Future Ditch Doctor

Before I get too deeply into what the title of this post is about, the #questforthediscopatch for Fall 2010 is coming to a close.  I see a light at the end of this tunnel and I’m really hoping it’s not a train.  Tomorrow I have my final for lecture and Tuesday my classmates and I will have one last pharmacology test and a critical on dosage calculations.  All of this will, of course, determine whether or not I move on to next semester.  I’m really hoping for few problems.  I’ll be spending a lot of time studying and in my final clinicals for the semester too.  I’m hoping the next time I post about school, I’ll be celebrating a break and getting ready for Spring.

Now, on to some non-school fun!

Thaddeus Setla is not only the genius producer of Chronicles of EMS and an appreciator of wines, he’s also a huge fan of the University of Michigan Wolverines.  I am a huge Mississippi State University Bulldogs fan and our two teams are set to square off in the Gator Bowl on 1-1-11.  Naturally, I saw the opportunity for a friendly wager.  When I suggested to Ted that we come up with something, I was expecting something along the lines of “loser has to display the winner’s logo on their Twitter and Facebook profiles” but I was pleasantly surprised when he suggested a wager involving wine.  So, here we are!  I’ve warned Ted that I know very little about wine but he didn’t seem worried about that.  Essentially:  If Mississippi State (likely) wins, Ted’s going to send me some wine that he’s been holding on to for a little bit.  If Michigan (unlikely) wins, I will send him a Zinfandel of my choice.

I wonder if he’ll accept a fine vintage from Mad Dog 20/20?

In all seriousness, I’m looking forward to this.  The smack talk has already begun and I invite you to follow our banter on Twitter and Facebook as gameday approaches.  I just hope Ted and the rest of his Wolverines are ready.  A pissed off wolverine is a dangerous thing but a pissed off bulldog with 40K + ringing cowbells is going to be a big challenge.  Plus, Michiganders are used to cold and snow this time of the year and Florida doesn’t normally have any snow.  Seeing as MSU is a cow college, we’re used to grass and won’t question what the field is made out of and its intentions.

Let the games begin!  Oh, and on behalf of the Bulldog Nation, I present this as a warning of what the Michigan faithful have to look forward to!

First, I want to brag a little.  Today we had our intubation check off in lab and I passed on my first attempt!  The only thing I lost a point on was that I didn’t verbalize the depth of the tube at the teeth but otherwise I did well.  I don’t mind telling you that I was nervous because I figured I would do something silly like rocking the teeth or forgetting BSI but thankfully I remembered my steps (except for the aforementioned depth issue).  I’m happy that I passed!  I didn’t do as well on my test as I had hoped, though.  It’s just something to work on improving.

It’s a good thing that I don’t mind a challenge.

I had a clinical rotation at an ICU on Friday and I really enjoyed it.  I only had two patients (and one of those went to the floor) but I still got to practice several medication administrations and work on assessments.  Ah, assessments:  The bane of medic students’ existence.  I’ll be the first to admit that when I first started doing them for school, it sucked.  Yes, I said it:  My assessments sucked.  I feel that I’ve come a long way and I want to continue to improve so that I accurately and thoroughly examine my patients to determine a proper course of treatment.  The only patient I had who was able to speak (the other was on a vent – more on that one in a bit) was a bit of a challenge but, as I said above, I sure don’t mind one.  He put me to the test and I’m glad that he did because it helped that much in making me a better EMT already and a good medic later on.

As for the other patient… she wasn’t so well off unfortunately and I was around when the family got some not so good news about her prognosis.  I kept my distance, of course, while the doctor was giving them the dreaded news but I still saw their grief from across the room.  I’ll be honest:  Seeing the family go through a loss (or immanent loss) is something that is hard to get used to.  I think everyone in EMS (or in any other field for that matter) knows how too well what they’re going through.  It stinks knowing that, whether I’m a basic or a medic – or even a doctor – there’s nothing I can do to bring back their loved one (last time I checked, there was only one God and I’m certainly not Him).  In those situations a family loses their aunt, uncle, granny or whomever they’re grieving for and I don’t think anyone would disagree that it’s tough to witness.  We also have to remember that at that point we’re not treating one patient anymore, rather we’re treating that patient’s entire family and friends who may be there to witness you calling the code.  I hope that empathy is a skill that I never lose sight of as I learn all of the new ALS interventions I’ll be able to do as a paramedic.  May this is true of anyone in EMS now and those who are going to enter the field after basic and/or medic school.

Anyway, sorry to get off on that tangent.

Later on when I went into the room to reassess her and give her the meds she had due, I could tell how much the family loves her.  They were telling me about how healthy she had been up to that point and how she hated hospitals.  I got to hear them share special memories of her and how much they will miss her.   I couldn’t help but think of my loved ones who have passed and even of my mother who was on a vent for 15 days back in 1999.  It was a scary time; I know how they felt because I felt that way too. More »

I just got home from my last clinical of the Fall and I’m grateful that I’m not but some pathophysiology and drug information away from officially being on break.  Mentally, I’m tired.  Physically, I’m tired.  Tomorrow will be the first time I’ve slept past 0500 since August.  You have no idea how much I’m looking forward to that.

Unfortunately, I also got some bad news when I turned on my laptop.

I logged onto Facebook and noticed several local EMS friends had changed their profile pictures to the Star of Life with a black bar.  Before I had a chance to ask any of them why, I found a story on EMS 1 about an EMT in Montgomery, Alabama who was struck and killed while she was working a MVC on I-65.  This hit close to home for a few reasons.  One, she was my age (29).  Plus, it’s literally close to home.  Montgomery is about three hours from my house.  My thoughts and prayers go out to EMT Laura Elizabeth Pullam’s family, friends and co-workers at Care Ambulance in Montgomery.  More »

I hope that everyone who may read this had a very merry Christmas or whichever holiday you may have celebrated.  I got a great Christmas gift from school when I got my final grades:  All Bs!  I’m not complaining one bit.  We report back January 11 so the quest will begin again at that point.  In the meantime, I’m trying to relax as much as possible.  So far, so good on that one (just ask my wife).

I also spent Christmas on the truck and we were actually pretty busy.  The two biggest things we seem to be picking up right now are flu symptoms and stomach virus symptoms.  I took a flu vaccine a couple of months ago and so far it seems to have worked.  However, I really wish we had a vaccine for the stomach virus as I came down with a pretty good one on Sunday.

Merry Christmas to me!

We were finally able to find someone to come in for me (in fact, it was my director who had to come in – and I appreciate it very much) and I’m thankful that it finally happened because I was miserable.  I had been talking to my wife throughout the afternoon and I let her know that I was finally about to head home.  By the time I arrived she even had PJs laid out for me, Sprite and crackers by the bed (for when I felt like eating or drinking something) and bed itself was even ready.  I went to sleep but woke up every so often to… well, to do what those with stomach viruses do.  It wasn’t fun and I’m thankful that I’m almost over it.

I don’t wish this on anyone.

So after now two days of basically doing nothing, I’m reminded of what  a patient must feel like and my wife has gotten a taste of what it’s like to be a healthcare worker.  I’ve been at some weak moments and my wife has had to help me in ways she normally wouldn’t have to.  I’m grateful for her willingness to assist me just as I’m sure our patients are grateful for us helping them.  It’s a sobering reminder that anything we can do for a patient to make them more comfortable matters.  Being a patient for the first time in a long time has given me a renewed sense of what we do.  On my next call – and hopefully on many more to come – I’ll remember what I’ve felt the last couple of days.

During this time I’ve also discovered first hand what many other EMSers have told me…

EMTs make the worst patients. I believe it wholeheartedly.

The project started out innocently enough in August.  On my first day as a paramedic student, all bright eyed and bushy tailed, I was handed a list.  The list was about four pages long and included information about the drug cards we would be making, what information was required and a list of drugs that stretched from acetaminophen to warfarin and everything in between.  The information gathering was done at various points along the way and slowly but surely I made my way through the list.  Then, last night, victory!  The drug cards were finished and this morning I handed in my stack of alphabetized cards with information about the medications.  However, the victorious feeling would be short lived as I was hit with another realization.

Dosage formulas. They are now the bane of my existence.

We began studying and practicing the formulas yesterday.  Today we had more practice and I found out that the critical skill check off on dosage calculation would be right before we start Christmas break.  Pass or fail.  All right or all wrong.  Three chances max.  I’ve never been the best at math.  I’m sure my high school math teachers still laugh when they think about my feeble attempts to master what they were trying to teach me and I had the grades that showed I had no idea what they were talking about.  I was scared then.

Now is no different.

My problem really isn’t the math itself.  Once I see a formula and learn how it works, I generally don’t have much of an issue.  My issue is remembering all of that when I’m handed a test.  The plan is to practice, practice, practice, practice and do the absolute best I can.  The best effort will be put forth and I plan to do my absolute best.  That and hope for the best is really all I can do.  Somehow or another it will work out and I’m thankful that I have a great support system in place.  I have some practice problems to do over the weekend so I’m optimistic that this will help me with my confidence. More »

There was a moment today where I honestly thought I would be posting and announcing that I was no longer a paramedic student.

Today was a day that I had  been dreading from the beginning. It was a day that I knew was coming and that I tried hard to prepare for.  Yes, today was the day when I thought my future as a paramedic student might most be in jeopardy (up to this point).  It was:

The drug dosage calculation critical. (DUN DUN DUNNNNNNNNNN)

Today we had the critical and a final test on pharmacology.  I wasn’t sure which would be first when I first walked in.  I was the second to arrive (as usual) and I made some small talk while I looked over my formulas and a few drug cards that I had a particular hard time remembering.  As class got under way, my instructor told us that our first order of business for the day was our dosage critical.  Cool, let’s get it over with.  Pencil at the ready, I awaited my paper.  Down on my desk it went and I started working.  An hour and seven math problems later (I got stuck on a couple), time is called.  We go over the answers.  Now, I should point out that this critical, as I’m sure it is at most every other paramedic school, is an all or nothing affair.  I missed two.

“Fudge.” (yes, that’s an actual quote) More »

Good news: I’m still alive (although I’m sure at least a few people are disappointed that I’m rambling again).

The Spring has sprung and school is back in full swing.  As I mentioned previously, we’ve begun the cardiology portion of paramedic school and, as I thought, I love it.  The heart is truly an amazing organ.  The way it operates, the redundancy it has built in, just the sheer magnitude of how it works is mind boggling.  And that’s just the A&P portion I’m talking about.  Tuesday we started studying sinus and atrial rhythms and on this coming Tuesday we’ll have our first rhythm test.  I’ve enjoyed every bit of it and I don’t mind saying that I’m now a cardiac nerd.  I plan to learn as much as I possibly can about cardiology (and everything else about our branch of medicine!) and put as much of that knowledge into practice as I possibly can.

Clinicals are fun.  Last week I spent a 12 hour shift in a busy ER at a regional medical center and, as has been the case at other times I’ve been to this ER, the different types of patients I encountered didn’t disappoint.  Well, maybe “variety” isn’t the best word to describe the patients I encountered last week.  All but one of the patients I assessed were throwing up and having issues on the bottom end either.  Seeing as the green apple trots is making its way all around this area I got to start several IVs and I was grateful for the practice since I hadn’t started an IV since December.  I only missed one!  I guess it was re-beginner’s luck.

I keep getting interesting calls at work and I’m really thankful to be able to get that good experience.  Since I’m bound by my EMT scope of practice when I’m at work I don’t get to actually perform any ALS interventions but get to see a great variety of patients and it’s been a great opportunity to learn.  Lately it seems like I’ve been learning just how powerful and fast an amp of D50 can be.  You would think that in Mississippi, which is one of the most unhealthy states in the US, that we would encounter more hyperglycemia.  We get our fair share of diabetes and the DKA that often results from it but it seems with all of the viruses going around lately, the blood sugars have dropped like the temperatures lately.  One patient I encountered recently had a BGL of 20 mg/dL.  Obviously our altered friend was in rough shape (and had some other issues happening that required intubation) but the simple act of pushing an amp of D50 cleared up a lot of the patient’s problems at the moment.  The more I learn about our medications, the more I realize just how much can be done in the field to help a patient and possibly even correct the underlying issue that led them to call for EMS in the first place.  We truly are mobile medicine.  I’m proud to be a part of it.

For anyone reading this blog who may be considering taking up the Quest, first I want to say congratulations on even being interested.  We need more good people in EMS and I am willing to do anything I can to encourage more bright and dedicated people to get involved.  Please know, however, that if you’re an adult who has been out of school for a while, going back to college for the first time in a long time may be a bit of a shock.  Take for example today:  We finished a little early before lunch so I went across the street to the main campus.  Sitting in the library and using their WiFi for my iPhone wasn’t so bad, in fact it was a very nice break.  The cafeteria, on the other hand, was a zoo.  In order to save time and moolah I buy a meal ticket with my financial aid money.  Thursday is chicken day.  Baked, friend, name your poison.  It’s what the college’s lunch room is known for and it’s also the day that the line will stretch well past the doors with people waiting to get in.  I take my place in line and wait just like my mama taught me too.  Apparently, some of my younger brother and sister students (I do NOT mean fellow students in my paramedic class – they know how to act!) did not receive the same manners instruction because people would cut in line.  These kids act like it’s the first time they’ve ever seen fried chicken and also the last.  It’s maddening, not because it means I have to wait longer for my lunch but mainly because these people are supposed to be adults, want to be treated as adults and yet don’t act like adults.  I really shouldn’t be surprised and I suppose I’m not.  It’s actually a good study in human behavior.  It’s just amazing that college students are still practicing junior high behavior.

I’m a pretty basic Basic/medic student.  Truthfully, I don’t have a Batman belt of gadgets, boomerangs and pouches for this and that.  I could tell you some stories of things I’ve seen and even things I’ve heard about on the various EMS message boards that I’ve visited but I really don’t see the need to carry a bunch of crap on my belt.  Even the uniform I wear itself is pretty basic.  I wear a pretty traditional light blue button down shirt, navy blue tac pants and black boots.  I’m not too particular on my brand of uniform stuff except for my boots.  The only boots I wear are Magnum Stealth Force 8.0 waterproof side zips (and no, I’m not being compensated for this plug; although if they wanted too…).  They’re truly the best pair of boots I’ve ever owned and I will buy a new pair when this pair finally wears out.  Aside from that, I carry a pocket knife, handheld radio, ALS field guide and my iPhone.

I included my iPhone because I consider that to be just as an important part of my uniform as anything else.  I have some useful apps on it that I use almost every shift.  One of my favorite apps is the Epocrates app which has info on almost any drug I could ever want to know about.  I also have the electronic version of the ALS field guide, mainly because of the built in calculators that make things a lot easier if/when I need them (which – honestly – I don’t use much at the moment but I know they’ll be more useful when I become a grown up paramedic).  I also have an ACLS simulator and an EMS time logger that I use sometimes on calls.  Now, granted, I don’t normally pull out my phone in front of patients but it provides good resources if I have a question after a call or if I just think up something random between calls.

Otherwise, I don’t worry about carrying a bunch of gadgets.  I don’t understand why some EMTs have this facination with having more gadgets than Batman.  I remember a conversation I saw on an EMS message board (that shall remain nameless) where a guy talked about the window punch, glove pouch, Mini Mag and a few other things that he carried on his belt at work.  Come on; why would anyone need that much stuff?  Carry the tools that you actually need to do your job. Don’t be a whacker.  Believe me: No one’s impressed, especially your patients.

So that’s what I carry!  It’s nothing fancy but it gets the job done, which is the most important thing.  Of course, the best thing we can “wear” is the education, clinical knowledge and understanding that’s essential to give the best patient care possible.

To me that’s more important than any gadget that anyone could invent.

Those that know me tend to think I’m negative about my home state of Mississippi.  Truly, I don’t enjoy that but I’m also sick and tired of the citizens of my state being satisfied with the way things are (which aren’t good).  I also want, in some way, to encourage my fellow Mississippians to better themselves by actually using the brains that God gave them.

I was a radio personality and programmer for 8 years before I joined EMS and I’m familiar with (and have participated in) the many stunts a station will do in order to bring attention to itself or an event it’s sponsoring, etc. A radio station in Biloxi has been airing an on-air countdown, which the station management state is a countdown to a new format.  I’m not sure why but some of the citizens down there apparently thought it meant a terror attack was about to be launched on coastal plants for industrial companies such as Chevron.  How they assumed this is anyones’ guess but I think it’s pretty sad that people are really that stupid.  I also realize that there’s stupid everywhere the grass is green (and even where there is sand, etc.) but this is just plain nuts.

Usually when you see a title like that you’re drawn to a website that makes you do some ridiculous junk in order to get a “free” whatever but since you’re seeing this here at FDD, you can rest assured that this is the real deal!

Kelly Grayson, one of my favorite EMS bloggers ( A Day In the Life of an Ambulance Driver), is also a published author. Kelly wrote a book entitled En Route: A Paramedic’s Stories of Life, Death and Everything In Between.  Kelly’s publisher, Kaplan, has made several of their titles available for free for a very limited time and Kelly’s book is one of them.  You can download to your Kindle (er, actually you should see update below on that), Nook, iBooks or other e-reader by going to Kelly’s blog right here!

The free downloads start tomorrow (January 4th) and go through the 10th so be ready to enjoy some free quality readage!

Jonathan

*UPDATE 1-4-10*

Ok, evidently I misunderstood and I apologize.  The reading devices you can access the free Kaplan books through are the Nook, iBooks and the Sony E-Reader.  You can go here to access instructions on how to down the free books, including Kelly’s and many others.  Take advantage an stock up!  Also note that if you have an iPhone, you can still download the free books via iBooks even though the site only indicates for the iPad on the front page.  I just downloaded my copy of En Route and I’m going to grab some others as well!  Again, sorry about the mix up.