Helpless....

I've been looking at the pictures of the devastated towns and thinking of where I would put my command post. I've closely examined the faces and bodies of the injured in the photos and video and found myself thinking of treatment procedures. I've seen the hundreds of bodies floating in the water amid debris and am thinking of cleanup methods.

I've responded to disasters, I've treated the sick, I've distributed food and supplies and I've recovered bloated bodies of the dead from the water. I CAN help. I've done it before. I, and many of my brothers and sisters in the Coast Guard can help. We're really good at it. History has shown that to be true.

If my commanding officer called me right now, "Maddog, be ready to hop at 0800, we're heading East." I'd be turned out and ready to deploy by 0730.

We have the a collection of the best military organizations in the world. We are all volunteers and do this because we feel it's right. Why are we not on the ground in Indonesia, India, Sri Lanka?

Why do Coast Guardsmen get injured and die in Iraq protecting oil platforms when there is the biggest humanitarian need right around the corner? That's what we do, Dammit! Coasties save lives! Set us loose to do our job!!

We are a fat, rich country. We have a force of men and women who are smart, flexible, competent and compassionate. I can think of no shipmate of mine, past or present, who would not drop everything and run to aid if the Commandant just said so.

We're helpless. We don't have to be.

Dammit! Dammit! Dammit!

--maddog

Hindsight, Foresight and why I suck at school...

I'm looking back upon my last academic semester and I am not pleased. I felt that the entire semester was a struggle to keep up. I finished with 4 B's and and A. I passed, yes. Where I feel I did poorly is that I did not finish with the level of understanding I should have had.

Cardiology, for example: I'm still don't have a clear grasp of how the drugs we administer for cardiac emergencies work. That is to say, I don't understand them enough to be able to figure out which one goes for which arrhythmia. I only know them from rote memorization and some great memorization tricks. I ended the semester feeling lucky that I passed rather than feeling that I passed because I learned what I was supposed to.

In a field where knowledge and understanding affect other's lives, I'm shaken to realize that I may care for patients based on rote memorization. Is that fair to the people I treat?

I have felt that I've spent the entire semester trying to keep up with what I have to know to pass the tests and not spending any time learning the material. Miserable, I know. College is supposed to be a time where I'm full of excitement and wonder at all the cool things I'm learning. I've experienced that in the previous semesters. I know how to enjoy the wonder of learning and still have the discipline to get my assignments turned in on time. I'm an adult. That's what I do.

I know, I know. I've had some "acceptable" distractions: Non-stop school since last January, soon-to-be-adopted twins, dead soon-to-be-adopted twins, my uncle dies, my beloved mother-in-law dies and I moved twice.

It's enough to make Socrates stop asking questions! I know!

It is not an excuse. I HATE excuses.

All this self-recrimination aside, what I really need to look at is my attitude towards learning. In the 13 years between the first and second semesters of my Freshman year, I attended a lot of classes. These were classes that were given on a work related basis. Military training, law enforcement academy, technical schools, and much more. They were all driven by learning a bunch of specific, ordered objectives and were easy to map out. I had a clear list of what I was expected to regurgitate or know and I performed within those parameters in order to pass the course. Not a whole lot of actual thinking was required

Often times, the real learning did not occur until I went out to apply those skills in "the world." Working with another officer, another engineer, another crewman (or woman) gave me the necessary experience to apply what I had learned and give me the opportunity to screw up without causing too much harm.

I'm sure there are those of you out there who have met 'Medics who don't think too much and do everything by rote. That is, most emphatically, not my goal. I can be a basic EMT and do everything that way but I want to be a Paramedic. The more I learn about this profession, the more I learn that I must be thinking, diagnosing and analyzing, all the time. I must take nothing for granted and always be ready to change.

Therein lies the fear from my last semester. I fear I haven't learned enough. I've passed the tests but, standing next to my classmates, I feel profoundly stupid.

Well, I'm a "can-do" kind of person. I would not be me if I wasn't thinking of how to fix this problem. Here's my approach: I will take advantage of the next 4 weeks of break to enjoy the "learning" part that I missed last semester. I'll throw myself into the world of cardiology, pharmacology and more with the enthusiasm of a true maven. In the next (Spring) semester, I resolve to enjoy and learn. I will not bog myself down with the worries of trying to meet specific criteria. They'll come easily if I know the material. I'll know the material if I'm enthusiastic about it and, finally, I'll be enthusiastic about it if I take the time to enjoy it.

Lao Tzu talks a lot about the "Art of Non-doing." Now, I'm no ancient sage but it sounds good to me. I'll just do my best to emulate my "Study Monkey":




I love that smile!!

--maddog

Santa Was Good To Me!

Right after finals, I was hurled into the holidays and have been catching up on all the parties and shopping I had been neglecting in order to study.

Fortunately Santa was very kind to me:




My mother says I was born in the year of the monkey and when she saw this, she shrieked aloud.

I love it.

I'll be posting a ton this week, I promise. I have much to tell and more questions to answer from my querilous reader from Japan.

Thanks for your patience and Happy Holidays.

--maddog

Finals, Haiku, Rockin' Irish music and Guinness...

I'm in the throes of final exams for the semester right now. They end on Monday.

So far I've only killed 3 patients during my practical exams...

A haiku for you:

Finals Loom
Tension-twisted guts
Must Not Fail!

I did take a break last night to go see these guys:

http://www.gaelicstorm.com/

The last time I saw them I was brought on stage to race a few chaps to the bottom of a couple pints of stout.

I won.

--maddog

"Personal Injury after an assault, Police on scene."

I love calls that are dispatched like that. They NEVER are boring.

Romeo and I hop in the bus. Before we've gone 100 yards, we're talking about what we need on the call. Romeo has decided to leave behind his idyllic lifestyle as a twenty-something heartbreaker and become a medic in the Army Rangers. He's got an appointment with "Pre-Ranger indoctrination" and he's excited about both being a medic and being a Ranger.

"O2 bag, Aide Bag (our usual "all around" kit) and the suction unit." says I.

"Suction?" asks Romeo.

"You ever been popped in the mouth?" I ask him.

"Oh yeah!" He says. We understand each other.

What this means to me is that he takes EMS as seriously as I do. We arrive at the restaurant/watering hole to see the usual scene of 2-3 police cars and a crowd of bystanders. I'm ready for a belligerent, bloody drunk who's going to alternately complain of life-threatening injuries and swear he'll kill anyone who comes near him.

A person approaches me as I step down from the ambulance. The cops don't even look my way. ...Odd!

"Hey." Says the approacher

"Who's hurt?" I ask. (Simple questions work best sometimes.)

"Me."

"You called the ambulance?"

"Yeah, I'm hurt."

Mind you, all of this dialogue is delivered clearly and without slurring by a person who has walked up to me with no apparent difficulty. I look around. Nobody else cares that there's an ambulance in front of the bar/restaurant. I guess this is it.

My patient is about 20-30 years old, black and of an indeterminate gender. Complains of head pain 8 on a scale of 1 to 10 after a police officer shoved him/her into a brick wall during a scuffle. A quick examination with my flashlight shows no swelling, bleeding or deformity on the site of pain.

"Let's go into my ambulance where the light's better."

"Ok."

In my ambulance, I discover she's female, oriented and alert and exhibits no signs of being drunk or even drinking. I conduct a physical examination of her head, palpate her cervical spine (feel her neck bones) and assess her eyes for pupil response along with horizontal and vertical nystagmus (shaky eyes that indicate either inebriation or brain damage). She comes up negative on all tests. Physically she's fine.

"Ok. Listen. I'm not a cop and I don't care what happened or why. All I care about is you. You wanna tell me what happened?"

She gives me a detailed, coherently delivered narrative of some silliness of her sister's boyfriend being drunk, the manager, an unpaid bill and a tussle involving drunks, girlfriends and cops. Apparently in the scuffle, she got shoved back and hit her head on a wall. She denies any dizziness or loss of consciousness and only complains of pain.

I tell her that I'll take her to the hospital if she wants. I also tell her that if she was my kid, I wouldn't be worried. She says she doesn't want to go to a hospital but wanted to be seen. I'm seeing that my role is an emotionally supportive one at this point and I'm OK with not transporting her to the local ED. After assuring her that she can call 911 at any time if her condition worsens and getting a signature from her, Romeo and I roll out.

"Dude! So, was he hurt?"

"SHE was fine, man." says the maddog

"Wow! I was feeling kinda weird. I thought she was pretty good looking for a guy."

"Well, Romeo, you are pretty hot, yourself, you know."

"Shut up, man!"

I'm still laughing.

--maddog

Question From a Reader, Part Four (Continued)

In a previous post, our querulous reader asked, "Have you ever answered a call and found someone had begun first-aid that was helpful (or not)?" I put out the request to my other readers for their stories but have received none. Alas. I suppose an anecdote or two of mine would be appropriate.

I ran a call for a personal injury at a local bar. It seemed that the bass player of the band had stepped on broken class from a stage light and it went right through her sandal and into her foot. From the eyewitness reports there was a copious amount of blood involved and it was quite dramatic.

When I arrived, I found an alert, oriented and somewhat attractive woman sitting in a chair sipping orange juice. Her foot was elevated on another chair and had been dressed perfectly with cloth napkins. there was 2 of them folded perfectly as a trauma pad and 2 more rolled into cravats holding them onto the wounded part of her foot.

It seems that there were 2 trauma nurses and an EMT in the audience along with a bar manager willing to give up some linens. The bandage looked very good, wasn't soaking through and her toes were showing that it was not on too tight. She told me that the nurses and the EMT cleaned out the wound with a pitcher of ice water, dressed it with the napkins and gave her some orange juice because she was feeling woozy.

At this point, considering the quality of the foot dressing, the patient's mental status (good), level of pain (low) and proximity to a hospital (almost next door), there wasn't much for me to do but load her up. We did have a large audience and many of them taxpayers in our jurisdiction. Well, I love to do my job so I methodically checked her vital signs, got a good assessment of her foot further down from the injury to check for pulse, motor ability and sensation then we loaded her up and took her to the hospital.

I think the only thing we really provided above what she got from the bystanders was a stretcher! That's a case of good first aid.

The most frequent cases of inappropriate first aid that I see are when bystanders pull people from badly deformed cars in auto accidents. This presents a real danger of aggravating a life-threatening injury that requires immobilization before moving the patient. Many times, the patients remove themselves from the automobile.

Another frequent case of inappropriate first aid that I see comes, unfortunately, from the firefighter first responders that get to the scene before me. None of them are particularly egregious but they seem to indicate either a lack of skill or care. For example:

-A 35 year old female assault victim being administered oxygen via an infant rebreather mask. I changed that one out for an adult mask from my bag to the surprised and somewhat shamefaced looks from the firefighters.

-A firefighter attempting to move a patient with abdominal evisceration by pulling on his arms over his head. A clear and authoritative, "STOP!" put an end to that attempt.

-A patient having trouble breathing being administered 6 liters per minute of Oxygen via a Nasal Cannula and the nasal ports are not even pointing into the patient's nose. A nasal cannula is a tube with 2 holes in it that sits under the nostrils to supply oxygen. Useless for a patient that's breathing through their mouth and completely useless for a patient that's having trouble breathing.

-A hypothermic patient being treated with blankets and hot packs. What's wrong with that, you ask? They were being placed on TOP of the patient's wet, cold, cotton clothing. ("Hypothermia = Naked, no exceptions!" says I to the firefighters as I'm pulling off the patient's wet socks and shoes)

I don't have any particularly funny stories of inappropriate first aid. Voodoo and Santoria are not common in my area. I can imagine all kinds of stories of strange home remedies and odd poultices but, alas, I have none to tell myself.

How about my readers? Got any to share? Email me or drop it in the comments below.

--maddog