Dear Selfish Smoker

I realize you have been a smoker for probably 45+ years. I know how hard it can be to quit. I realize that when you heard your diagnoses, and that it was untreatable, you took the "why bother quitting now?" approach. I honestly can't say I would do any differently. However, when I went to pick you up at your house because you couldn't breathe, your daughter- also a long time smoker- was sick with worry watching you struggle. Your precious, 4 year old granddaughter wanted me to assure her that you were going to be just fine. I tell her we are going to check you out and help you breathe better. She understands this, but I still see the concern in her huge brown eyes. "I love you Paw-Paw" she says in her high-pitched voice. I do what I can to help you, but it won't change anything. You will light up another one as soon as you can breathe again. You are not mobile enough to step outside, and here, selfish smoker, is what makes me so angry. Not only are you subjecting your precious 4 year old granddaughter to your smoke (that has already yellowed your ceilings and permeated every stick of furniture you own, as well as the children's clothing and bedding), but that now innocent little brown eyes gets the pleasure of watching you die.

The "Eyes" have it....

Most pediatric classes are now taught with the simple question "Sick or not sick". It's a fairly simple philosophy- A.B.C. Appearance- does the child look sick? In kids, their eyes tell it all. Breathing- are they breathing normally, or are they working to get air in and out. When kids are sick, their respiratory rate increases, and if they are working harder, they will have nasal flaring- their nostrils go in and out. They can also have retractions- when the skin around the ribs and collar bones sucks in as the child inhales. Circulation- are the fingers and lips pink? Pale? Blue? If you pinch a finger does it take a long time for the blanching to go away or is it prompt?

So, if you were to come across the world's sweetest 2 year old princess, but her eyes were devoid of their sparkle like this:

And she wouldn't eat more than one bit here and there. And you have to force fluids down her when she normally begs for juice, milk, water, juice, and more juice all day:

And she sleeps

And sleeps

and sleeps

and wakes every 2 hours in the night for a few nights in a row, and runs a fever of 102, well, then you know this little princess is SICK. According to her phenomenal pediatrician, she has been blessed with bilateral ear infections (yeah, this kid makes up for the other two genetic mutant children that NEVER got ear infections) and pneumonia. That would explain her respiratory rate of about 60 (about twice the normal rate for a toddler, er, I mean princess) and her retractions. She has some Motrin, Tylenol, and bubble-gum flavored "pink stuff" all working to help her highness feel better! Hope to be back soon, but for now- work will have to wait, this patient takes priority.

Beans and Okra

We were in training. PHTLS. Pre-hospital trauma life support. We had just covered airway management and brain bleeding, and dispatch must have been listening. We left training to respond to a possible stroke. Arriving on scene, the first-in engine asked for our ETA (we just put it in park, so about ten seconds?) and advised our patient was seizing. I tossed the jump bag onto the stretcher and grabbed the Narc box out of the drug box. The narc box hold three medications- Morphine, Versed, and Toradol. Versed helps stop seizures. We entered the house and found our patient on the floor, unconscious, with snoring respirations. One of the experienced guys was pretty worked up and told me "he just had a seizure". "OK." I said "Well, let's get him on the stretcher". It's not my emergency, it's not my place to flip out, but he needs to go and he needs to go now, so there is an air of urgency about the room. The fireman says "no, I mean he just had a SEIZURE" and starts flailing his fists up and down in what appeared to be an imitation of a toddler throwing a temper tantrum. I couldn't help but smile, and repeated "OK....let's get him onto the stretcher" which in itself was no easy task. Our patient was pushing 240 lbs, and we grabbed his shirt, pants, belt, arms, legs, feet- all of the above, annd hoisted him onto the gurney.

We are back on the road. We are miles and miles away from civilization. Even though it's foggy and drizzling, I ask dispatch to check availability of an aircraft. Of course nobody is flying. I figured as much, but had to try. Our patient is unresponsive. I check his pupils. His eyes are bloodshot. His gaze is off to the right. His left pupil is tiny and his right one is huge. He is having a stroke. There isn't much we can do right now- we open his airway, put some high flow oxygen on him, attempt basic airway devices but he still has a gag reflex, so out those come for now. We monitor him closely and drive fast. I was in the captains chair at his head. I leaned to the right ant toward him to check his blood pressure again. Over my shoulder I saw his mouth twitch. It looked like someone who burps and lets their cheeks balloon outward. He did that twice. I had asked another fireman to ride in with me in case his condition deteriorated. And it was about to. I told my partner "lookout! Watch him!" and just like that he vomited. We turned his head and removed the oxygen mask to suction out his airway. Navy beans, okra, and what looked like boiled eggs came out- none chewed very well at all. It was disgusting. I had the hot stench stick to my nostrils. I winced, then continued suctioning chunks and liquid out of his mouth and throat. Whole beans hit the floor of the bus. One stuck to his shoulder. After his airway was cleared, I took a towel and wiped his face. Poor guy. I was doing everything I could for him.

As we neared the hospital, his condition took yet another turn. The side of his face drew up, his eye began twitching, and he had another seizure. Only one side of his body seized. Thankfully we were able to stop it, but it didn't change the root cause of his problems. He was having a massive stroke. We took him into the hospital, the ER staff took over patient care, and he was whisked away for a scan to see exactly what was going wrong where. In a stroke, they say you have 3 hours to get the patient to medical care from the exact onset of symptoms. From the time our guy's family called 911, to the time we had him to the hospital (30+ miles away from the middle of smack-dab nowhere) was 46 minutes. We did everything we could. I hope he makes a recovery!

A bit puzzled...

I had the opportunity to make a little overtime evaluating EMT and Paramedic students taking the hands-on portion of their tests. The station I was participating with involved placing a KED on a patient. The KED is a device that helps secure a seated patient like so:
The straps are color coded, and putting it onto a patient is fairly basic. Apply the device securely without compromising c-spine. Yanking on the patient, twisting them, or failing to actually secure them doesn't cut it though. Knowing that they were being tested today, many of the students were a bit nervous, but blew through this station with the ease and comfort that comes from repeated practice.



But what puzzles me is that more than one person declared "I have never used one of these" or "It's been years since I put my hands on one of these!". Now let me get this straight- you've been going through EMT or paramedic school for what, 4 months minimum, probably closer to a year, and you have had ample time to familiarize yourself with your equipment. You should have practiced and practiced and practiced until you could do all your skills in your sleep. The skills you were being tested on were not randomly drawn from a hat- you KNEW what you would be expected to perform, and yet you announce to the evaluators that you aren't prepared? Don't get me wrong, if you came in and looked at this thing like you were trying to read Arabic then that pretty much gave away that you weren't as prepared as you maybe should have been! I don't understand... Did someone call some of these people and wake them up at 7 this morning saying "Surprise!!! You have your test today!!!"?
In either case- Congrats to those of you who did so well, and to those who had to redo their skills for whatever reason, best of luck to you. Remember- practice makes perfect.

Help! I've fallen, and I can't get up...

We went to go pick her up. She wasn't hurt, just slid into the floor and couldn't get up. She was elderly- probably in her 80's. Her front door was locked, so we went around to all the other doors. The sliding glass door was locked. The back door was dead bolted. The back kitchen door didn't budge. The door to the back bedroom not only had sagging, rotten wooden stairs with the bottom step missing and iron railing rusted and falling off the side of the house, but the door at the top of the stairs was locked as well. We circled back around to the front of the house, my partner advised dispatch that we may have to force entry. While circling the house I took inventory of the hundreds of potted plants she had in her carport, on her sidewalk, and lining her stairs. Wonder which one had a key hidden underneath it? I went back to the front door and peeked in the window to try talking to the lady. She gave me a thumbs up sign and interlocked her fingers behind her head, getting comfy while waiting. At least she had a sense of humor. She then sat up and her face had an "Aha!" expression. She began making hand motions and pointing upward. I didn't understand at first, then looked up. There, are the top of the door frame, was a nail. Hanging on that nail was the key to the front door. Doh!

The one call I wanted to be there for!!!

So my sister was pregnant with her second baby. I had jokingly asked her a few months back if I could "catch". She shrugged her shoulders and said "sure, would you pass the ketchup?" and that was the end of that. As it turns out, even the first-due first-responders didn't make it to her home on time!

Congrats Lisa and Stephen!!

http://lifeofasahm-lisa.blogspot.com/

Outside work...

In order to tie this post anywhere remotely close to work, you'll have to check back here to see the cooking we did at the station http://mommy-medic.blogspot.com/2008/12/random-comments-and-suicide.html. I have been a big fan of "The Pioneer Woman" for a while. I love following her blog and trying the amazing recipes! She released a cookbook (that you need to go get if you like to cook. If you can make toast or chocolate milk, you can probably follow several of her recipes. It's firefighter proof- there are pictures to follow along!)

So, I discovered her blog, followed along, and learned about her brother, Mike: http://thepioneerwoman.com/blog/2008/09/of_mike_and_firemen/. I read about mike and felt compelled to send Mike some souvenirs (as did many other people! I was amazed at the response and love for Mike! http://thepioneerwoman.com/blog/2008/10/nicenesses/ )

Ree, The Pioneer Woman, did a book tour and came to my home town! I was pretty excited (OK, I was REALLY excited) and went to the book store to stand in line. There was a much larger turnout that I expected- I got there shortly after the event started and the book store was giving everyone color coded wrist bands and making people wait according to color and letter. They told us it would be about an hour's wait. An hour came and went. It was getting late and having not eaten, I checked to see how quickly the line was moving. Determining that I had a lot of time still to kill, I went to go eat some sushi and came back. The line still wound through the aisles of books, and my color group had yet to be called.

I sat and watched those who had gone through the line. It was fun to hear all the stories and chatter of the people coming through. Everyone was very pleasant, which is something fairly uncommon in a large group of "general public"- there's usually at least one in every crowd who will be rude or irritating, but I never saw anybody like that last night.

I waited patiently and it was finally my turn! (And I have no clue what blogspot has done to the picture quality here, because it looks NOTHING like this on my photoshop but I can't seem to make it transfer to here correctly- something is going terribly wrong here!)

I got to meet Hyacinth and Betsy too- Ree's friend and sister. Ladies you three were super nice- I don't see how you smiled and were patient and polite for so many hours, but I'm so glad you did the tour and really very thankful that I was able to go! Off to try a new recipe- the cowboy sandwich (Hyacinth I promised) .

Make sure to check the more recent posts too- a lot can happen pretty quickly around here.

Inspired by Nurse K

*******Edited to say that Nurse K has taken a hiatus, wouldn't ya know it!******

If you scroll down a wee bit on my page and look to the right, there are links to some other blogs I find myself sucked in to. Crass pollination (Nurse K) has a witty dry style that is strangely addicting. I was reading her blog tonight and it reminded me of a lovely patient we picked up once. (They type of patient who makes you want to slap the palm of your hand to your forehead then take a vacation from this line of work and go flip frozen cow parts or deep fry something for a week or two). Anyway, here she was...

I was working another county at the time and we were called to whatever the specific address was. The building was a medical building physically connected to the hospital. It seriously would have taken then staffers at said doctor's office less time to put the patient in a wheelchair and roll her through the halls than it probably did just to explain to dispatch their suite number, location, nature of the call, age of the patient, etc, etc. Anywho, weee-oooooh, weeee-ooooh, here we come. We drag our stretcher up to said suite number, and find our patient lying on a hospital bed in the hallway outside the doctor's office. They had already done the hard part of maneuvering her through the thirty seven doorways inside the office maze. A disinterested girl dressed in scrubs stood in the hallway with the patient, chart in hand, picking at her nails, awaiting our arrival.

We scratched our heads, rolled our eyes, and pushed the patient through the hallway and the rest of the building to get to the ER. Our patient was conscious, alert, oriented, and complaining of (insert random, non-specific, non-life-threatening complaint here) so the three minute walk went by without a hitch. We got to the ER and gave report to the nurse. We handed the chart over to the nurse. The chart was missing basic info (hey- don't shoot the messenger) so the nurse shot us a dirty look, then sighed and asked the patient the name of their primary care doctor. The patient drew a complete blank (seriously, Bambi in the headlights) and said they didn't know. I tried a different approach and asked the patient which doctor they had gone to see today, the one that sent them to the ER. The patient looked at me as if I had four heads and snapped "Well! Don't YOU know where YOU picked me up?" Without missing a beat I replied "yes ma'am....on a bed in a hallway." She didn't like that, but it was the truth.

The nurse moved on to other questions, and each time our patient expected us to know the answers, or consult Sister Cleo or the magic 8 ball or a fortune cookie or something. That got really old really fast. I could tell her nurse had had enough. The nail in the coffin was when the nurse asked our patient if she knew what medications she was on. The patient thought and replied "Well, no, but if you have a list with all the medicines on them I could pick mine out..." The nurse turned on her heels, vanished, and promptly returned with the latest "Physicians Desk Reference" (PDR). It's a giant list of medications. It landed on the bed with a thud. "Here's your list!!!".
Nurse K, that wasn't you, was it?