Spring Break! (Yeah, right.)

Busy busy busy.
This is what I love about going to school or a really long training course. no time to be bored. Strangely, though, I still find time occasionally to be bored. Mainly because my study habits suck. I bought Ace Combat 5 for my PS2 a few weeks ago. You want to talk about wasting study time? That game is awesome, which also means it is a huge distraction.

Class is going good so far. I'm way behind in my clinical time though. The whole class is. So far I've done my time at the 911 Center, 2 ER rotations, and Part one of my mandatory rotation with our medical director. That was actually pretty cool. The Med. Dir. wants 2 rotations per student; one near the beginning of our clinical time, one at the end. Evaluation of our skills progression, they say. Anyway, the first thing I got to see when I got to the hosp. was the Doc setting some woman's elbow, whcih she had seriously dislocated while moving hay. That was pretty cool. Never seen a joint (or bone, for that matter) get set before.
After that, Doc and I were talking and I was asking questions and after a few minutes, he looked at his computer screen and said, "Go check out Mrs. So-and-so in Rm. 4, then come back and tell me what's wrong with her." So i did. I talked to the lady and her daughter for a while, got the HPI (history of present illness), PMH (past medical history), etc. I went back to the doc and told him she had A-Fib (atrial fibrillation. basically, the top part of your heart, the atrium, is quivering instead of rhythmically contracting.), I told him that i thought she had pneumonia, given her symptoms and lung sounds and all. He then said, "Alright, lets go find out." He hadn't even seen her yet. I was told before hand that that was his teaching style. It was pretty cool actually. I don't particularly like doing hospital time because usually you just follow the doc or a nurse around. Plus I just don't like hospitals.
Anyway, He agreed about my pneumonia diagnosis, which was cool.

After a while, he sent me in to another pt. This one had SOB (shortness of breath), also stomach pain. The stomach pain was from the liver cancer she was just diagnosed with 2 days earlier. She also had some CHF going on. I felt bad for her. She was really nice and she knew her days were numbered... I told the Doc when i came back that she probably had some CHF, plus there is always the possibility of lung cancer. Cancer usually doesnt start in the liver, i've been told. Usually it metastasizes from the original cancer and then sets up shop in the liver. This lady said she had been coughing for several months and it hadn't been getting better, soooo...

I got to bring my medications knowledge into play, too. I was looking at the monitor (you know, the ones that are in the ER that show all the rhythms of the patients who are hooked up?) and I saw bradycardia, multiple A-Fibs, and a Rapid A-Fib, which was chugging along at about 154. I pointed it out to him, his eyebrows went up and he said, "Well, we can't very well let her keep that up for too long, can we? What are we gonna give her?"
She was too slow for Adenosine, which probably wouldn't have worked anyway, so I said "Cardizem." "Good choice!", he said, and wrote the order.

I then went to see a guy who had passed out earlier due to a Sinus Bradycardia in the mid-upper 30's. He had been given Atropine, which brought him up to low 40's. The guy was relatively asymptomatic, except for weakness and dizziness. His pressure was around 80/50 when we got him... I'm wondering why he wasn't on Dopamine. Maybe because he wasn't having any major symptoms? Still, he'd had Atropine and a couple fluid bolus' and still his pressure sucked. They did slowly start to get the pressure up, i think it was in the low 90's when I left. I did get to do an IV on him though! Hospital policy dictates the removal of field IV's and then reestablishing access in the hospital if the pt. is going to be admitted. Something about sterility and infection issues. Anyway, the nurse was going to have one of the nursing students (it's a teaching hospital/Level 2 trauma center) do the IV, but he disappeared, so they gave me the honors. The guy had good veins, which was nice. I told them (the pt and his wife) that I was a paramedic student and i asked if i could do the IV... the guy looked at me and said, "It ain't your first one, is it?" I laughed and said no, that i'd done one or two before, so he let me. Got it on the first try, too!

So that was the fun for that rotation.

I've done a couple of rotations at the ER we go to alot with QVA, and i've seen some pretty interesting stuff there, even though it's kind of slow. I've seen some nice stitch jobs. It's strange though. I can deal with all kinds of madness, mayhem, blood, guts, and gore in the field, but make me sit through someone getting stitches and I turn green. The girl came in with a nasty lac on her thigh... about 2" long, 1" wide, and 0,5-1" deep. They called me in to help when they were cleaning it and numbing it. She started crying when the doc started cleaning around and in the wound, then really started howling when the doc started numbing the site. I wouldn't have been too happy myself... Jab a needle 20 times into the middle of a lac like that will get anyone a little steamed. Anyway, she was only crying for a minute and then calmed right down as the pain went away. She then said, "Mom, you can let go of my arm now." Mom was more freaked than her daughter, i think, because when she let go, you could see the red mark and indentation from how hard she was squeezing.

So anyway, we don't have class again til May 8th. I'm gonna use some of that time to get some rotations out of the way. I'm gonna do respiratory time tomorrow afternoon. I'm gonna try to get Resp. and ICU out of the way this week if i can.

Last week sucked. It was spring break from school, so I had the week off... buuuuuttt, i had to take the 30 hour bus driver safety course all week. And what a week it was. Not a cloud in the sky all week, mid 60's to mid 70's, and there I was, sitting through this class at BOCES. It was, most of the time, an interesting class, but i would soooooo rather have been fishing.

Today and tonite should be fun. My F.D. Installation Banquet is tonite. I am soooo behaving this year. last year was fugly. I almost got myself in trouble last year. Anyway, I'm moving up in the world... As of tonite, I'll be 3rd Lieutenant/Medical Officer. I was 4th Lt. but we had a shuffle this year so everyone moved up a spot.
Our Car 3 turned down his chiefs spot this year, he wants to go back to yellow hat. So one of the LTs (the one who works nights and is usually around during the day) got promoted to Car 3. One of our captains had to leave the Dept. to to an insurance issue... He hurt his back (for the 82nd time) and had to have major surgery and he got the surgery paid for and got a settlement, then the insurance said, "You're too much of a liability now. Goodbye." So he's joining a neighboring FD now, from what I heard. They aren't filling his Captain's position, so we're down to one captain (who also happens to be the county fire coordinator). They move all the LT's up a spot and The Chief's daughter is getting my old spot as 4th LT. i'm happy for her. she's calmed down alot since last year. She and I both went to the same college in the same fire protection program, had alot of the same classes, etc. She know's her stuff, i'll definatly say that. This is not a case of "My daughter is gonna be a LT this year because I said so." My dept. is good about staying away from brown nosing your way into a position. If you get an officer's spot, you earned it.

Anyway, the banquet is tonite. After the official stuff is over, i'm either gonna hang out there for a while or go to a bar for a bit with the friend I'm taking to the banquet. Then I'm gonna split around 11 and head back north of here for a concert/friend's birthday. It should be a fun night. I don't have a DD though, so I won't be drinking much, if anything.

Well, I gotta get running. Gotta go get some car parts and stuff.

ramblings?

Ok, i don't even know what to write about, i'm just in the mood to write i guess...
so maybe we'll start out with some jokes...
Warning, some of these jokes are gonna be pretty cheesy.


What did the farmer say when he lost his tractor?

Where's my tractor?

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What did the fish say when it swam into a wall?

Dam.

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What's the difference between unlawful and illegal?

Unlawful is against the law and illegal is a sick bird.

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Why did the chicken cross the road?

To prove to the possum that it could be done.

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Johnny's elementary school class starts the school year with a show and tell day.
The teacher told everyone to bring in something significant from their summer break and talk about it.
Sally brings in a seashell and talks about her vacation to the ocean.
Ronnie brings in a giant pinecone and talks about his big camping trip in the mountains.
When it's Johnny's turn, he walks to the blackboard, picks up a piece of chalk, draws a small dot on the board, and walks back to his seat.
The teacher sits there for a minute staring at the dot, trying to figure out what it could mean.
She knows she needs to be careful asking Johnny questions, because he can be pretty crude at times. Finally, she gives in and asks, "Johnny, what's that supposed to be???"
Johnny replied, "It's a period!" His teacher asked, "What's so significant about a period?"
Johnny replies, "Hell if I know! My sister said she missed one, Mom fainted, Dad had a heart attack, and the guy next door shot himself!"

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Random thought now.

I saw something disturbingly hilarious tuesday... driving through farm country on our way to go fishing, we (My sister, my brother and his gf, a guy from paramedic class, and myself) saw a cow mounting another cow. No big deal, we thought as we saw it from a distance... Until we got closer and realized that cow number one had mounted cow number two "Backwards" and was humping its head... strange.

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OK, one last joke and i'm gonna call this a night.


Steve was going to be getting married, so a week or so before the wedding, his 3 best friends, Joe, Al, and Dave were sitting around talking about the wedding night pranks over a few beers.

Joe, a carpenter, said "I'm going to saw through the slats in their box spring, so that when they start going at it, their bed will break!"

Al, an electrician, said "I'm gonna wire up the springs in their mattress. When that bed starts moving, the springs will all contact and give them a nice little jolt."

Dave, a doctor, just smirked and said "I'm not telling you guys what I'm doing, but trust me; they will never forget it."

The wedding comes and goes and 3 weeks later, the friends all get letters in the mail. The letter reads:

"To my friends.
I want to thank you for your support and all, but there are a few things that I need to address.

To whomever sawed the slats in our box spring: It was funny, although was mildly inconvenient.

To whomever wired the springs in our mattress: We definately caught a few chuckles from the jolt...

But I SWEAR I am gonna kill the son of a bitch who put the Lidocaine in the KY Jelly!!!"


:-D Goodnight everybody!

Goodbye Cardiology!

FINALLY!
It's freakin OVER. No more cardiology. We had our Module yesterday. It was a pain in the ass. There were some seriously BS questions on that exam. But I just keep telling myself that I passed. I'm done, I could have gotten a better score, but i'm content with what I got. Now I can sit back and take a few deep breaths. Next up is Endocrinology and Neurology. I can't see them being much worse than cardiology. Are they? We'll see, I suppose.
Wow. Anyway... I'm so relieved cardiology is over. Having that exam hanging over my head for the last few weeks has sucked. This next week is gonna be nice and relaxed. I'm going fishing today and tomorrow if all goes well. It's supposed to be in the mid to upper 60s today and tomorrow, so it sounds like good trout weather. I might see if one or 2 of the guys from class want to go fishing as well. A few of us were gonna go yesterday, but we didnt get out of the exam until late. I think i started the test at 1230 or so and i didnt get done until 1545 or so. It might have been even later than that.... It sucked. It REALLY sucked.
Anyway. Did i mention that my cardiology exam SUCKED???
Ok, enough. It's over. move on. sheesh.

So yes, fishing. I want to try this river up in North Nowhere that looks very attractive. I think I shall brave the horrifying back roads (dirt bike mogul course is more appropriate) and go try my hand with the fish in North Nowhere. That is if I do not have to go on duty. Mom is feeling sick this morning, so I may end up going on with my sister BLS. We'll see.

So i'm still looking for work... I like driving bus, but the hours are way too sporadic. If it wasn't for the class I have to attend next week, I would be so pissed. I didnt work yesterday, I'm not working today, and the next time I definately work is Thursday afternoon. Thank God next week is the bus class i have to take, so i'll be getting paid 35-40 hours for that.
I really have to go job hunting. I need a steady job so that I can budget myself.

Oh yeah. I'm on the quitting smoking kick again. Sort of. I went out saturday night and met up with a friend I haven't seen in a while. We had an absolute blast. Had a few at his place then went up to my house (He was driving because he was not drinking), grabbed a few things, went up to the bar for a bit. Just as we were about to leave, a sheriff went whippin by so we pulled back in... we were gonna go to the bar up the road because they had a big concert going on, but apparently the sheriffs knew that too because they were everywhere.
Plus my friend has a big, bright red, pimped out dodge truck, so he didn't want to tempt fate, even sober. We wound up heading back for his place, rocking out to Metallica. Ain't My Bitch is a really good song when you're drunk and pumped up. lol So is Turn The Page... and one or 2 others. Anyway, we just wound up hanging around and catching up and all that good stuff.
Wow, i got a little off track from the smoking thing, didn't I?
Anyway, I smoked way too much that night. I have a tendency to do that when I'm drinking. I woke up the morning with wooden lungs. And the sinus infection that had been nagging me for a few days kicked into high gear. Yeah. It's been a pleasant 2 days so far. lol
The way I felt sunday had me in nooooo mood to be smoking. I wanted to, but i knew how i'd feel if i did. I wound up buying a bunch of those Creamsaver candies and I've been living off of them since sunday afternoon. Not very good for my teeth, but I guess my lungs are a little more important. :-P Anyway, yesterday went good as well for the most part. I didn't smoke until I was doing the cardiology module and one of my friends/classmates who smokes showed up. I wound up bumming a few off of him. But I haven't had a cigarette since then, which was about 1530, 1545 yesterday. Small time period, I know, but it is a start.

So what's new with everyone in blogland? I haven't done anything on here in a while now because i've been so busy with class and everything... I should have some time to breath now. At least for a day or 2.

Velcro Jumpsuits, Ball Gags, and other random thoughts.

I'm guessing maybe the title of this raised a few eyebrows? Maybe, maybe not. This post will most likely be quite random. My brain feels like a beehive in fight mode right now... 2 million things buzzing around, stumbling over each other, frenzied, confused, aggravated, frustrated, etc.

As for the velcro jumpsuits and ball gags, I think those items should be standard issue to any kid who rides a school bus. Tell em when they get on: "You can ride as you are right now, but if you get out of hand you're getting stuck to the seat and getting silenced." I covered the same route for several days last week. These kids were pretty cool, but they got way outta hand friday afternoon. Especially the elementary kids. The High school/middle school kids were pretty well behaved, but after the elementary run friday, I swear I just about had to clean footprints off of the ceiling of the bus. The whole week was kind of crazy in the kid department on all the runs I was on. The whole week was crazy, period.

I started my ride time last friday. I rode from 0800 to 2130 and I caught one call, an MVC rollover at 1915ish that wound up being a sign-off. It got me out of Phase One anyway...

Sunday, I went and started my ER time. The day started out pretty slow, then a few walk-in's started coming in. One lady came in and was a perfect example of why you should listen to your doctor when he gives you instructions for medication.
She was on Digoxin and her doc told her no stimulants at all. So what does she do? She starts her Sunday morning with 2 cups of coffee and some chocolate chip cookies. Reeealllly smuckin fart.
She was pretty sick. I was later told that she was admitted and put on Dig. withdrawl protocol or somethin like that... We had a few other run-of-the-mill pts come in, several frequent fliers... I got to watch one guy with bad kidney stones get 50 mg of Demerol with 30mg of Toradol. yeah. sleep tight, sunshine. I followed one of the nurses in when he went to check on the guy and he was out cold. The nurse walked up to try to wake him up to check on him and the guy snapped "awake". He was in a royal med funk. You could see how thick the haze was as he was lookin around with that "WTF is going on and where am I" glazed over look.

Then we were sitting there being bored when a guy walks up and asks us to help his wife. He tells us that she cut her finger off. We asked how and he rolled his eyes and said "She was picking her nose and I punched her in the mouth". We laughed and went over to check her out. It turns out that she had started to fall, reached for a solid object to catch her balance with, and just happened to grab a heavy steel door, which just happened to be open, which just happened to slam shut and lop off about 1/4" of the tip of her left middle finger.
The doc asked if they recovered the fingertip and the husband says "Yup, got it and brought it with us". I'm thinking maybe they have it in the car still, but the husband reaches into his back pocket and pulls out a ziplock bag with her finger in it! I found that kind of amusing. The doc was able to stitch it back on and everything.

There were 2 docs on that day. The one who did the stitching was the one I wanted to work with, because he's a real cool guy, a great doc, used to be the Medical Director for the region, etc.
He didn't really seem in a big teaching mood. I asked him some questions and he answered them and everything, but he wouldn't voluntarily explain stuff, so i just followed him and watched for a while. When the second doc came in at 1100, he got himself settled in, asked me who I was and what I was doing, and once I told him I was a paramedic student he told me to stick with him. He went into deep detail on everything. He was asking me questions about patients we saw, quizzing me on stuff, explaining stuff in great detail... It was great. He seemed genuinely interested in helping me out with stuff. When we had our lunch he was asking me all sorts of questions about class, my plans after class, my background, etc.

I got to try for one IV, which I missed. The lady had crap for veins. The nurse wound up having to use a 22 ga. to get the IV, so I didn't feel so bad about not getting the stick with a 20 ga.

Then of course my white cloud status struck again. 2 hours after I left, a 37 year old came in with chest pains and wound up coding in the ER. Go figure. It was a save, too.

After I left the ER, I went to visit a friend. We went out to dinner at Applebee's. It was a pretty good time. We just hung out, talkin and stuff... I was soooo tired. I only slept like 3 hours saturday night/sunday morning then I had to be at the ER at 7. After sitting around all day at the ER I was drained. Anyway, we had just about finished eating when I heard clapping coming from the kitchen area. My first thought was "Somebody must have a birthday today". Followed by "Hey wait a minute, my birthday's tuesday... Nah, must be someone else." Then I saw the entourage of employees coming out of the kitchen toward our table. I was like "Oh hell no." Then they started to gather around our table and I said "You have GOT to be kidding me." I'm not big on the whole restaurant birthday recognition thing, so I sat there beet red with my head in my hands for half of the song. I think I stayed beet red for about 10 minutes. The song was pretty funny, I got a chuckle out of it. I think my friend thought i was pissed because of my reaction. I assured her that I wasn't pissed and I said thanks. I was in a weird mood that night on top of being exhausted anyway, so I'm not surprised that I might have come off as a bit irritated.

Then on tuesday, I had a bus route that came equipped with a Monitor, Aide, whatever you want to call them. Halfway through the elementary route she said "Hey, isn't your birthday today?" I said yes. No use denying it, it was on the transportation bulletin... So as we pulled in to the elementary school to drop the kids off, the bus monitor said "Ok kids!" and 60-something elementary kids sang happy birthday. That wasn't as bad as the restaurant. I guess you could say it was kind of cute. Most of the kids I drive for like me. I've been on at least 3 bus routes where the kids have asked me if I could be their permanent driver. I tell them that i'm just a sub and their regular driver will be back and then the kids tell me I should take the route, make the regular driver switch routes, get them fired, make them quit or retire, etc. I keep telling them that it doesnt work like that and they get all disappointed. A very common complaint that I hear from the kids is that their regular driver is mean, screams at them all the time, etc. I've seen a few of the drivers in action and it seems like they think they're driving a prison bus. "Get in, sit down, shut up, and don't move" is the mentality that alot of the drivers have. I guess i'm still young enough that I remember what it's like to be a kid. Sit down, shut up, and don't move are not words commonly found in kids vocabularies. I do try to maintain relative order while I'm driving, but the way I look at it, driving safely is more important than babysitting. Friday afternoon, the kids were running up and down the aisles, jumping around like rubber balls, and generally going bananas. It got to the point where I quit trying to tell them to calm down and stay in their seats because I was losing my voice trying to make myself heard over them.

The other thing they like is the radio. Alot of the drivers will put the radio on country and leave it there. Now, I like country, but i understand how you can only take so much of it. Usually when I get in the bus, especially in the afternoon, I'll turn on one of the rock stations. Alot of the kids like rap/hip-hop and similar noise. I'll occasionally put that on for them, but that usually requires me to be in a good mood. even then, as soon as the bus is empty I turn on the country. Country is the antidote for that rap crap. So on a rap day, i'll be listening to alot of country for a while after work.

Just as an insert, i've cooled off quite a bit. My little brother and I were just chillin for a while and talkin and stuff, plus i put a whuppin on the punching bag he's got out in his lounge (for lack of a better word), so i feel alot better. I've got the skinned knuckles to prove it. :-P

Anyway. I did more ride time earlier. I'm riding at 2 ambulances. My preceptor works for 3 area ambulances and I can ride at 2 of them with him. One ambulance is based in a village and covers an area that's a mix of village and boondocks (the one I rode at last week) then the one I rode at earlier today (Saturday, actually) is based in a small city and they cover a huge area with a little bit of everything.

We had some good calls. The first one we had came in as "unresponsive, pt is breathing". We got there and city rescue told us that the guy was bradycardic, but awake. We got him on the monitor and at first glance it looked like he was in 3rd degree AV block. Once we looked at it though, it was more like an irregular sinus brady. His rate was in the mid 30's to mid 40's, he was weak, somewhat diaphoretic, and that was all he was complaining of. 0.5 mg of Atropine didn't do anything, so we got him loaded and headed for the hospital. We found out later that his Potassium level was 7.9. Normal is like 5.5 or something like that. The nurse told us later that she was shocked that he didn't code on us because 5.8 is usually the pucker factor threshhold.

Then we brought in an elderly woman with a nasty case of cellulitis on her lower leg.

After that we got called for a possible cardiac. It was most likely anxiety related. His rythm looked clean, he had been experiencing burning and pressure in his chest earlier in the day and had told us that he's gone in for it before and they just tell him it's stress. So most likely it was a repeat. As my preceptor said; "If you hear hoofbeats, assume it's a horse, not a zebra."That goes alone the same lines of; "If it looks like a duck, flies like a duck, and sound like a duck, it's probably a duck."

Our last call of the day came in as injuries from a fall. Elderly woman fell outside and sat ther for about 2 hours because she couldn't get up and none of her neighbors heard her calling for help. I think she had some alzheimers or something going on, because she wasnt quite with it, but it didn't seem like an abnormal "not with it." She was a simple ALS because for one, she was outside in mid 50's temps for 2 hours with a stiff breeze, plus she thinks she might have passed out, but wasn't sure.
My preceptor started the IV and stuff on the last lady and then just plopped himself in the captains chair at the front of the box and started writing. He hadn't really asked her any questions, so it was obvious to me that he was handing the reins over to me, at least for the interviewing side of things. I'd already done the assessment on scene, so I guess he just decided to see how I could do for the rest of the call.

By the end of the day, he decided that I was ready for phase 3. The only problem is
that I can't start phase 3 until I successfully test out of cardiology on the 12th of this month.
On the evaluation form for the call, he wrote "Adam is ready for phase III". That's all he wrote on it. Good enough for me. Hopefully I can keep up the pace when we get into phase 3 and 4.
I'm loving this so far. I just have to be cautious because it's easy to get confident in yourself on cake calls. Throw me in charge of a call that is circling the drain and it could be a different story. We'll see. I will do my best, whatever the situation. I'll probably do another shift or 2 in phase 2 just to make sure i'm brushed up and everything.

Things got kind of weird during the last hour or 2 of my shift there. I got this really bad feelling. I mean REALLY bad. Bad like I was kind of concerned about the drive home, bad. It was just this knot in my stomach that said "something REAAALLLLLLY bad is gonna happen." I was seriously worried about the ride home. I called home before I left and made sure everything was ok there. I get feelings like that from time to time. Sometimes I find there is a reason, most of the time I don't. But I have learned to listen to those feelings. Those feelings have saved our (my family's) butts in the past. And mine individually, as well. I started for home and the farther away from there I got, the better I felt. I didn't feel totally better, but it eased up a bit. That feeling threw my whole evening into a funk though. Alot of other stuff that has been bothering me kicked into overdrive and I was in a really dark mood for a while. Then I started talking with Matt (my oldest little brother) and the darkness started to lift. Then I started using his punching bag while we talked and that helped relieve the stress even more. So now I am in a good mood with skinned knuckles on my right hand and and mild headache from laughing so hard during the conversation Matt and I had.

I'm going fishing this afternoon (sunday). It should be interesting. My friend called the other day and said he has a new spot, some place that i've never seen before. "The only thing is," he told me, "that we have to watch out for the bears." "Excuse me, did you say bears?" "yup, bears." "Ok, i'll make sure I wear my bells." Sheesh. I don't think it is a coincidence that the opening day of Trout season and April Fools Day just happen to both fall on April 1st every year.

It's 0130 now. I'm gonna head to bed because I have to get up at 8. I've gotta get some sleep so I can outrun the bears while trying to catch fish.