...Junkies make the best teachers for IVs....

"Hello, Sir. My name is Maddog and I'm going to start an IV line and get some blood samples." says I as I come into the room.

I'm on my first shift as an intern at the Emergency Room and the nurses are giving me all the IV line and blood draw orders.

"Yeah, ok. Ain't gonna be no worse than I done to myself." says the patient in Room 5. He's a well dressed, bathed male in his 40's. While I prepare my equipment, he tells me that he kicked his heroin habit 7 years ago and has since gotten involved in his nephew's life. He's become the assistant coach of his nephew's football team, helps him with his homework and spends a lot of time with him.

A few days earlier, he went out and got high. He thought it would be a one-time thing but it turned into a 5 day binge. Chest pains led him to call an ambulance and he has expressed his desire to clean up and "get back on track" once he's in the hosptial.

I've learned to not be judgemental in any way. I hate it when I see that in nurses and 'medics. My job is not to prostelyze, it's to provide the treatment. My patient in room 5 is in a confessional mood and his story pours forth as I get ready. His self-recrimination is occasionally punctuated by assertions that he's gotta get "back on track." We chat and get to know each other. He likes the ideas of new beginnings and my story of quitting my job and going back to school appeals to him. We get along pretty well.

He's got great veins and not all of them are scarred up. Nonetheless, I try and fail twice to start an IV.

"Well, my man." Says I, "I've tried twice and I don't want to hurt you any more than I have to. Time to call in an expert."

"No, man. You're a student. You need to learn. Go ahead as many times as you need. I've done worse to myself so go right ahead.

I try three more times and finally get it. Each time, he's giving me pointers on angle of the needle, how to keep a vein from rolling away and more. All told, we spend about 30 minutes together. At the end I've got a better understanding of veinipuncture and he's got a 20 gauge catheter in his left forearm.

Two hours later, when he gets transferred to another floor, I make sure to stop by and chat with him a bit more and thank him again for the "lesson."

"No. Thank you, man. You've done a lot for me. Good luck." He says.

"Good luck to you, too." Says I, and off he goes.

--maddog

Motivation

I ran a marathon yesterday.

About 10 of the 26.2 miles were head-on into 30mph winds.

Ugh!

The first 24.2 miles, I did fine.

The last 2, I needed some motivation. I rolled up my sleeve and, every time I felt like quitting, I read my motivation.




Thank you, Damage Controlman Third Class Nathan Brukenthal.

--maddog

The goodies are piling up.

I've got a TON of blogworthy goodies. Unfortunately, I probably don't have time to write them all up. I'll take a tip from Tom Reynolds and offer tidbits and let you all vote. You can do so by using the comments link at the bottom of this post or by sending me an email.

Here's the goodies:

-an ED rotation with Icky bedsores and cool nurses!
-a guest volunteer shift in another station with an SUV rollover!
-IV Drug Users teach me how to start IVs!
-Stabbed in the neck! Nervous paramedics! Maddog gets a blister!
-Another rotation in the ED, Maddog Tries to be an IV Jedi!
-Maddog's bedside manner, "You Funny! Go ahead. You can stick me again!"
-75lb (32Kilo) mastiff vs. Maddog. Can you guess who lost?

Ok! let me know which one you want to hear the most. I'll write up the ones that get the most votes first.

Thanks for reading!

--maddog.

My Angel has saved me!

My new preceptor is a wonderful person. She's a runner. She is a bottomless font of compassion. She's sharp. She LOVES working in EMS. She's a goofball.

Clearly, it's a match made in heaven.

I shall call her Angel. I'm sure that's what many of her patients think of her. She calls them all "sweetie," even the junkies.

We run an auto accident. Driver of car A is hit by a taxi that runs a red light. Driver A is pissed because she's been a bus driver for 14 years and has never had an accident on the job. She gets hit by a cab while driving her kids to school.

Low speed impact. All minor injuries.

At the emergency room Driver A glares at Taxi Driver while waiting for the solitary triage nurse to get around to them.

We're outta there!

Another car accident.

Only the passenger has complaints. We do a full spinal immobilization and transport. Nothing much worth mentioning here other than the fact that Angel applauds me for remembering to pad the voids of the backboard to make it more comfortable for our patient.

Wow! Compassion, skill and attention to detail! I'm home.

The next patient is "2 year old. Not breathing."

Shitohshitohshitohshitohshit.......

We arrive to find a little girl in the middle of the floor twitching rhythmically. Mom says she's got an implanted pacer/defribrillator. I see it under her skin. it's almost as big as she is.

I position the kid to open her airway and I see her stomach rising and falling in rhythm. I find a pulse. She's out like a light.

"You carry her. We're going." says Angel.

I scoop up the little girl and take her out to my ambulance.

"Hey, Little one! You there, Little One?" I say.

She seems to be rousing from all the activity. In the ambulance we get her on the cot. I remember from the pediatric seminar I attended (the morning after drinking beer and having dinner with the MacMedic), how to position a toddler to maintain the best airway. She's perfusing at 84% at first. A couple blankets under her shoulders elevate her body enough to allow her head to fall back and her airway to open.

One minute later, on 100% Oxygen, her hemoglobin saturation is up to 98%. Right!

I set up a 12 lead EKG on her. This requires me to place 10 electrodes on her body that I'm trained to do on an adult. Fortunately, the landmarks are the same and I find the 4th intracostal space (the space between the 4th and 5th rib) and the mid-clavicular line (the line straight down from the collar bone) with ease.

I crowd the big adult-style electrodes on her little body and press the button marked "12-lead". I get a readout (Sorry, I didn't get a copy) that tells me she's bradycardic (slow heart rate) with no abnormalities except a cardiac pacer spike (the electrical readout of her pacemaker shocking her heart) and a slight left sided hypertophy (the left side of her heart is a bit bigger than normal from working so hard). She's slow and low.

Meanwhile, Angel tries and fails twice to start an IV in the kid's fat little arms. We discuss an Intra-Osseous (that's where you jam a needle through the bone and into the marrow of the lower leg bone in order to administer fluids and medications) but we decide that our ETA of 3 minutes to the pediatric emergency room rules that out.

We can't get a decent blood pressure on her and I'm watching her oxygen saturation closely while trying to decide if I need to start bagging her (providing breathing assistance with a bag and a mask, effectively forcing more air inter her lungs when she inhales). Her activity level is increasing and she's becoming more responsive to pain and stimulus. These are good signs.

So far, we're thinking she's one of the rare kids with cardiac problems. I get three 12-lead EKG readings on her in sequence to give to the doctor when we arrive.

We arrive.

Into the ED. Nurses galore. Lots of consulting. Someone asks me to show them a pacer spike on an EKG readout. Eight people, one medic (Angel), one medic student (me), one nursing student and Mom are in this room.

Chaos.

Or is it?

3 minutes into it, the little girl cries.

"Moooommmmyyyyyyyy"

A collective sigh and everyone relaxes.

"Blood sugar?" asks the doc.

"Too low to read." says the nurse with the glucometer.

Blood Sugar? I look over at Angel.

An exasperated "Dammit!" is written all over her face.

We were so concerned with cardiac that we didn't test her sugar. Dammit!

The nurses couldn't start an IV (intra-venous, or needle-into-your-vein) line either. The doctor ordered an NG (naso-gastric, or a tube that goes into your nose and down to your stomach) tube and they filled her with glucose.

She came around beautifully.

I heard later that she went home the next day.

After the call, Angel was more concerned with figuring out how we could do that better next time than with justifying her actions. She is, truly, a Jedi. She believes in what she does so much that she can set down her pride and learn from her mistakes. I am humble in her presence.

All my worries about not learning or having a bad preceptor have vanished. Angel and I are of the same mind and she doesn't mind giving me the time to do the skills I need to learn.

My next shift with her is on Sunday night.

I can't wait!

More to come!
-an ED rotation with Icky bedsores and cool nurses!
-a guest volunteer shift in another station with an SUV rollover!

I've been sick. I haven't been dead.

--maddog.

10,000 hits

My blog achieved 10K hits today.

Happy birthday to me!

w00t!

I'm working on a rather long-ish post about my first run with my new preceptor ("Angel").

Stay tuned!!

--maddog

Birthday presents.

Today, I'm 34.

I've gotten 2 presents.

1. I've slept without nightmares, sweats and fevers for the first time in 2 1/2 weeks.

2. I succeeded in registering for the 2005 Marine Corps Marathon.

#1 means I feel awesome. #2 means I'll be running one of the most beautiful marathons in the world for the second time in my life.

Oh, yeah. I've gotten 3 presents.

It's 80 degrees Fahrenheit and sunny today.

I'm going running!

Once I'm done playing outside, I'll write up about some of the more interesting patients I've seen lately.

It's good to be alive.

--maddog

Sick....

This sickness has lasted for two weeks now.

Somehow, through it, I've done a rotation at the ED where I've seen a type 4 decubitous ulcer (that's a bedsore with bone showing through), moved my household goods into my home, took a midterm exam and assembled my new grill.

Bloodwork results come on Wednesday.

It's all been a haze.

The worst has been the fevers. I go to bed at night freezing cold and I wake up hours later, bathed in sweat with bizarre and nightmarish dreams.

Here's one:

My left hand grabs a magazine out of my belt as my right index finger releases the empty one from my rifle.

Hold it by the bottom. Feel the mark in the front. Jam it in. Slap the bolt release with the palm of my hand.

Sight in....

"Sproingggg!"

The M-16 makes a distinctive noise. My cheek is jammed against the stock, right over the long spring that returns the bolt to the forward position. Those on the other end of it hear the deep bark as I fire. All I hear is the spring transmitting through my cheekbone.

My right thumb switches my gun to semi-automatic. Three shots at a time.

Sight in...

BUh BUH Sproingggg!

Pick a new target....

Sight in....

BUh BUH Sproinggggg!

Next!

Sight in....

It goes on.

All of my thoughts are on my actions.

I sight in with my right eye. My left one is looking for more targets. My hands do their work. New magazine, Clear the jams. Reload. Change sights.

I focus on what to do on my end of the gun.

The nightmare is on the other end of it.

If I don't get better soon, I'm going to go crazy.

--maddog