit up and tie my boots, and all of about 2 seconds to take them back off and get back into bed. Not a single executive function involved. Thinking back, this is somewhat surprising, because it was about 20 years ago when I last did this. I hadn't really "heard" the call, I just saw myself sitting there with my boots on all of a sudden.

Sunday morning, I did my CEVO (emergency vehicle operations) training. I had a discussion with the training coordinator about my progress, and he wants me off training in the next couple weeks. I'm to be driving all calls at this point so they can clear me on that. I'm through phase two, and in the middle of phase three.

Overheard at the pumpkin festival: "that's a female dog, because she's got nipples." I had to point out to the fellow that unless I was mistaken, he himself probably had a pair, so how exactly does that work?
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So I'm reading this news article on the 1033 program (this is the program that puts surplus military weapons in the hands of local law enforcement -- tanks, grenade launchers, nuclear missiles, illudium PU-36 explosive space modulators, etc) and it mentions the Dartmouth, MA harbourmaster as being a recipient of some of this largesse. So I'm thinking OK, so maybe southern MA just got itself an amphibious assault ship or something, but it turns out the bloke just got a humvee (for the marshland that is indeed a part of the local landscape) and a pair of night vision goggles, to facilitate finding people when it's dark out. Fair enough, IMHO, on both counts. (Perhaps the one and only reasonable use of the 1033 program that I've heard of... ever.) Turns out the humvee even had its weapons mounts removed prior to delivery.

But I also thought "well, what if he did indeed get an assault rifle or three?" And it struck me that part of a harbourmaster's job is enforcement of the law on the high seas of Dartmouth. Sometimes you have to inspect the boat of an unruly navigator who's got a few too many adult beverages on board. Things could get nasty, and backup could be leagues away.
And then I thought that yeah, in that case, it would be nice to have some bight to back up one's barque.

Thank you very much. I'm here all week. Don't forget to tip your waitresses!
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Tired. This was a bit of a marathon weekend.

Saturday morning, get to class by 8, lecture until lunch, and then practical stations on IV medications and CPR until about 16.00 in the afternoon. Go home, eat dinner and gather my stuff: uniform and sleeping bag/etc. On duty from 18.00 until 06.00 Sunday morning. Did two calls all night; slept with moderate, but by no means unqualified success, from a little after midnight until 6.
Luck had it that the retaining ring that holds the diaphragm onto my stethoscope gave up the ghost after my second call. As in, the entire thing had become embrittled from time, and just broke spontaneously into small pieces with little force. (Will one week be enough time to order a replacement and have it delivered before my next shift?)
Go home, eat breakfast, clean myself up. (I did get to watch a little bit of Inglorious Basterds. I'll have to Netflix it to see the whole thing end-to-end, because counting on watching it without interruption at the station just isn't going to happen.)
8.00 Sunday morning go back to class. Lecture until lunchtime on endocrine disorders and toxicology. Afternoon practical sessions on cardiac arrest management, drawing medications from ampoules (glass, because epinephrine leaches through plastics), injection via IM, IV, and IO. (Intra Muscular, -Venous, -Osseous. The latter goes into the bone via the EZ-IO: a "battery drill" like device.) Where IO administration was once for people who were either severely unconscious or dead, IO is now approved for anyone, and has similar administration capabilities as a central line.
In the coming weeks, we will be doing practical stations on injections on each other before being set loose on hospital patients for our clinical rotations.

After all that, I'm wiped the heck out. Still on the to-do list: laundry, dinner, preparing lunch for the week, and emptying the dishwasher. As they say, "after ecstasy, the laundry."
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A well known politician made a campaign stop at my place of employment today. It was everything I dreamed it would be.

From the moment he strode into the room, exuding confidence from his perfect smile, his perfect hair, and the perfect knot on his perfect tie, through the perfectly rehearsed stump speech, to the perfectly planted members of the "crowd" asking perfectly expected questions, everything was... perfect. Even when he walked around to all of us imperfect people, his handshake left nothing to chance, and he made sure to press the flesh of everyone in attendance. Everyone.

The veneer was unblemished throughout. The owner of the company delivered his prepared remarks that were probably vetted first by the candidate's team. I know he can speak comfortably, but he hit too many bullet points on the candidate's campaign platform for it to be pure chance. (Then again, he and I first met when he was a salesman at a machine shop where I worked during college, so you never know.)
The machines weren't running on the shop floor, but were idly humming at just the right volume to convey that the candidate was a man of the people, comfortable with the men and women of the working class. When he took questions, they were from outsiders who didn't lob slow-pitch softballs, but rather set up a game of tee-ball. And afterward, when he went around the shop with photographer and videographer in tow, his interest was as authentic as anyone could expect.

The questions he asked me about what I was doing (I was trying to figure out why our customer didn't like the parts we made for them, and how I have to adjust the tooling to accommodate changes we have to make) were unimpressive; not even a half hearted attempt at reaching out. It was an event I'd rather have been able to miss, but unfortunately, management made it clear that they wanted a good showing from everyone. Unmistakably, the difference between us was large: while he was busy shaking hands and talking about getting people back to work, we were busy rolling up our sleeves actually doing it.

I'll be happy if no-one else tries to waste my time like that.
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So today was a continuing ed training session, meaning training that I need periodically to keep my basic license (and by extension) knowledge up to date. Given the unseasonably clement weather, we went to a large disused parking lot on the edge of town with all our ambulances and interceptor vehicles,* set up some cones, and did driver training.

There was a 4 cone slalom, to be driven in forward as well as reverse. Then a 3 point turn, followed by backing into a spot only inches wider than the truck itself (and oh by the way, get close to, but don't hit the line of cones at the end), finished by driving around the building to end up back at the starting point. There's a choke point behind the building with some overhanging trees, so this wasn't a freebie.

This was the first time I've driven an ambulance in years. It's also the heaviest ambulance by far -- our primary trucks weigh about 13,000 pounds -- that I've driven. On the flip side, we have a backup camera, though it's not as helpful as you'd think. It did let me get to within an inch of the cones while backing up, but on the backward slalom, it was useless.

That being said, my partner, who has 20+ years behind the wheel, did a 4 point turn, so I'm feeling pretty good. (The director of the service also did a 4 point turn, but he normally drives an interceptor. My partner did give him some guff about that, which was well taken.)

Second half of the day featured a presenter from the New Hampshire Hospital for Children, who spoke about issues with pediatric patients. Kiddos are not little adults in the slightest has been my mantra for years (their physiology is entirely different, and their physical make up is such that they've got all their own landmarks, too) but it's nice having someone dust off knowledge I rarely get to use. It's a double edged sword that most kiddos are healthy, but at the same time, it means we all have less experience with them than we'd all like.

*A fancy way of saying "a Ford Expedition that's been tricked out with lights and a siren" that the paramedics can use to jet around town.

Can't win

Sep. 28th, 2014 07:43 am
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Last night was the first 12 hour overnight shift. Field training candidates are supposed to only work 6 hour night shifts (ending at midnight) but they want me out of training soon, so they allowed me to deviate from that rule in an effort to get more patient contacts. An average overnight should net a couple more calls than I was getting, so instead of maybe 2-3 per shift, I'd get between 3-5.

Got the truck checked out by 19.00. Around 21.00, we went out for ice cream. At 22.00, I watched I Am Legend. Throughout the night, I caught up on reading the various EMS journals.* By 00.30, I was sleeping.

As far as calls? Crickets.

Oh well.

*Including a really cool article on video laryngoscopes; success rates on inserting an ET tube on the first try went from about 65% (traditional laryngoscopes) to somewhere north of 75% -- might have been 90%, I can't recall for sure. This is going to be a game changer as far as airway management.
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I got into work today about half an hour earlier than scheduled. Unbeknownst to me, it was a good thing because there was a job that had fallen into limbo (completely unrelated to me or my boss) and it's due on the 30th.
A little after 8.30, I had some face time with my boss, and the first thing I did was put an envelope, containing my resignation letter, into his hand. He said "thanks" and put it down while we discussed a project we'd been working on for awhile.*
Come to three in the afternoon, and I hadn't seen hide nor hair of HR or any of the other higher-ups for whom I'd prepared resignation letters, so I sent an email to HR, asking her if I could leave them somewhere safe. The company has 4 buildings spread out across about half a mile, so this is expected and there are accommodations for exactly this kind of thing.

"I've got some correspondence for you" was the thrust of my email.
"OK, what is it?"
"A letter of resignation."
"I'm sorry to hear that. Did you tell your boss?"

That last line confirmed my expectations. Somehow, when I saw him leave my area in the morning, I knew that the fact that he hadn't opened the envelope meant he wouldn't open the envelope. I can't believe that if he knew I was resigning that he wouldn't make mention of it to HR. We're a two-man division, so you'd think he'd want to get cracking on hiring my replacement ASAP.

It was with no small sense of trepidation that I prepared those letters and passed them on to their relevant destinations. For years, I'd wanted a job -- any job -- so leaving a job still seems an alien concept. But if I had any doubts about why I was leaving, the regard my boss paid to my resignation letter erased them all. Either he's dimwitted, or a complete and total asshole who wants me to know he doesn't care if I come or go. Regardless, it made me feel like I was making the right choice.

*The job was formally cancelled by the customer last week when it was obvious to them that we couldn't deliver after hacking away at it for a month. We already spent about $7,000 on custom tooling for that job, which has pretty much gone down the toilet at this point.
Today's hacking was basically a last-ditch effort to make something of those parts that might be acceptable to the customer, and perhaps at least cover the cost of the tooling. At the very least, we'd learn something about how to do this in the future, or whether it's well and truly outside of our wheelhouse. In terms of the customer, I think that ship has sailed.
The thing that makes that interesting is when someone mentioned overhearing the COO talking about my boss, in the context of that money-sink, and not using particularly congratulatory terms. It was his assessment that my boss's days are numbered unless he pulls a heck of a rabbit out of his hat, and soon. This doesn't surprise me, based on the scuttlebutt that's been going around recently.
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Given the crap earning potential* at my current job, I came to the realization that it was probably time to fire my employer.** The planets must have been in alignment, because coincidentally, I'm in a really good position to do just that. This morning, I took a call on my cell at work from a local company with whom I'd interviewed recently; they extended me an offer, and I accepted.

Pay is significantly better. The commute is incredibly short. Potential for career advancement is much greater. The list of upsides is long. The one downside is that it's second shift, and incumbent on that is I may have to withdraw from school for the time being. (I'm going to speak with my instructors and find out if I can do self study and take the final, and get credit. I think at least one will extend that opportunity.) I'm perfectly fine with this.

Work today was mindlessly boring. My immediate boss is the one finding new work and writing quotes. I design tooling for the jobs he scores. So basically, if he's not finding anything, I'm sitting around, tasked with Trying To Look Busy. As anyone knows, that's often more exhausting than actually being busy. Today was no exception. Couple that with a nearly overwhelming sense of "what're you going to do... fire me?" and it's fairly obvious that I'd have done anything to get out of the office.

*Just how crap is earning potential? I'm making an hourly wage that I'd expect if I were the night manager at McDonald's. Talking with others that have been with the company for years, the best I can ever expect is basic annual cost of living raises, and no real advancement in position. How the company manages attrition is way beyond me, but if ever a critical mass of people got the bug in their ear that "hey, there are better ways to make a living out there" the company will be in deep trouble.

**I don't think enough people truly grasp this concept. You CAN fire your employer.
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