Death

Last week, in clinical, we had an eldery patient with cancer come in - in cardiac arrest. EMS had ROSC (Return of Spontanious Circulation) multiple times, and we lost pulses more than conce. The wife was in another room, and the patient's oncologist talked with him, then came in the room and told us to stop, that the pateint had a valid DNR, and the wife wanted it to be followed at that time, even though she had apparently told ALS to provide care and disregard the DNR.

Odd thing about it was that it was the LEAST sad cardiac arrest I'd ever seen. Everyone agreed that it was sad - but it was an older patient - and he had multiple cancers and was already going down fast. I think it also helped that there was only a spouse (that seemed to expect the outcome), not 20 family members screaming and crying.

Just some random musings.

Standbys

So I'm working today on a standby. I sit around at the convention center and kill time waiting for folks to need help.

It isn't a bad job - and this particular shift, I've got internet access. This makes the day pass faster. No one really cares what we do, so long as we get moving when we get a call. Well... we can't sleep, but it is a pretty good gig.

Maybe I'll get an interesting call later.

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!

Stars

As a Scout and Scouter, I’ve spent countless nights sleeping in tents – ranging from one-man backpacking tents to supersized wall tents on huge platforms when I was staffing Science camp. Many of the nights have been in my own, small tent… and many nights have been spent in tents at Horseshoe Scout Reservation…

Still, there is one night that stands out as being different… I was about 13 or 14, and still involved with my local scout troop.

It was a clear, warm fall evening, and as the campfire burned down and the troop members headed off to bed, everyone went towards the tents they used the previous night.

Then one of the scouts my age, actually a year older than me, points out that he was using a jury-rigged tarp as a shelter. The tarp is very large, and an idea is planted… there will be no rain. It is a clear night, and lots of stars are in the sky. We discuss, and several of us agree that we should try to sleep “cowboy style” under the stars… no tents, just using the large tarp as a ground cloth to put our sleeping bags on. If things go wrong, our tents are still set up – and empty.

Thinking back, I remember two things about that camping trip – one was the idiot scout that used gasoline to get the fire going, and the other was falling asleep under the stars… no tent, going back to a more primitive time.

Since then, I’ve only had the opportunity to repeat that once… about 8 years later, on my OA Ordeal, where I was “required to sleep alone, apart from other campers” and using the same minimalist supplies of a ground cloth and blanket/bedroll. That was a much colder fall night. And it was wet… and we were under trees. It wasn’t nearly as pleasant, but it was a formative experience.

That said… one of my goals for this year is to find a perfect time to yet again sleep out under the stars… not in a tent.