Quick updates

In chronological order:

1. I had a DNR patient die during transport last week and that was a rather awkward situation. We loaded him into the ambulance and my usual procedure is to have whoever is driving get moving and then take vitals and such. This patient was baseline unresponsive and in bad shape, so it wasn't like he suddenly quit talking to me or anything terribly obvious to realize he had died. When we were in the ambulance and I couldn't get a pulse, I realized that I think he quit making the nasty gurgling sound that was accompanying his breathing sometime in the elevator or short hallway out to the exit. We had to turn around and take him to the emergency department of the hospital we took him out of (we only got 2 stop signs away) so they could pronounce him, but there really wasn't any doubt. I'm glad I double-checked to make sure the DNR paperwork was in his file before we left.

2. K has had a cold and I've just come down with it, so we're pushing the limits of the household kleenex supply.

3. I didn't have to work Turkey day, so K and I had a quiet meal at home and watched football all day, interspersed with liberal napping. I do have to work Xmas day though, and K is working Xmas eve (until 0800 Xmas morning), so it sounds like we'll be doing presents sometime around 1800 Xmas night which is going to be torture for K as he still likes to be up around 0600 for presents!

4. I worked a cheerleading competition yesterday, it is highly disturbing to watch more than a thousand cheerleaders, both on the floor and in the stands, doing the same dance to a song. I saw a wide assortment of strangely dressed and oddly competitive parents as well. Several other ambulance folk working said that most of the concerts are less crowded than this was. Most of the calls while I was there were TGS (teenage girl syndrome).

5. K's grandfather died this morning - I'll try and post some further information, thoughts or reflections as they come to me, because I don't think a quick update is an appropriate last word.

Technical issues

I blame part of my lack of posting on computer issues, which were supposed to be solved yesterday. My laptop has been having issues with charging and running on AC power, so I've been babying it and trying to get as much real work done on the battery life as possible. Yesterday was the scheduled service day for a technician to come replace the motherboard (since that is where the power connection is). Surprisingly, the connection had finally given up the ghost 3 days before the warranty expired, so it was being repaired free of charge.

Tech shows up, parts in hand and proceeds to tear the laptop into a hundred tiny screws and plastic pieces. Swaps the board out and begins reassembly. Here is where things went wrong. He had to remove the keyboard off the top to get to some other pieces, and when he goes to put it back, I hear a "hmmm" noise. I head over and see him holding some tiny plastic pieces and trying to put them back onto a connector. No dice, the plastic connector that links the keyboard to the rest of the computer is broken beyond repair.

He calls the company and asks them to send a new keyboard. They tell him my machine is now out of warranty and I'll have to pay for it or the service company will. I manage not to blow a gasket as he calls his supervisor and gets told that the service company isn't paying for a keyboard and I have to take it up with the company myself. Approximately 1/2 second after the tech leaves, I'm on the technical support chat trying to type without punching the keys so hard that I break my external keyboard too. The company tells me that there is a keyboard on order, billed to the tech, and they'll be in touch to replace it.

So now, I have to wait another week for the part to arrive and service to be scheduled before I can use my laptop as a laptop. I'm hoping the service group doesn't procrastinate just because they got billed. Until then, the laptop is permanently mounted to my desk.

Ooo, that smell.

The smell was almost indescribable. Decaying flesh, infected pus, oozing nastiness. The patient was in a room with glass doors, in an area with no other rooms with doors, that was the first sign. The nurse looked at us and asked, "Have you ever taken this patient before?" When we said no, her face kinda fell, that was the second sign.

Brief report from her included that the patient had a bandage on his face because he was missing a large area and a little information about his cancer, but nothing about the smell. She opened the door to let us in and before anyone moved, the smell hit like a tidal wave. At first, I couldn't quite figure out what it was, but when I saw the wound there was no question. I honestly don't know whether there was anything he could've done about it, but I have to think he's grateful that most of his nose is gone because it probably doesn't bother him much.

In the ambulance, we have an exhaust vent to try to eliminate the smells, but there was no way it was going to keep up. We had the heat fan blasting, the windows open in the front, but still it was thick enough you could almost see it. I made the 17 miles without retching and eventually we dropped him off. We did as much covert decontamination as we could in front of his place, and when we drove back to the hospital we continued cleaning and by the end of the day you almost couldn't tell (or so I was told). I had that smell in my nose the entire day and just the memory of it now makes my stomach flip-flop a little.

Politicking

The FD has had some major upheaval this year. This spring the anti-tax crowd converged on town meeting, slashed the town budget, and elected anti-tax candidates to the town council. Since then, department heads (except the police who seem to be exempt) have been fighting an uphill battle for control of their own departments and the money to keep them running.

FD started the budget year by cutting their budget almost 3% before town meeting. With the level funding from last year translating into another 3.5% cut, the chiefs sat down to make some major changes. Overtime call-back - time that off-duty and call ffs come in to cover the station while the on-duty crews are out on calls - was slashed to nearly nothing, the engine from the south end of town now drives to central station to cover when that engine goes out instead of off-duty ffs coming in. The department had capital funds for a new rescue truck this year and had spec'd it out, gotten all the estimates, and just needed final approval from the council. Instead, they were told to slash 10% off the truck, and when they did, they were told just to scrap the plan and wait until some other budget year because the truck was "not necessary".

This environment encouraged the chief to retire, with about 5 weeks notice, and allowed the council to appoint whomever they wanted as the acting chief while a "search" started. They promoted a captain (over three chiefs), posted the position with the publicly stated intention of not spending a dime to find candidates and stating that they weren't going to hire anyone who wasn't willing to work to continue to reduce the budget. I don't have an opinion on whether the captain is qualified or a good candidate because I just don't know enough about it (opinion through the department seems mixed), I just find the process to be very strange when you take someone with no experience and thrust them into a position of authority in the late stages of the critical budget process for next year.

What does this have to do with me? Beyond K's overtime salary cut, the department is now looking to have call ffs and ambulance volunteers fill regular shifts when full-time people are out sick or on vacation because they will not be earning overtime, just regular pay. The council is of the opinion that more volunteers is the solution to the budget problem because everybody wants to work for free (or cheap at most). K honestly came home and asked me whether I would keep volunteering with the department if these changes happen. I told him I didn't know. I know I would not go in and work a shift to cover a full-time person so the town doesn't have to pay overtime. I'm not qualified or interested. Apparently the word is out among the call ffs though that there will be a mass exodus rather than helping the council slash the budget like that.

There are several critical facts the council is forgetting. Many of the volunteers/call ffs are paid ffs somewhere else, so they are all part of the same union and they aren't going to undermine the union here in town. All the EMS volunteers and call ffs have other full-time jobs, so it is unlikely they would be available to pick up shifts when called at 0700 for an 0800 start time. And most importantly, the department has been actively recruiting for new volunteers/call ffs for years and very few people have the time and commitment to work for free for an extended period of time, so there isn't a huge pool of people to pick from and those that are here are (as a general rule) much less experienced than the full-time members.

Right now, I'm falling on the side of wanting to keep doing what I've been doing (at least until I get into school) and let other people hash out the bigger issues. No covering daytime stuff, just one night a week and every fifth weekend. I'm concerned about getting even more crap about not supporting the union and such, like I did when I started volunteering, but until and unless K specifically asks me not to volunteer with the FD, this is the way I'd like to make a contribution to my community.

One day at a time

That is what it should say on the sign outside my padded room because that is how I'm going to drive myself insane - one day at a time. This week, I picked up over 30 hours of work on ambulances for the next six days - above and beyond what I was originally scheduled for. Each individual request from full-time people looking for a day off didn't seem to bad, but when I really looked at the calendar this afternoon, the weight of all those shifts suddenly seemed a little more real. I didn't even realize Thanksgiving was already next week - I mean, I knew it at one point, but not recently. Thank goodness though, it is the only day I have off next week.

EMT quote of the day (from a staff member on transfer truck leaving the station to pick up a patient for transfer to the local mental health/detox facility): "All aboard the sad bus! Don't make us come back for you, just pile in! Non-stop service to [facility], trips leaving daily!"

Ahem

Um, yeah, I forgot yesterday. I worked my first ALS transfer shift, was tired, hungry and cranky by the time I got home, argued with K, had dinner, went for exercise, baked cookies, and crashed in bed. I remembered about writing somewhere around cranky, but since I didn't do it right then, all was lost. Still though, twelve days in a row is a personal record. Maybe next November I'll make the whole month...

Reading

I read a lot, which you may notice by the rapid turnover in titles on the sidebar. Primarily, I read for entertainment, but every now and then I like to pick up something different. In this case, K bought it for me because I'd talked about being interested after the author appeared on the Colbert Report. The book is The God Delusion by Richard Dawkins. Although I don't necessarily agree with all of it, the basic idea is that it doesn't make logical sense for there to be a supernatural power in control of the natural universe and that there are rational arguments against it and against most of the claims that a belief in some type of god or religion are strictly necessary for humans.

I also found it interesting to read a non-American's opinion on how an American's social standing suffers just for denying a belief in a supernatural god. When you live in a society where such a large proportion of people are believers in at least their public persona, it can be difficult to know when to express opinions to the contrary. While I've never had the personal experience of friends and family turning their backs on my because of my lack of belief, it has certainly been a problem at different points which I'm not going to go into.

It is also something that has come up a few times on the ambulance. EMTs are all taught about patients who may refuse care because of a variety of religious beliefs, and that isn't even what I'm referring to. Patients have asked me to pray for them or with them, sometimes on the spot. Since I'm in a professional capacity, I generally defer with some vague indication to "do what I can later". I try to reinforce to myself that I'm not actually lying, because what I can do is exactly what I do, nothing. I don't think it is appropriate in the back of an ambulance to try and explain/defend why I have come to the conclusions I have about god and religion, nor the place to try and "convert" anyone else, but my patients seem to have no such issue. I treat the situation like any other piece of extraneous information on a call, but every now and then it is hard to bit my tongue so it is fun to read a book where someone doesn't pull their punches and attacks the superstitious religiousity head on.

Well-supervised

I made it out of the kids football around 1530, so I actually had enough time to stop at home and drop some things off before heading to the overnight shift. No major injuries at the football thankfully, because I really don't want to see what a parent willing to paint his face for a 9 year old's football game would do if the kid were actually injured! Top three teams went home with trophies, and for the New England fans - you'll be happy to hear that the Patriots won.

Tonight I'm rolling with the shift supervisor, so I'll be getting lots of feedback on how/where/when/why I do things. On the first call the list of things wrong included: not having my radio in hand when the tones went off, leaving the ambulance door open, not being able to lower the back shelf on the stretcher to get it to fit in the elevator, not turning off the heat in the back of the ambulance so I was sweating when we got to the hospital, not having my cell phone on me, and missing a couple of boxes that I've never used before on the run sheet. Nothing critical, but by the time we got back, I was feeling like I'd missed a bit too much. A big part of the reason I'm rolling with the sup is to learn, so what I have to do today is survive the feedback and show improvement. I'm aiming to get to the point where the sups feel comfortable having me on the trucks so I stand a chance some day of getting a full-time shift again if I decide I want one.

Schedule snafu

Today is the start of a long stretch of hours for me between now and Sunday. I was supposed to be on an ambulance from 10-2000. I found out on Tuesday that I was going to be working with the paramedic Lt. I had planned to bring in cinnamon rolls as a thank-you for the crew I third rode with last weekend. I thought I had the day all figured out, ha!

Cinnamon rolls went as planned, making several city crews fat and happy. Shortly after 10, the Lt. shows up and tells me they moved him to a different truck that had to have a medic, because I was on a BLS truck. At 1030, I find out that they don't have anybody coming in for this shift at all, and if you don't know it actually is not possible or legal to work an ambulance by yourself. Around 1200, dispatch called and asked me to drive the ambulance down to the southern station and man a wheelchair van down there. But they didn't actually have any calls for me to do, they just wanted me hypothetically available instead of definitely not available. At 1500, they finally found someone coming off shift who was willing to stay until 2000 and work, so I actually did 2 calls this evening and now I'm about ready to call it a day.

The next two days will push my commitment to blogging every day. Saturday I'm working the kids football from 800-1800, then heading to a city shift overnight (1700-700). Sunday, I have a couple of hours off, then a BLS shift from 1000-1800.

Valued employee

I made a trip up for a meeting at the office job yesterday and while I was there, I picked up the mail I've been neglecting for a couple months. I got a hand-slap email from one of the administrative assistants for not picking up my mail, so I thought I better empty out the box before someone decided to stick all that garbage in an envelope and send it to my house.

There were really only two relevant pieces of mail, the benefits enrollment information and a letter about my status as an employee. Thankfully, I wasn't making any changes to my benefits because I completely missed the enrollment period while that information sat in my mailbox. The letter though, made me laugh. Since my position is funded by grant money, it isn't really permanent but rather contingent on someone with grant money being willing to keep me around and cover my salary. Also, as a "soft-money" position my job can be eliminated at a higher level without a lot of recourse for me. This leads to an entertaining letter every year. This year's was dated October 1, and stated that I have "been approved for reappointment effective July 1, 2006 through June 30, 2007" also I'm congratulated "on this appointment and thank you for your contribution" to my employer. I'm not going to like the year that I find out in October that I haven't had a job since July!

While I was up there I also ran into the FOB (see NSP) who thankfully did not want to have a conversation any more than I did, but it was still weird to even realize he's still alive beyond the abstract small bits of info I get from my sister. If I'd been expecting him, I would've had something probably insulting to say about his treatment of my nephew, but I just managed a surprised "hey".

p.s. K is home today and a bit wiped out. The rest of his immediate family is heading to MI tomorrow to be with Grandpa. They were able to arrange hospice care at the VA, so hopefully he will be comfortable and well-tended for as long as he has left.

In this corner...

we have the new EMT-I and in the other corner the reigning champeen, the big city. And this morning, one of the experienced EMT-Is snuck up behind me, grabbed my arm a la a heavy-weight title fight and declared to the oncoming staff in the garage that I had hearby survived my first city shift. Many folks laughed, and those that hadn't punched my new patch yet took the opportunity to do so.

The medic I rode with wished for an easy night because he didn't feel like working too hard, and he got his wish - which is probably better for me anyway. We ended with a total of just four calls, all dispatched as falls. Three of the four actually were falls. One patient had fallen but just wanted help up rather than a trip to the hospital. One patient swore there was a broken hip involved, but the symptoms seemed like it probably wasn't that severe. One patient spoke no English and the most information we got was from a child on-scene translating, who did not go to the hospital with the patient.

Overall, not a bad night, but I'm wiped out today because I really didn't sleep much - per usual in an unusual place. After 200+ miles in the car and taking the final test for Haz Mat, I'm going to call it a night.

p.s. K reports his grandfather seemed slightly better today (appetite was up a little and slightly more aware) and they are in the process of arranging hospice care for him.

Gray day

No major change in the condition of K's grandfather, but they were able to confirm the brain bleed. Doctors report he has 1-45 days left to live. Not a very helpful bracket for determining what we're going to do for travel. Today, at the request of his dad, K left for MI and will be there until Thursday. He was quite uncertain whether to go, but ultimately decided he wanted to be with his family when they needed support, even if it means he has to turn around and head back soon.

Fairly dreary day weather-wise around here, and my last patient personified this by being the saddest person I've talked with in a long time. He was fairly oriented for being demented and we had a pleasant conversation during the transport. The only way he seemed sad was that he kept saying he didn't have any reason to live, nothing left to do, no way to go anywhere. I tried to just talk about positive things with him and avoid disagreeing or supporting his negative statements. I also informed his nurses at the home, but I'm not sure that he hasn't just given up, so he definitely needs more qualified help. He actually thanked me for such a pleasant conversation and I was glad to have given him something good today.

Edited to add (20:04): Lucked into a spot in the big leagues tonight, hoping for a reasonably quiet night to get my feet wet...

Lazy

I can't tell you how positively wonderful today was. K is working his 24h shift. I have no where to be until 1830 and nothing strictly required of me today. So I did, nothing. Well, I did read a little - an interesting book I'll probably write more about when I'm done - but mostly, just lazed on the couch.

Sadly enough, I consumed 100% less halloween candy today - because there isn't any left here - so I think that I probably had less excess calories today by sitting still than I have the last several by moving from place to place with leftover candy. Mmmm, candy, droooool. This is the start of the overeating time of year. I find that from halloween to at least Valentine's day, I eat too much. I try and balance it out with exercise, but I haven't found a place to play basketball yet this winter.

Other news from an unfocused mind - I don't know who to vote for tomorrow. NH is having a gubernatorial election which I'm all set on, as well as a multitude of other state offices, some of which I have no idea what they are. What is an "Executive Councilor" and does it matter to me that one of the candidates is a lying, two-faced backstabber according to her opponent? Is there actually more than one person running for sherriff? Ugh. I may just go vote on the governor and the constitutional ammendments tomorrow and leave.

We may be making a trip to MI soon. K called this morning to tell me that his dad called and said grandpa is not doing well and had a significant decline over the weekend. The docs aren't sure whether they are seeing bleeding in his brain or some sort of calcification, but either way, he isn't a candidate for any sort of intervention to relieve the building pressure in his brain. This has been a bad year for funerals. I'm trying very hard to wish positive thoughts and keep my spirits up for K.

Patience

I have rediscovered my intolerance for idiots today. Some folks had been doing stupid things to annoy me, but I was still making it through by reminding myself that I only had to deal with them for a little while. Today, I think retarded monkeys would've been better company than the idiots I was forced to sit through class with. The majority of the people in the Haz Mat class are part of a firefighter 1 class, so many participants are young, over-testosteroned wanna-be firefighters. They can't keep their fat yaps shut and listen to lecture and they have no practical experience in anything, so the only thing they have to offer the class is their particular idea of humor - which involves inside jokes and guffaws at the expense of one of their own. If I'm ever on fire in the town they're from, I think I'll just keep driving until I get to the next town over.

I'm not entirely sure how K ever made it through a series of FF classes involving people like this. I asked him today, and he reminded me that his class was actually worse because there was one guy who couldn't even read and they were all volunteers who knew they were never going to be professionals. The guys in my class think they're going to be hired some day, so they have at least a small motivation to pay attention. It is very hard to sit and try to learn anything, and I'm about out of patience. Being one of only four women in the class means that saying anything will get me labeled a bitch (or worse), but I think that it may have to be done to avoid any further disrespect to the instructor.

Hazzzzz....

Out at Haz Mat Operations this weekend, learning all about the kind of scenes I never want to show up on. Apparently it is a FD requirement for all staff, but I would've avoided it if possible. Today was eight hours of powerpoint slides, following a night of poor sleep, that just about put me to zzzz's. The lecturer wasn't too bad really, just a total lack of interest in the material. We're starting earlier tomorrow so we can finish up by 1500, so I'm hoping to catch an afternoon nap.

Tonight I'm in the city, running on the 911 truck as a third rider. So far, one MVC who got collar/board/IV (which I stuck on the first try!! and I was nervous after over 6 weeks of no live sticks), and one call that was really a PD call and not an ambulance call so we cleared up quickly. I always feel guilty wishing death/dismemberment/illnesses on people, but hey, that's what I'm here for!

Five truths

Okay, tagged by NSP to give you five things that are true in my life.

1. I am scared. Scared to get into medical school, scared to not, scared that I will never even hear anything from them. A thousand and one negative scenarios swirl around my brain on a daily basis.

2. I am indescribably glad I am not 22 anymore. Not that I think I was ever the kind of 22 that is currently annoying me, but if I were young and single again, I would probably have to kill these boys.

3. I am addicted to Diet Coke and I don't care. I've gone through periods where I try and cut back for the sake of caffiene and irritated primary care physicians, but I rationalize it by the facts that I don't often drink and I don't smoke, so what's one little vice?

4. I do not hate my body. Sure, there are times I wish it could be more (or less), but mostly I'm glad that it gets me where I want to go and that it is quiet enough that I can usually take it for granted. This is probably a result of seeing a lot of people whose bodies don't get them where they want to go.

5. I'm outta truth today....gotta get crackin' on some w-o-r-k, so hopefully four will do!

Patched!

The store that does clothing for the ambulance company (and unfortunately also the FD) usually sews all the patches on our shirts as part of their "full-service" ordering. Bad enough the company only forks out for the cheapest shirts which drop buttons regularly and need constant trimming for lose strings but most of the time it takes 1-2 weeks per shirt and you have to take at least one patch per shirt back to be re-sewed within a month. I'm no professional seamstress, but I have not been particularly impressed.

With my new credentials, I get one new patch per shirt (I'll try and get a picture up). I went by the shop on Tuesday and asked for a patch to swap out because I wanted at least one of my shirts done for work today. I've never seen the woman look so happy as when told I wasn't asking for her to sew my patch right then - just to give me one so I could do it. Her husband came out to see what was going on and gave me a suspicious look, but they let me take the patch. The rest of the shirts are heading to them today. It took me over an hour, but I have to say that my unskilled job looks at least ast good as theirs and will probably last longer too.

Spooky

Halloween was a bit of a disappointment this year. I was working a vanbulance shift - in a real box ambulance - and nobody on day shift was even kinda costumed. We went around to hospitals and nursing homes as usual and there was a disturbing lack of both holiday spirit and CANDY. These are places that have had candy for a week or two now, and on the actual day, nada. The best I saw all day was a patient at one of the homes who had an orange vest with bats, a matching headband with stuffed bats on springs and bright orange garland with plastic bats wrapped around the wheels of her chair. I wish I had a picture for you, but this particular place wasn't a likely candidate.

Trick-or-treating is town-regulated to run from 6-8p only and my shift ended at 6p so I was home for most of it. I'll just say that there were so few candy-begging ghouls and goblins, we actually watched all of Saw from 7-9p and only had to pause twice to answer the door. So much for being in a better place for trick-or-treat.

Patient quote of the day, as we were lowering the stretcher so she could move to her wheelchair and I had just been hit by a n-a-s-ty wave of stink: "Oh, girls. You made me so excited I just farted. Sorry, I think it smells a little." I could only wish I had been at the head of the stretcher instead of the foot right then.