More EMS-related entries on the way, I promise!!!

Here's a preview:

1. White pickup with empty beer bottles, bad Mexican pop CDs and two perfect stars on the windshield...Patients?? Where???

2. Three little kids in the back of a car. Belted. Liver Lacerations?? Uh oh!

3. Truck + Car + Car + Car = maddog transports 2 patient in his ambulance and delivers efficacious care!! w00t!

4. 80cc Scooter with flame decals, alarm system and remote start. or "Manly fun at the firehouse!"

I have my first big cardiology test tomorrow. I'll be reading EKG strips until I'm blind. Today's pharmacology test whomped my butt. I'm still reeling from the blow. I'll write more soon. I swear!!

--maddog

Politics vs. Patriotism.

Yesterday, after I expressed dismay at the lack of leadership in the Democratic party and concern over the behavior of the Republican party, I was accused by a 21 year old student of being unpatriotic.

I made no partisan political comment or statement supporting or endorsing one candidate or party over the other. I have, however, been registered to vote for 15 years, have voted in every state, local and national election since then (absentee ballots when necessary) and have served 13 years in the military.

Somehow, I'm unpatriotic?

Well, F***k me! I never knew!

I guess I'll go turn myself in now.... But before I do:

"To announce that there must be no criticism of the president, or that we are to stand by the president, right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public."

-Theodore Roosevelt (1918)

Hey! Wasn't he a Republican????

--maddog

More marginalized medics...

This article comes my way via Nancy's Blog. It's covers San Francisco's struggle to figure out where to put their medics. Once again, EMS is being treated as the redheaded stepchild by the fire department.

I have great respect for the fire department and their need in our communities is both dramatic and clear. Unfortunately the need for EMS doesn't seem so clear to everyone. I've ranted about this in a previous entry and I'll be sure to rant about it again.

San Francisco fire department has been unsuccessful in its attempt to absorb all of EMS into itself. For example:

"Under the merger, paramedics said they endured a heavy workload and hostility from their firefighter colleagues at the firehouses where they both worked 24-hour shifts."

Of corse the firefighters would be hostile! These Medics were bad for their health or something!

"Firefighters, among other things, claimed they could not sleep because of the sound of sirens from the responding ambulances housed at stations"

Can't sleep?? CAN'T SLEEP??!!!!!

Oh my!! Boo-f***ing-Hoo! I'm crying for ya!

Well, at least the medics will be fairly compensated right?

WRONG!!!!

"At the entry level will be 200 lower-paid civilian paramedics and emergency medical technicians to staff the city's ambulances. They will be hired at $65,000 or more a year, $20,000 less than fully trained firefighter paramedics. ... The next rung will be firefighters, followed by the highest paid group, the firefighter paramedics created in the merger, who earn a starting wage of $85,000."

To those of you who don't live in SF, $65K can sound like a lot but, just ask Nancy how expensive that city can be, especially since the Dot Com boom. I lived there from 91 to 94 and then went back to visit in 2001. Wow!

Sigh!

Not to dump on the firefighters out there but I'd rather have a well equipped, well funded and well trained paramedic come to my mom's house when she falls down the stairs than a hundred well financed, well equipped, well trained firefighters. Hell! She's not on fire!!!

GRRRRR!!!!!!!!

--maddog

Thank you.

To all my readers who have left comments, email and other murmurings of support and condolence, thank you. It has been very comforting to hear from each of you.

--maddog

Gmail invites.

I've got a few Gmail invitations.

Anybody want one? Let me know via email or use the comments link below.

w00t!

--maddog

"I can't breathe!"

The patient looks like crap. Pale, cold sweat and her lips are blue. She looks about 80 but her worried daughter says she's 55. I look up at my partner. She looks just as worried as the daughter. The patient is in the tripod position and working hard to breathe. She's wincing.

"Does your chest hurt?" I ask.

She nods

"Have you had heart trouble before?"

Her eyes are screwed shut and she's nodding.

"Mom had a heart attack last year!" Says the daughter, her voice rising with anxiety.

"I'll...uh, i'll go get the cot." says my partner and she's gone.

Next I'm in the back of the ambulance with the patient. My partner has closed the doors on us with a finality that gives me a chill. Through the window I see the anxious face of the daughter.

I grab and IV bag and a needle but it's huge. Somehow I can't figure out how to put the two together. Isn't there a tube that goes between?

The patient codes. Falls right out. Dead as a doornail.

Shit!

The ambulance is rocking as we head out the winding streets of the suburban enclave.

Shit!

I grab my Lifepack 12 and a set of electrodes. The wires are a mess and the electrodes won't stick. The patient slides off the cot on a hard curve and I fight to get her back on. Where the hell are the straps???

Shit!

Somehow she's got an IV in her arm. A good one too. Thank god.

I ventilate and do chest compressions for 1 minute and then grab the drug box.

I open it and all the vials are black, red and green. No labels. Nothing. Just rows of bottles filled with red, green and black fluid.

Shit!

I don't even know what I'm supposed to give her! Or how!

We take another corner and the side door flies open. The lifepack bounces down the steps, pulls the leads off the patient and I see it skittering across the pavement of the shoulder before it's gone behind us.

Now it's raining and we're sliding all over the place.

Shit!

Drugs!

Shit!

Do I have an AED in this rig?

SHIT!

My patient has the dead stare. She's looking right at the overhead lights and lolling around the cot with each bump and swerve.

Did we just hit something?

Shit!

Is that hail????

Shit!

She's been pulseless for how long?

Shit!

What the hell am I doing?

SHIT!

I wake up with a start. Herself is quietly breathing beside me. My heart is pounding. Despite the over powered air conditioning in the house, I'm soaked with sweat.

I get up to get a glass of water.

What the hell am I doing? Am I going to make it? There's so much to learn, so much to know. Gear to learn, drugs to memorize, signs and symptoms to learn. The sheer volume of information to absorb is staggering.

Is there any way possible I can do this? Logically, I know I can.

Focus and Discipline.

But late at night, I wonder...

--maddog

WARNING! GEEK ALERT!

Today, my 40Gb iPod arrived.

I took it out of it's lovely box, plugged it into my 12" G4 aluminum Powerbook and they immediately began to love each other.

Ahhhhh!

11.1 days of continuous music will now reside in the palm of my hand.

I also got an iTrip.

My commute just got a LOT better!

--maddog

Pharmacology test tomorrow. Here's a sample question:

"Your patient weighs 148lbs. Start an IV of Lactated Ringers solution. Administer 1500ml over 5 and a half hours through a 10 drop set. Give the patient a 3% drug via IV push. The Physician requests that the patient receives 1.5 mg/kg. Hang a medication Drip. Start the patient at 3 micrograms per kg per minute through a 60 drop set. The medication drip is 800mg in 500ml.
Please provide:
1. Patient weight in kg:
2. How many drops per minute do you run the LR IV? round to the nearest whole drop:
3. How many milliliters of the drug do you push?
4. How many milliliters of drug do you infuse per minute? Give the raw number to the 4th decimal place.
5. How many drops per minute do you run the IV medication? Round to the nearest whole drop."

Fun, eh?

Oh yeah, no calculators, Show all your math, I have about 5 minutes per question. My test will be about 6 to 8 of these questions.

Wheee!!

--maddog

Message to my classmates:

"Team,

I'm sorry that I haven't had time to let you know. I've had a pretty crazy weekend.

At about 1:30 on Saturday morning, the mother of my Very Best Friend, (my wife) passed in her sleep.

She wasn't worked (no tubes, no cracked sternum and no ugly corpse). She had been fighting a cancer that made it tough for her to fight infection. She died quietly and as well as she could. She gave a noble death.

My wife, my best friend in the world, is now an orphan (her father died in 1999).

(((Yeah, What the F***k do I do with that?))) You ask?

Well, she's MINE and I grieve with her. (She's a part of ME, isn't she?)

"What the hell do I do?" you ask?

I'll tell ya: The maddog is on point to support Herself (my wife). It's all about her (and, when she's not looking, I cry for me). The answer: Just keep being my classmates. I value you all as you are and don't stop being who you are.

I'm here to be the best paramedic in the world. I'm sure you all are too. Thank you.

Don't be ashamed if I cry for no reason when I'm talking to you. Don't feel weird when my eyes get glassy and filled with water. Put your arms around me and tell me you're my brother or my sister. That's what I need. We're going to have patients and families of patients who are going to feel this pain. I'm a fellow medic. Practice on me.

I'm gonna miss that lady. She gave me my wife. She made me proud to be in her family. She was a great lady.

Thank you all for having the guts to want to be a medic. Compassion is no small part of what we do. I'm glad to be counted amongst your number."

--maddog

"¡Soy el Doctore! ¡Soy el Doctore!"

The best way to keep a kid happy in the ER is to put gloves, mask, gown and cap on him and tell him he's a doctor.

He then proceeds to "treat" his dad who's there for an allergic reaction. I suppose the distraction is welcome. This is an ER that goes to "Yellow" status with 4 empty beds. Yellow status means that they can only take emergency patients and everyone else has to wait until they have space. Including my patient, the father of "El Doctore" who's eyes are so swollen shut, I have to guide him to a seat.

"I'll make you better, Daddy!" says the son (in Spanish). Hugs ensue.

I get a signature from the charge nurse and prep for the next call. Nothing has prepared me for my next call.

Dammit!

--maddog

Day one:

At 2 am, my phone rings. It's the Oncology charge nurse at the hospital where Herself's mom is.

"I'm so sorry...."

My lieutenant is the best:

"Go home, maddog, there's no patient here who needs you more than your wife. Go, man, go!"

I wake her up. There's no other way to say it:

"I'm sorry, honey. You're mom has passed away."

I have not stopped hugging her.

I call her sister and wake her up. She's crying:

"Mommy's died! Mommy's Died!"

I feel like the angel of death.

Herself and I sleep entwined like pretzels. In the morning, I make a huge breakfast and nudge Herself and HerSister to make decisions. To her credit, Herself's mom had already made arrangements with the Anatomical Gift Foundation. Her remains will be sent to us.

My job is to work the phones. Every 5th call or so, I have to stop and cry. Herself's mom has touched many people in her 78 years. She's touched me too (stop to cry).

Now we're planning parties. So many people wish to honor her and we are the crux of her life. We have a lot of parties to plan. My parents come home early from their weekend getaway. My mom (the one who who forces planes to land): "Of course, I had to come home. We have to be with you." Tonight, we gather as a family should, share funny stories and cry a little.

Herself has gone to bed. The day has been busy with grief, business and condolences. Herself's mom was extremely well known and loved. Everywhere I went today I made people sad with the news.

Herself has a lonely road. I'll do my best to be the friend I hope I can be. I can't make her pain go away but I will try my damndest to make her life as good as I can. Is there anything more important in life?

(stop to cry)

--maddog

"I'm having an allergic reaction! My eyes are burning! I'm allergic to pepper spray!"

I look at the police officer who's handcuffs are on my patient. We share a wry smile. I get vitals and my "Patient" goes to lockup, not the ER.

I'm sure he's allergic to pepper spray. Aren't we all?

--maddog

I'm sorry for not posting. I've been busy.

This morning, my mother-in-law passed on. She's a great lady. I will miss her.

Herself is now an orphan. My heart breaks every minute.

--maddog

maddog AWOL

I haven't been arrested or anything. My mother-in-law has been very ill and my time has been mostly spent at the hospital with Herself and Herself's mom.

School has started with a bang.

I have a ton of blogworthy calls.

I was in a parade.

I'll post when I can.

--maddog

Recent call:

The buzzer rings once. That's the signal for a "rescue" call. That means that I'll be going out on the ambulance. I stand by the printer, waiting for it to spit out the paper that will give me more information than the scrolling LED screen above the TV set in the lounge.

"MVA, Injuries after accident" Ok, does that mean they got out of their car and fell down or did they discover they were hurt AFTER the accident? I don't care. We roll and I'm ready for spurting blood, broken necks and flail chest. That's what I do, right?

Cap'n Jack, one of the "Old time" firefighters happens to be driving my ambulance this evening. I've never ridden with him and he's a quiet sort. I call him Cap'n Jack because, as I discovered later, he loves sailing as much as I do and moved about 40 miles away so he'd have a place to dock his boat by his house. I can appreciate that. The Cap'n is a quiet sort who manages to exude the air of competence without saying a thing. He does everything as if he was born to it.

We arrive on scene to Suchandsuch Interstate to find the patient sitting on the guardrail next to her mildly deformed car. She's got a shoulder that is about 3 inches below the other one and she doesn't want to go to the Emergency Room. Mom, Dad, husband and many others are there and they are trying to tell me to take her there NOW before I can even look at her.

Of course, I get her into the ambulance because it's "Safer." (Really, I want to get us away from the family members who are giving me a headache!)

Of course, all 20 family members want to come in too.

I'm so glad the doors have locks.

While I'm assessing what I think is the obvious patient, Cap'n Jack discovers that her 4 year old son was in the back seat (in a fully restrained child seat) during the accident and begins assessment. A quick glance tells me that I only have to worry about one patient myself. I LIKE working with The Cap'n! He's regularly looking to me for affirmation and confirmation of his diagnoses. He's been fighting fires since I was 8 years old but he looks to me on the medical. Wow!

Nobody's going to die, Mom's got pain, Son's got a small bump on his forehead but fully with it and alert. Dad (who showed up later) looks like a complete Gangsta or rap star on a bad hair day rides in the ambulance with us.

I never cease to be pleased and surprised by how people do not live up to the expectations set by their appearance. Here's a big, scary looking man, the visual archetype of inner city thug, who's entire attention is tenderly focused on his wife and his son. He's bigger than me but he's so gentle with them both. I am an ass for thinking what I thought when I first saw him on scene.

The entire time we're transporting, the son is fixated by the gear and mechanisms at the "Action Station" in the ambulance. That's where we keep most of our tools and materials close at hand. I joke with dad that this kid's going to be an EMT some day and dad says, "That would be cool."

Right on!

-maddog

School

I've started classes. This is the point where all of my classes (except about 2 electives) over the next 2 years are focused on me becoming a paramedic.

in Pharmacology today, my teacher handed me a list of 105 drugs to memorize. I have to know their typical dosages, what they're taken for, their brand and generic names, interactions with other drugs, overdose symptoms and OD treatment.

Woo hoo!!

I think we might see a shift in my blogging style. knowing that there's some Paramedics out there that actually read my drivel, I might be asking you some questions through my blog.

--maddog

Today was a cookout to welcome the new students to my program and to re-connect with old classmates and teachers. What better time to call in my bet!

Ah! Sweet victory!

Here's one of Peaches and I:


Don't he look sweet? (The flowers were Herself's idea!)

This is the sign I wrote up for him to wear:

All the students now agree that it's a bad idea to make a bet with maddog.

Hee hee

--maddog