Confidentiality

The recent HIPPA law makes a big deal out of patient confidentiality and everyone's rights to keep information confidential. It requires every organization to provide patients written notice of their rights and responsibilities, lays out specific penalties, and generally makes a big to-do about PHI (protected health information). Even your zipcode is considered confidential because it might identify you. Most medical organizations had detailed privacy policies and practices before this law went into effect, the change now is just that everyone has to document everything. For every patient, I have to document that I explained the ambulance privacy policy and offered the patient a written copy including getting a patient signature, or that the patient was unable (e.g. demented) to sign. Not too bad on a transfer truck, but much more difficult during an actual emergency.

The funny thing about this is that hospital employees are the most concerned about confidentiality as patients, and the least likely to seek care in their own hospital because of a lack of confidentiality regarding their medical care. Today we transported a woman 20 minutes away because she refused to be treated in the hospital she works in. Slightly more understandable since she was having a mental health issue, but still makes you wonder how confidential anything really is when the employees won't even seek treatment there. Orientation at the ambulance company included a lecture on confidentiality and how even talking around the station, talking to your spouse, or maybe even talking in your sleep could be a breach of confidentiality. In the end though, it all comes down to patient trust. If your patients trust that you aren't going to blab, you're set. If not, people go 20 minutes down the road with us.

"A" in conversation

Yesterday was another one of those days where a patient actually made me feel good about my job. She was going a fairly long way with us, about an hour, and was very coherent for her age and the fact that we picked her up in a locked down dementia unit. During the ride, we talked about her hospital stay and roommate there, her family, her desire to go home but knowing that she was a burden to the family, the painful process of outliving your friends and being mostly house-bound and bored, and just generally chatting. About half way there, she suddenly looked at me and said, "This is the most I've talked in a month. It is so nice to have someone to listen." I may not get to provide actual medical care, but sometimes I get to provide some small amount of happiness for people who may not have a lot left to be happy about.

I finally got brave and talked with one of the supervisors about transitioning to part-time and he said I needed to talk to the director of the company. Unfortunately, that man is based in the other city the company covers, and while we have to go there regularly, we usually don't have time to stop and talk. But, luck was with me, as he appeared in our city yesterday for unrelated reasons and I was able to talk with him. He seemed fine with the idea, just needing something in writing, and my shift already got posted as needing to be filled yesterday afternoon. Hopefully, less craziness ahead!

I've worked with 2 men since D's been out of town, and it is definitely an improvement over the share-too-much women. Yesterday and today I'm working with Bandicoot, who also works as a ff with K but on a different shift. I was a little nervous about it yesterday, for no good reason, but things went well and I was even able to relax enough to harrass him a bit by the end of the day. Since he's a paramedic, we should be able to run as an ALS truck, but there are only so many trucks and drug boxes to go around, so starting at 10a means that we're BLS all the way. It probably works out better for me in the end, because then I get to take my turns with the patients instead of driving all day because the patients need a higher level of care.

I checked the schedule and there will be one day that D and I get to ride together before I'm gone to Texas, so this will be quite an extended break for both of us. I hooked D up while I'm gone though - I found a very nice, young, attractive, single woman to cover 2 of the 3 shifts I'll miss. It won't surprise me if he's slightly less single when I get back! If so, I think it will have to be his turn to buy ice cream.

Can you hear me now?

I think you can, but yesterday Blogger refused to publish anything for me, just sitting there with the 0% published going round and round taunting me with it's refusal to let me communicate. At least it didn't eat my post. I was frustrated enough that I even complained in front of several other EMTs, who now know I have a blog. Oops. Nobody asked for the address, but the title is quite clearly written across the top of the pages in Blogger, so it wouldn't be hard to find.

In other news, I'm a big chicken. I want to go to part-time at the ambulance in June to get myself a bit more free time and the ability not to run around like a crazy person. But I don't know who the "right" person to talk to is, and I'm worried that if I just go around talking to the supervisors, things might not go well for me. The deal with part-time is that you get whatever shifts are open on days you are available. And if the scheduling supervisor doesn't like you, you get squat. As a basic, there are only 2 places for them to put you, a truck like mine and a wheelchair van, which doesn't add up to a lot of shifts. But the upside is that I would actually have the time to work some of the special shifts they run which cover the minor league baseball team, hockey, arena football, highschool games, etc. which could be kinda fun and actually require providing medical care instead of just hauling people around. I just need to suck it up and get brave and talk to someone in charge. I'm sure the sooner I do it, the happier they would be because there would be time to hire someone full-time on my truck. I think I can, I think I can, I think I can...

Relief

R-o-l-a-i-d-s? I don't think so, how about no more M-C-A-T!?! As always with any major stressor, the actual event is something of a let down and then I'm left with a big hole in my mental energy which is immediately filled with exhaustion. Something like, "holy crap! have I really been studying 4 hours a day? I'm just going to curl up over here and someone wake me when it's summer". Of course, I don't have the time to actually sleep until the summer and I'm still working too much, but the joy of stretching out on the couch, turning on the TV and turning off my brain can not be underestimated. I think the test went well, I found the verbal section and the biological sciences sections to be annoying because I finished in 1/2 the allotted time, so I just had to sit there with nothing to do and wait quietly during the rest of the time. By the time I got home, I was bouncing with enthusiasm for being done, but K was sick with a GI bug similar to what I had a few weeks ago, so he wasn't really up for celebrating. This is when I strongly regret that none of my friends live closer to me.

Everyone at work yesterday noticed that I wasn't quite right, one guy even asked me if I'd lost my best friend or something. I guess looking like a gelatinous puddle on the couch at the station was a bit atypical. I read some junk paperback fiction (my favorite kind) for a while, but around chapter 11 discovered that I had no idea what was going on, moved the bookmark back to chapter 9 and gave up. The woman I was working with was one of the very talkative, sharing types, so I now know waaayy too much about her menstrual cycle, her relationship with her husband, her kids, and her general theory on life. Apparently it has been very good for me to be working with a guy, because great googly-moogly can these women talk! I didn't have the energy to try and get a word in edgewise, so the only thing she learned about me was how long I've been married, that I have no kids, and I'm not from around here. Which generally takes people about 30 seconds to learn. And we worked together for 8 hours.

Quick update

I am a) tired, b) cranky, c) ready for Sunday so this insanity can be over for a while, d) all of the above. If you selected d, you may pass go and collect $200.

Work is okay, D was out Wednesday and I rode with someone very odd and talkative. He's out again Sunday, back Monday, then gone for a week, so I'll be riding with all sorts of different people which has me at mixed emotions. It is good experience to ride with different people, as everyone has their own perspective on things and it means I get to know more people in the company (which is good if I ever want to get onto a 911 truck), but I'm used to D. We're a compatible height and strength so moving people is easy. I don't stress over looking like an idiot any more, because he already knows I'm an idiot. Oh well, he won't be around forever as he has recently completed a class which should allow him to work on a 911 truck (the same class I'm starting in mid-May), so maybe I can find someone else tolerable to partner with when he leaves.

K is finished with his final required state ff training today, so he'll be back on his regular schedule instead of working day shifts like he has been for the last 2 weeks. Good for me because there will be food at home instead of quite so much fast food and because I'm fairly tired of hearing him whine about having to go to this stupid class. Sounds like some people might be going out for celebratory refreshments this evening, but I can't go for long, nor drink at all, so it won't be much of a celebration for me.

As soon as I get enough brain cells freed up to be able to count days on the calendar, I'll be counting down to when I get to see little Z (and everyone else in TX). Right now, it is the only near-term positive event so it is keeping me going.

Busy busy

Naturally, since the big test is this Saturday, this week has been insanely busy on the ambulance. Lately, we've been doing 3 or 4 calls a day. Yesterday, we had 8 and today 6 (including 2 that were almost 1 hr each way). So not much studying is getting done during the day and I'm completely exhausted when I get home. I probably won't update much until after the weekend so don't worry, I'm not actually MIA.

Brief update and a little hypocrisy

First of all, wallowing completed, nose back to the grindstone, in case you were wondering. D was back at work yesterday with his health much improved, so that helped break up my snowballing bad attitude as we got to play cribbage and hang out waiting for patients on a day that was supposed to be rainy, but ended up 74 and sunny.

Our first patient was a geriatric screamer, totally demented, and after we got her in the nursing home bed she pointed right at me and said "I'm going to punch you in the eye", the only entirely enunciated and clear thing she'd said the whole time. I told her okay and have a nice afternoon. Second (and third, technically) was one of our frequent traveler dialysis patients who was heading for a different appointment, so I got to chat with his wife during the drive back and forth. Last of the day was a lady from the psych campus who was a touchy-feely and "used to be a nurse". We were waiting for staff to be ready for her when she reached out and totally looked like she was going to feel up my boob. At the last second (before she got swatted away but after I'd already scooted back a little), she switched to a single finger and pointed on my nametag. D found it entertaining until I told him that if we had to come back for her after the appointment, he was riding in the back with her and likely to get fondled.

As far as the hypocrisy goes, I think you may be clear on the understanding that I'm not really a "church person" given my reaction to the induction ceremony at the ambulance job. So, can anyone explain to me how a job that feels obligated to bless me and commission me with spreading the joy of christ can not consider Easter a holiday when it comes to paying their employees?!?

Bleh

I'm feeling pretty down this evening. I don't want to study and don't want to work, just feel like curling up with chocolate chip cookies and trashy television and calling it a night. Why? Lots of reasons, including: yelling at K when I saw him this evening for the only hour I'll see him in the next 24 since he gets to go to a hockey game tonight and I can't, losing one of my favorite and most expensive earrings today, feeling stupid because I can't seem to internalize pKa and solubility for the MCAT, wasting a perfectly good meal by forgetting my lunch box yesterday, screwing up my patch to the hospital today for the 1 pseudo-real ambulance call I've had in several weeks while working with someone not D who proceeded to tell me all day how terrible it was, and making my dog miserable because I haven't had time to take him for a walk. F*!# it all, I'm just gonna go walk the dog and wallow in my misery for a while.

Party like it's 1999 baby!

Yeah, so I'm older now. I had a patient tell me that 29 was such a great age, many people stay there for years. If only I could do that and let some of these younguns catch up to me. At any rate, my wild and raucous birthday consisted of: work, studying, work, leaving the house briefly, work, studying, seeing a movie. Woohoo, doesn't everyone want to come party with me.

Leaving the house briefly consisted of going out for fast-food lunch, and going to the fire station and the local brewery to take pictures with our guest Guillermo. Who is staying with us? A life-size replica of a kindergartner from Washington. K's sister has her students do a Mailing May project and some of the kids don't have many family to send them to, so we get one. This year, we have the cousin of the kid we had last year. What you're supposed to do is take your kindergartner places and take pictures, then write a little journal and send it back. Last year was a lot easier because we went on a trip for my birthday and drove through VT, NH, and ME so we were able to get lots of pictures and little stuff for the kids. This year, I'm so busy I don't have time to go anywhere and we haven't found much yet. The big reason we went to the brewery is because it has 1 of only 4 clydesdale stables in the country (if you know what brewery I'm talking about). The horses were huge. They only get them dressed up one weekend a month, which was unfortunately last weekend, but they were still amazing.

Going to the movie was actually pretty cool. It is the first time in a long time that I've seen a movie in a real theater where the screen is more than 10% bigger than my tv. They also had the nice stadium seating and comfy chairs. The movie was great and if you're into movies where many people die, I highly recommend it (see sidebar for more info). The crowd was also pretty entertaining as we had people who just couldn't keep their thoughts to themselves during some sections, including the woman directly in front of us who "eeeewwww"ed when one person got killed. I'd also forgotten what it was like to go to a movie theater filled with 8 billion other people. It wasn't bad once we got to our movie, but the lobby was jam packed since it was a Friday night and all the kids were out. The joys of city life.

Still employed

Well, nobody even said boo to us yesterday about the coat incident, so apparently I'm still employed. It was a busy day for us and we even got a "real" ambulance call because we were the first unit on the scene of a 2-car accident that we happened to be driving by. Nobody was hurt or wanted to go to the hospital, so the advanced providers were more than happy to let us do the paperwork and be on their way. It was also a day of amusing patients, nearly all of them were alert, younger, and intelligent, so they were fun to talk to and work with. I wasn't in the greatest of moods yesterday morning, but after a couple patients, I was feeling much better - to the point that D noticed and commented. He finds it somewhat amusing that nothing really cheers me up more than patients, but honestly, I'm not doing this job to deal with him or anyone else in the company, I'm here for the patients, so I think that's a good thing.

But as described previously, opportunity never comes in an orderly fashion. Yesterday also brought offers from two separate groups at my old job to take on more work, meaning that I could be employed 30-35 h/wk if I wanted to be and make quite a bit more money. This would mean that I'd go down to one or maybe two days a week at the ambulance and I would have more time to study and more time to volunteer, which sounds like a tempting offer. But part of leaving the old job was that I don't really enjoy doing it, and getting sucked back in probably wouldn't be much better although at least I'd know there was an end in sight.

The whole point to being on the ambulance full-time was to make sure I like dealing with patients all the time and to get patient contact experience in case I want to go to PA school (since they require 1000-2000 hours). Since a variety of folks have been engaged in talking me out of being a PA, that is seeming less and less likely and number of hours on the ambulance isn't as important. I feel like I should at least stay put until I'm off of probation at the end of the month. K suggested staying put for now and waiting until I get my MCAT scores back in June to decide. Sounds reasonable, but I'm having a hard time being patient with this entire process, I just want to be there. Wherever there is, that's where I want to be.

It rolls downhill

So I've waited more than 12 hours to try and write about this, and I'm still annoyed enough that I'm not sure this will come out in a way that expresses what I'm really trying to say, but here goes anyway...

Yesterday, D and I were headed to the southern city our co. covers to help move ambulances from the repair shop back to the appropriate stations and pick up some paperwork. It is a 30 minute drive down there, and yes, we do it all the time even though there are ambulances and staff in that city which could conceivably do it. The weather was extremely nasty with rain/snow mix and poor visibility.

When we were at exit 7 on the highway, we received a call from dispatch that they wanted us to meet with a unit between exits 6 & 5 to pick up their patient because they were on-scene of a motor vehicle accident. From listening to the other radio traffic previously, the story was that a school bus had sideswiped the ambulance and the patient they had on board was headed back to the hospital after cancer therapy. No big deal, a patient only requiring basic care. The hardest thing about it was going to be getting him out of one ambulance and into ours without being run over or toppling the stretcher in the mud on the shoulder. When we get to the other ambulance, the first comment from the paramedic is "where are your coats?" Now, before you think I'm an idiot, I was wearing a coat. But not the neon yellow, reflective, signed/sealed/approved by the government coat officially issued to me by the company. That coat was hanging at home because it has gotten a little old to be mocked by every nurse and every co. employee I encounter for wearing it frequently. The comment from the other provider on the truck, not wearing his coat, "where's your coat?"

Shortly after we got there, the supervisor truck rolls up. We had swapped stretchers with the truck involved in the accident, and had the patient out on the side of the road, rolling him towards our truck. His partner, "don't you guys have your coats?" The supervisor then lit into us for not having our coats. In front of the patient. Who was being rained on and had just been involved in an accident.

The first couple of statements the supervisor made went uncommented by D and I, because really, there isn't anything either of us could say at this point that is going to satisfy him. He's really just looking to yell at someone because he's at the scene of an accident that is going to cause him a bunch of paperwork, and we're lowly EMT-Bs (and I'm still on probation until the end of the month) and thus a perfect outlet. Then, he gets very close to me and starts shouting something to the effect of "where the hell is your g-dd-mn coat?" I managed to control myself to only responding "not here" without adding the "obviously" that was waiting, and with the traffic and such on the highway, he probably couldn't hear quite all of the sarcasm inherent in the statement. He then proceeded down the stretcher to yell again near D, who responded "we're only a basic truck and we don't respond to accidents. my coat isn't here." This of course, pissed off the supervisor a little further, who then yelled some more about how that was no excuse, and blah, blah, blah, because quite frankly, I wasn't listening - I was busy trying not to roll the stretcher off the pavement into the mud or into the side of our ambulance since we had about 1" clearance.

D seemed pretty certain that we will get "written up" over the incident. And if we do, I'm gone. Getting written up during your probationary period is supposed to mean that you have not passed your probationary period, i.e. hit the road jack and don'tcha come back. But that isn't really what gets under my skin about the whole incident, because there are other places to work, and I doubt anyone is going to hold it against me that I got fired for not having my coat one day. What really irks me is that the entire situation was completely inappropriate. The first two non-supervisory employees taking us to task. The supervisor pitching a fit, including cursing, in front of the patient. Out of all the things that were going on right then, us not having coats was far and away the least of anyone's concern and yet everyone on that scene felt that attempting to humiliate us in front of the patient was the appropriate response.

I got home feeling too old for this B.S. I'll be 29 tomorrow and I don't need some power-mad yokel bitching me out on the side of the road like I'm 12. I also feel like $10/hr isn't really worth this, as I could probably work at Burger King for the same rate and not be in danger of being run over by a car at 65 mph. Yes, yes, I'll take my coat or vest from now on, this was approximately the 5th day in the 2 months I've been working that I didn't have my neon coat. But that isn't going to change the attitudes of the ALS providers in the company that shit rolls downhill and piles onto all the BLS providers.

Crazy part 2

Last month I wrote briefly about a crazy lady telling me I'd just won $150,000. One of my calls today had a familiar name. She turned up again today, in a different hospital and a different city. But today, she'd been having excellent hospital care and appropriate medication. She was pleasant, friendly and apologized for anything she may have done last time when she found out that we had taken her previously.

Before we got her on the stretcher, I cornered the nurse and asked how the patient was doing today. Her nurse was somewhat evasive until I told her that we had previous experience with this patient as aggressive and combative, then she opened up with a glowing review of this wonderful woman that we would be sooo happy to have. And finished with, "and she's totally different than two weeks ago." You think? At least she didn't hit anybody at this hospital.

Today was also the day of long waits. Something was not ready for every patient we transported. Two were missing paperwork (from the same unit, surprise, surprise) that took over 1/2 hour to get together. The third had paperwork, but was otherwise entirely unprepared to leave the hospital, including still having his PICC line in place and his personal possessions strewn all over the room. Fun fun.

State of me

Someone pointed out that I hadn't updated on the prospective volunteer experience with K's department..so the current story is that I had an oral board interview two weeks ago and a chief's interview last week. I passed both and am now waiting on the results of the background check before getting the official okay to volunteer. I will be going through orientation at some point, probably soon, then getting to start going on calls one evening a week (5p-7a) and one weekend out of every 5. I will be on probation for 6 months so I can be trained, then they will allow me to drive their vehicles and have lights and sirens on my own vehicle if I want to pay for them. Everyone's big concern was how well K and I were going to work together, how I'd respond if I disagreed with his decisions, how I'd handle it if someone else was talking about him, whether I'd bring any disagreements home with me, etc. Nobody really seemed to care whether I was any good as an EMT, but I guess they have 6 months to figure that out for themselves.

I'm still working 40h/wk on the ambulance, and 20h/wk on the old desk job, and studying my behind off for the MCAT. Since the MCAT is at the end of this month, I'm considering starting an EMT-Intermediate class in May, and hoping the ambulance is willing to let me go part-time while I do it, because I'm working on driving myself completely insane. Transfer shifts on the ambulance are pretty boring, but the only way to get into a position to do something more interesting is to take more classes, and of course, it is difficult to be out on-time to go to class and they pay for more of the class if you are full-time than if you are part-time. If I wasn't still working the other job to pay the bills, it would be an easy choice, but I guess I'll just have to see how it goes.

MCAT studying is stressful and I had a conversation with D the other day to the effect that I was worried I wasn't going to do well so the stress of studying didn't really seem worthwhile. He commented that if being an MD was my goal, then it seemed worth striving for even if it took a while. Which was an incredibly nice and supportive thing to say - but the part that really hit home was "goal". What is my goal? The best I can express it is that I want to help people by providing medical care. To be a part of the healing process for illness and injury. Do I need to be a doctor to do that? Not really, although it would certainly pay better if I was. What benefits would I get from being a doctor instead of a PA? Autonomy certainly, more flexibility in choosing the type of environment I want to work in, a much easier time being accepted as a researcher if I want to do that some day. What if I want to just stay on the ambulance as a paramedic? Would that really be so bad? So you see, I'm killing myself for something I'm not even entirely convinced I want...