Midterms

Today I completed my mid-term exam for Fire I; and my first live structural burn exercise.  I’m sore, I smell like fire, and my turnout gear (and car) reeks of fire. I’m also really happy. I’m at the halfway point to fire school. The next 2 months will bring classes on fireground ops and more live burn exercises.

I’m really glad that I decided to take Fire I, and take it in the spring. Things I've realized: I’m not in the shape I need to be in to be able to do this 100%, and I’m working on fixing that (more on that later). On the plus side: I’m not claustrophobic, I’m not afraid of the dark, and I’m not afraid of a little heat. I can throw ladders, I can roll hose, and I’m keeping pace with the class.

I did make one mistake this morning. When backing up my partner for a hoseline attack, I wasn't in a good position, and wasn't able to take enough pressure off the hose for him. He lost his balance and fell over. Afterwards, we got a chuckle out of it – but the more I think of it, I let him down, and I won’t make that mistake again.

Next week we're on break. The week after, we get to do ropes and knots (Boy Scout time!).

Anyway – That’s an update from school. More to come!

Snow

I have a love-hate relationship with snow. I love how even an inch can turn a grimy cityscape into a fresh Winter Wonderland. I love the reflection of my strobing red lights in falling snow. I love the way the town is turned into an otherworldly Christmas card.

I love the feel of an all-wheel-drive vehicle hugging the road, even through a thick white blanket. One can even practice things like resolving skids and handbrake turns without putting undue stress on vehicle parts.

Snowmen. Snowball fights. Even just walking in snow can be fun, if you're in the right mood.

I hate snow, though. It piles on you and weighs you down. It makes even the most routine responses anything but routine. It hides the street signs, and it can give you the same powerless, out-of-control feel of sledding - in an ambulance.

After its done, though, all there is to do is hate it. It goes from pretty to dirty, soot stained and yellowed in a day or two. Then, depending on how much there is, it can linger. It makes simple tasks like parking on the street, and walking down the sidewalk, a treacherous challenge. It also makes good people have accidents. They slip and they fall, and as they shovel out, they overexert and injure themselves, in some cases, they even have MI's


Tonight I get to enjoy it, though. It is only a dusting - an inch, maybe two. Someone else did the driving, and I'm off duty for my last weekend off before my (hopefully) last undergraduate semester starts next week.

Jon

The begining of the end

Last class we started ACLS - 4.5 hours of lecture - not fun. Then we ran a slow megacode - not as bad.

ACLS is this week - PALS is next week... and then we are done. I realized last night, looking at the course syllabus, that we are DONE with the classes out of the Paramedic textbook. Part of me is relieved, and part of me is frightened. I've been here before - and I wasn't ready. Now I feel almost ready for my final field internship.

I was asked a question today by a paramedic who is my age, and I consider a friend. He aksed me if I feel ready to run a code (cardiac arrest) by myself. I had to think a moment before answering, My answer was two-fold. “Yes – I know the protocols, and codes are pretty simple. But No… because I’m not done school and through field intership yet – and I am not a paramedic yet, I’m not even sure I’ll be ready for my first code when I’m out on my own… but I’ll just have to get through it.”

I look around my class, and I still see a classroom full of people. We’ve only lost 2 people from the class. This is a very small number, compared to previous classes. I think this is a good sign, but I also know that statistically, there are a few folks who aren’t going to make it though the final testing, and will never become medics. That sucks… but it is life.

All that said – It was a shocking realization that we are DONE with the easy classroom portion and are moving onto the full-out balls to the wall practical phase, where everything will become my show. This scares me more than anything, because this is where I fouled up before. Anyone can sit though classes – but being able to come up with an adequate treatment plan at 3am in the cold and the rain, on a patient that just doesn’t quite fit the protocol? That is a different challenge, and requires a knowledge of the body, the protocols, and the patients disease/injuy processes. That is what being a paramedic is all about – and some medics are AWESOME at that, and some aren’t as much. I want to be AWESOME… but first I’ve got to be there, and do that.

Well – Tomorrow night is the megacodes – wish me luck.

Musing about preceptors

I’ve been running a lot of clinical shifts with one paramedic. I started running with him at the beginning of class, and I realized that he walked the talk, and actually wanted me to succeed. It hasn’t been all sweetness and light, and we’ve had some rocky times. More than once I’ve had to explain ‘what the heck I was thinking’… but each case has held a lesson for me, and I’ve learned it. I had one shift where we ran back-to-back cardiac arrests… part of my “Angel of Death” period, where I attempted to intubate someone on every shift I ran for a week and a half. We’ve found things I’m good at, and some things I need to seriously improve at.

We’ve also had some rock-star moments. I’m still flying a little high from a call a few weeks ago, where we had a hypovolemic patient with a head injury. First thing he asks me: “Do you want a helicopter?” I hedged my answer and asked for one on standby – meaning I’d do a secondary assessment of the patient and talk with the command doc of the trauma center before I decided to fly the patient.
He tells me “You don’t have that choice – are you going to fly the patient or not!”
Not knowing what to say, I started running through the patient’s condition and verbally rattiling stuff off – he called to me from the other room “So you want to fly the patient!”
I agreed, and he says “Good. Next time, be faster.”
Aeromedical then advised us they were down due to weather, I pushed to go to the closest hospital, rather than drive an hour to a trauma center, because the more I looked at the patient, the more unstable they seemed, and I didn’t want to have them bleed out in our ambulance. I made the call to the Medical Command doc and sold them on it as he sat back and watched. As we were a minute out from the hospital, I couldn’t feel a radial pulse – MAJOR pucker factor. We got to the ED, handed over the patient, and as both my preceptor and I apologized to the doc for bringing them a train-wreck patient, the doc said I made the right call.

I think I’ve found a keeper of a preceptor – he gives me enough rope to let me learn and make mistakes, but he’s also running the show. He challenges me and makes me learn every shift I run with him, and I push myself to impress him whenever I can. I know that he doesn’t give out a lot of praise – and when he does, it is earned – and I get just enough praise to make me want to do better!

Medic Students say the darndest things.

So in class tonight, we learned some new descriptive phrases – this is meant mostly as humor, and also evidence and reminder for the T-shirt or “remember this” list that we’ll be coming up with eventually.

Pulmonary function is now summed up in one word: Flowability. “Doc, the patient has bad flowability and we're CPAP'ing 'em"

And 12-lead interpretation got easier… if the ST segment looks like a smile from a smilieface… that is good. If it is a frown, it’s bad. So from now on, when we call a certain doc on the command line, we can say “I’ve got smiles on the ST segments and good flowability… I’ll see you in 10. Of course, if we get any other doc… this could be really bad.

And Miles to go before I sleep.

So we use this program called FISDAP to track all of our clinical hours for school. We have 72 hours to enter in all our data, and we also need to turn in a paper form with our clinical preceptor's signature, etc. I was up until 0300 taking care of school paperwork. Today starts at 0500, working 0600-1400, then clinicals 1800-0000.

As I was typing last night, I thought back to a poem I once read... Robert Frost's "Stopping by the Woods on a Snowy Evening". I can appreacate some poetry, and I remember this one from middle school englis

The line that kept running through my head was "And miles to go before I sleep." Given my current schedule, sleep has become the "optional" part of my scheducle. So When I got to work this monring, I took several shorter naps, and probably slept for close to an hour.

Anyway.... I need more sleep.

Whose woods these are I think I know,
His house is in the village though.
He will not see me stopping here,
To watch his woods fill up with snow.

My little horse must think it queer,
To stop without a farmhouse near,
Between the woods and frozen lake,
The darkest evening of the year.

He gives his harness bells a shake,
To ask if there is some mistake.
The only other sound's the sweep,
Of easy wind and downy flake.

The woods are lovely, dark and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.
~Robert Frost

Tuesday - Post 1

So... I'm sitting at work. Working 2 hours overtime to cover a hole in the schedule. I'll take the money.

I'm about a month into medic school - and we've got some form of mid-term tonight. There is a study group gathering before class... and I might stop by.

I've been running myself ragged between work and school. I need sleep. I need a day off. I'm also sick - had a sore throat start last night during clinical, runny nose today, and I feel miserable.

I had 3 calls so far today at work - 2 were cancelled before getting to the scene, and the third was a moderate MVA - high speeds, limited injury.


Last night at clinicals was cool. I had the first shift of the class in Labor and Delivery. That meant that I was the guinea pig. I stood around looking a little out of place (6'3" big guy in gray shirt and blue pants surrounded by female RN's in green scrubs. Then they realized that I needed to get into scrubs - which I did.

I don't like wearing scrubs - at least not in public. My scrubs at home are reserved for around the house and use as pajamas. I'm used to having pockets, and thicker fabric. I feel so out of my element in scrubs. No trauma shears, no key ring, no glove pocket.

I got to observe a C-section last night. C-sections are WAY out of the paramedic scope of practice, but it is intresting to watch. Because I went through a different paramedic program already, but now get to start over from scratch, I'd actually already done a few shifts through L&D, but at a different hosptial, in the City. So I actually had seen one before... but it is still intreesting to see. I also spent a lot of time talking with a medical student doing his mandatory OB rotation. I learned some from him... and even more from watching the attending teaching him. I also spoke with a PA in the OR.

I've been in OR's before. I understood what was sterile, and what wasn't. I had to ask where I would be able to stand out of the way... but otherwise, stayed back and watched. The procedure seemed to go without any trouble, and the NICU folks were there to resusitate the baby, but didn't have to do much. Initial APGAR was 9. I had a discussion about that, too. Although the perfect score would be 10, they only usually get 9, loosing a point on color.


Anyway - it was a good experience. But I really hope to keep my rig "life-neutral"... no one dies in my truck, and no one is born in my truck. I've done pretty good on the second half, lately. OB was a great change for me - in my previous 2 clinical shifts, I'd worked 3 codes... 2/3 were unsuccessful. The 3rd one we actually got ROSC (Return of Spontanious Circulation)... AFTER we started working the code, the nursing home gave my preceptor the patient's living will, which called for no heroic measures. By the time we got this, we were transporting - so we kept going, consulting with the hospital staff. So we walked in the door and got a pulse back - but the patient didn't want to be there... now what? I'm not sure if the ED staff continued mechanical ventialtion, as the patient had no spontanous respirations. I'm going to guess that that patient died, too... making me 3/3.