I was doing good, I was working on studying, I was almost on top of things.
And now I a, overwhelmed. I still have secondaries. I have cardiopulmonary lectures that need studying piling up left and right. I got sleep but it feels like it wasn't enough.
I had a busy night on the ambulance. It was good, I got to see things that I had not seen yet and learned a lot. But then something as simple as ice now has me feeling guilty that I couldn't have done more. I feel like a should have warned someone, even if it was 4 in the morning.
I want time to pause. I want break to be here. I just want to make it through this holiday season and not break down.
Time. I just need some time.
Thursday, December 9, 2010
Wednesday, November 17, 2010
A Brief Moment of Venting
I am my own worst enemy. I know exactly what I have to do to get where I want to be in life. EXACTLY. And yet, I procrastinate. I still haven't finished several secondaries that I REALLY need to do. I have a lab notebook still because I told myself, 'Oh, I can get this done in between classes'. HA! Right. Have I touched it? No. So now I feel horrible that I am months later giving it back to my lab and needing to ask for recommendations at the same time. And I know I have done it all to myself. Why? Why on earth can I not get my act together? I am loving being in class but if I can't get myself together to study and you know, do well on the tests, what was the point of going to class? ARG!!!!
Friday, September 24, 2010
Heart and Head Problems
This post needs a little bit of background that I would normally not give. While I work in a more urban setting now, this took place when I was working in a much more rural area. Its also mid morning.
Dispatch says we are going to the local doctors office. Not the first time I had been there so I knew they meant the building in the center of town, not the hospital on the edge of town with a few doctors offices. Dispatch also says its cardiac related. Could this mean I actually get a code?
Now one thing I still do not understand about this building is that despite the fact that it has doctors offices on the second floor, the elevators will not fit our cot without it having the head raised and the frame dropped at the top end. We wheel into the doctors waiting room and are quickly directed to an exam room with out AED and gear.
I see an older lady in her seventies with a beautiful LifePack12 from the doctors office nearby. But she herself seems to be in only mild distress, not sweating, normal breathing, no visible pain on her face.
Well, guess this means no code, but maybe I can give nitro?
EMT GFP: "So what is going on today?"
Lady: "I came in for my appointment."
Doctor: "She was complaining of chest pain and has a history of heart problems, so we gave her three nitro. She is still in pain so we called 911."
Darn! No nitro today, but the doctors seemed decidedly worried so we got a quick set of vitals and got back into the ambulance as I started asking questions.
EMT GFP: "Have you had a heart attack before?"
Lady: "Yes, last year."
EMT GFP: "Does this feel like the last time you had a heart attack?"
Lady: "Yes."
EMT GFP: "When did the chest pain start?"
Lady: "Last night around 2 AM."
Blink. Blink. You are having chest pain that is identical to your last heart attack and you are just NOW getting to the hospital? Its nearly 10 AM?! Mind you, I did my best not to show my utter confusion and astonishment.
EMT GFP: "So why didn't you call 911 when your chest pain started?"
Lady: "I knew I had a doctors appointment so I just waited for that since I don't live close."
She didn't code on the way to the hospital and I am pretty sure she did not die that day, though I am not sure about her long term outcome. I am still amazed at the denial of her situation or her lack of education on heart attacks. Sure, for you 20-30 minutes might be a "long distance" but in an ambulance that is not far at all when going lights and sirens and we really don't mind being woken up at all hours to help you out. We will take a hit on our sleep if it means you will live to see another day. I hope that maybe this time she well get the education/wake up call that she need to understand 911 is there to help her!
So please people, if you are having cardiac chest pain, whether you have had it before or not, please call 911!
Dispatch says we are going to the local doctors office. Not the first time I had been there so I knew they meant the building in the center of town, not the hospital on the edge of town with a few doctors offices. Dispatch also says its cardiac related. Could this mean I actually get a code?
Now one thing I still do not understand about this building is that despite the fact that it has doctors offices on the second floor, the elevators will not fit our cot without it having the head raised and the frame dropped at the top end. We wheel into the doctors waiting room and are quickly directed to an exam room with out AED and gear.
I see an older lady in her seventies with a beautiful LifePack12 from the doctors office nearby. But she herself seems to be in only mild distress, not sweating, normal breathing, no visible pain on her face.
Well, guess this means no code, but maybe I can give nitro?
EMT GFP: "So what is going on today?"
Lady: "I came in for my appointment."
Doctor: "She was complaining of chest pain and has a history of heart problems, so we gave her three nitro. She is still in pain so we called 911."
Darn! No nitro today, but the doctors seemed decidedly worried so we got a quick set of vitals and got back into the ambulance as I started asking questions.
EMT GFP: "Have you had a heart attack before?"
Lady: "Yes, last year."
EMT GFP: "Does this feel like the last time you had a heart attack?"
Lady: "Yes."
EMT GFP: "When did the chest pain start?"
Lady: "Last night around 2 AM."
Blink. Blink. You are having chest pain that is identical to your last heart attack and you are just NOW getting to the hospital? Its nearly 10 AM?! Mind you, I did my best not to show my utter confusion and astonishment.
EMT GFP: "So why didn't you call 911 when your chest pain started?"
Lady: "I knew I had a doctors appointment so I just waited for that since I don't live close."
She didn't code on the way to the hospital and I am pretty sure she did not die that day, though I am not sure about her long term outcome. I am still amazed at the denial of her situation or her lack of education on heart attacks. Sure, for you 20-30 minutes might be a "long distance" but in an ambulance that is not far at all when going lights and sirens and we really don't mind being woken up at all hours to help you out. We will take a hit on our sleep if it means you will live to see another day. I hope that maybe this time she well get the education/wake up call that she need to understand 911 is there to help her!
So please people, if you are having cardiac chest pain, whether you have had it before or not, please call 911!
Monday, September 20, 2010
And Fructose 6 Phosphate is converted by PFK 1 to...
I love science, don't get me wrong, but there is something about having to memorize metabolic pathways that I just haven't mastered yet. Ugh. That was a brutal exam. And its sad that I am excited to get back to endocrinology (because endo really doesn't excite me all that much other than I know it fairly well being the ooooh, fourth time I will be doing it now).
However, it has made me realize (yet again) I have some serious study habit issue I need to resolve. This is my last chance into medical school, I had better not waste it. I may be pretty absent for a bit till I get this studying thing down, but I promise the next post will be an EMS one!
However, it has made me realize (yet again) I have some serious study habit issue I need to resolve. This is my last chance into medical school, I had better not waste it. I may be pretty absent for a bit till I get this studying thing down, but I promise the next post will be an EMS one!
Sunday, September 19, 2010
The Masses
I started at this school during the summer in hopes I would get into the program that I am in now. The library was quiet, the campus was fairly depopulated and I only had to worry about lunch when there were camps going.
The classes started.
All the med students came back. I was there taking classes with them. And the library was packed. I thought that many people in one place was nuts.
Then the rest of the campus started classes.
Undergrads started/came back. Grad students appeared. The library became packed (though still the best library ever because it lets you take in food and drink).
I miss the summer not because of summer, but because it was quiet on campus!
The classes started.
All the med students came back. I was there taking classes with them. And the library was packed. I thought that many people in one place was nuts.
Then the rest of the campus started classes.
Undergrads started/came back. Grad students appeared. The library became packed (though still the best library ever because it lets you take in food and drink).
I miss the summer not because of summer, but because it was quiet on campus!
Monday, August 9, 2010
Seizures: Part One
As all good calls are, it was some hour just after we had all gone to bed. We had three on the ambulance and we knew the engine from a near by station with a medic was headed out to the call too.
Dispatch was for Status Seizures.
I was still not a crew chief at this point in time but I was almost there so I was trying to be more aware of myself and what I would if I was in charge, even if I wasn’t.
We get to the apartment complex and manage to squeeze everything inside the elevator before heading up to the room. Not seeing the engine out front, we were assuming we were first on scene. Large red fire engines are kind of heard to miss.
We get to the apartment to find the engine crew half in, half out of the door, our patient on the floor still actively seizing with the medics trying to get a line. He was elderly, mid-eighties, and somehow still moving air despite the face that there was no sign of these seizures stopping any time soon. The engine had parked at the other apartment entrance and in rare occurrence in my area, had two medics on it.
I promptly get to pin the arm down so my medic can go for the IV stick, as does one of my fellow crew members for his medic. My medic misses. His get the IV. My medic goes for a blood pressure. His medic goes to mix up drugs as my fellow arm holding crew member is making sure the IV stays in place. Our third is setting up O2 for the NRB that he fished out.
Pressure is decent all thinks considered and there is a prompt debate over the proper mixing and dosing of medications (it is after midnight and everyone wanted to get this right). That was about when I realized that the arm I was holding was bleeding. And not just a trickle, really bleeding from where the medic had gone for a stick. Hand is promptly slapped over that as I pin the arm down. Someone passes me a 4 by 4 to help with the holding of pressure.
The meds are pushed and in what I can only describe as a "better living through chemistry" moment, he actually stops seizing. We all breath a small collective sigh of relief before quickly getting him into the cot. Downstairs we go in two elevators and hop in the back of our ambulance.
I help with a EKG (simple four lead, Smoke over Fire, Sky over Grass), other arm holder is driving as fast as safely possible and our third is working the O2 when our patient stops breathing. That leads to a whole new set of flurry, our third bagging, as we find an oral airway just as we pull up to the hospital, no time for an update.
In we go, nurses and doctors promptly taking over to keep this man out of cardiac arrest. I slowly back off, hoping that this man lives. We stopped his seizures, we made it to the hospital, we did what we were trained to do.
I never found out if he lived or died. Never found out if he seized and hit his head or seized because he fell and hit is head or if a third possibility was running around. I will probably never know but we did our best. And I learned blood pressure cuffs really do work well as tourniquets.
Dispatch was for Status Seizures.
I was still not a crew chief at this point in time but I was almost there so I was trying to be more aware of myself and what I would if I was in charge, even if I wasn’t.
We get to the apartment complex and manage to squeeze everything inside the elevator before heading up to the room. Not seeing the engine out front, we were assuming we were first on scene. Large red fire engines are kind of heard to miss.
We get to the apartment to find the engine crew half in, half out of the door, our patient on the floor still actively seizing with the medics trying to get a line. He was elderly, mid-eighties, and somehow still moving air despite the face that there was no sign of these seizures stopping any time soon. The engine had parked at the other apartment entrance and in rare occurrence in my area, had two medics on it.
I promptly get to pin the arm down so my medic can go for the IV stick, as does one of my fellow crew members for his medic. My medic misses. His get the IV. My medic goes for a blood pressure. His medic goes to mix up drugs as my fellow arm holding crew member is making sure the IV stays in place. Our third is setting up O2 for the NRB that he fished out.
Pressure is decent all thinks considered and there is a prompt debate over the proper mixing and dosing of medications (it is after midnight and everyone wanted to get this right). That was about when I realized that the arm I was holding was bleeding. And not just a trickle, really bleeding from where the medic had gone for a stick. Hand is promptly slapped over that as I pin the arm down. Someone passes me a 4 by 4 to help with the holding of pressure.
The meds are pushed and in what I can only describe as a "better living through chemistry" moment, he actually stops seizing. We all breath a small collective sigh of relief before quickly getting him into the cot. Downstairs we go in two elevators and hop in the back of our ambulance.
I help with a EKG (simple four lead, Smoke over Fire, Sky over Grass), other arm holder is driving as fast as safely possible and our third is working the O2 when our patient stops breathing. That leads to a whole new set of flurry, our third bagging, as we find an oral airway just as we pull up to the hospital, no time for an update.
In we go, nurses and doctors promptly taking over to keep this man out of cardiac arrest. I slowly back off, hoping that this man lives. We stopped his seizures, we made it to the hospital, we did what we were trained to do.
I never found out if he lived or died. Never found out if he seized and hit his head or seized because he fell and hit is head or if a third possibility was running around. I will probably never know but we did our best. And I learned blood pressure cuffs really do work well as tourniquets.
Sunday, July 25, 2010
Happy Day!
I got in! I got in! I got in! I got in!
No, not to medical school, unfortunately, but to a Master's program that is going to be my next step to medical school!
Haven't had time to post much due to a class I was taking (which, by the way, physiology rocks!) but I do plan to get back into the swing! And still find time to ride the ambulance. We have been having a really slow summer but it does allow us to train!
I got in!
No, not to medical school, unfortunately, but to a Master's program that is going to be my next step to medical school!
Haven't had time to post much due to a class I was taking (which, by the way, physiology rocks!) but I do plan to get back into the swing! And still find time to ride the ambulance. We have been having a really slow summer but it does allow us to train!
I got in!
Saturday, July 3, 2010
Perceptions
I hear car tires squealing, I flinch and wait for the sound of crushing metal.
I walk into elevators and immediately gauge whether or not I could fit a stretcher in it, with the most common answer being not.
I go past house were the front door is up three flight of steps, half a hill, and looks about as narrow as legally allowed and wonder how on earth would I get a patient down on a backboard, let a long a stretcher.
I glance at people and wonder what their underlying medical conditions are.
I look at buildings and wonder if everyone could get out fast enough in a fire.
I hear sirens and instead of wondering what they belong to, I try to tease out if its police, fire engine, ambulance, or squad and if its heading towards the highway or towards the hospital.
I no longer see the world simply as it is, I see it now as how I need to interact with it, read it and think 'what can I do in this situation?'
I walk into elevators and immediately gauge whether or not I could fit a stretcher in it, with the most common answer being not.
I go past house were the front door is up three flight of steps, half a hill, and looks about as narrow as legally allowed and wonder how on earth would I get a patient down on a backboard, let a long a stretcher.
I glance at people and wonder what their underlying medical conditions are.
I look at buildings and wonder if everyone could get out fast enough in a fire.
I hear sirens and instead of wondering what they belong to, I try to tease out if its police, fire engine, ambulance, or squad and if its heading towards the highway or towards the hospital.
I no longer see the world simply as it is, I see it now as how I need to interact with it, read it and think 'what can I do in this situation?'
Tuesday, June 29, 2010
Yes, I am geeking out over this...
I started taking classes recently at Local University which happens to have a medical school attached. And a hospital. So I am on my way to lunch, starving, and notice there is an ambulance just chilling on this little hill. Now, I know what this hill is and promptly rush to get the quickest food I can find and get back outside.
So I just missed the first one landing...
but much to my surprise, a second one landed!
Here they are together with the ambulance for the second one. This totally made my day.
So I just missed the first one landing...
but much to my surprise, a second one landed!
Here they are together with the ambulance for the second one. This totally made my day.
Monday, June 28, 2010
Sunday, June 27, 2010
Down Time
I am a volunteer EMT, giving me the reverse of many. To me, the ambulance is where I go when I need a break from lab and school. Running call is a nice practical break from all my theory. Seeing patients reminds me that not everyone will be as hard to deal with as a squirming mouse.
Yes that is right, a mouse.
I am a research scientist whose focus ranges from pediatric graft versus host disease to immunotherapy for solid tumors. Simplified, I work to cure cancer.
In fact, I have miracle mice.
I cured cancer.
A highly aggressive, clinically relevant, pediatric solid tumor.
Okay, it was only in mice, but it was with limited distress to the mice who had very large, typically incurable by chemo sized tumors. I swore this new drug wasn't going to work, swore that the tumors were too big, swore that I should just give the mice a break and sacrifice them before the experiment was up.
But science and mother nature (and my boss) proved me wrong. While I didn't cure all the mice, I made a very nice dent in what would have otherwise been a death sentence. Over half of my experimental group are alive and currently tumor free. No surgery. No chemo drugs. No hair loss. No damage to the immune system.
In fact, it was their own immune system, with a little help, that cured these mice. All I gave was a drug that makes the immune system a better immune system, breaking the tolerance that many tumors create in a host to protect themselves from the immune system. Breaking that tolerance is hard as the body doesn't like kill off 'self' cells. But it work and better yet, it may even be repeatable.
So yes, I am a science geek and love research almost as much as love my clinical interactions with patients on the unit. I believe that a strong foundation in science, in understand research as the basis for why medicine works and advances is key to being a good clinician. Sure, I am not research emergency medicine and maybe I won't always be research when I reach my goal, but I know that it will help me understand. And hey, in the mean time, I may have just put this drug in the 'to be developed for clinical trials' box. Who ever said research can't save lives :)
Yes that is right, a mouse.
I am a research scientist whose focus ranges from pediatric graft versus host disease to immunotherapy for solid tumors. Simplified, I work to cure cancer.
In fact, I have miracle mice.
I cured cancer.
A highly aggressive, clinically relevant, pediatric solid tumor.
Okay, it was only in mice, but it was with limited distress to the mice who had very large, typically incurable by chemo sized tumors. I swore this new drug wasn't going to work, swore that the tumors were too big, swore that I should just give the mice a break and sacrifice them before the experiment was up.
But science and mother nature (and my boss) proved me wrong. While I didn't cure all the mice, I made a very nice dent in what would have otherwise been a death sentence. Over half of my experimental group are alive and currently tumor free. No surgery. No chemo drugs. No hair loss. No damage to the immune system.
In fact, it was their own immune system, with a little help, that cured these mice. All I gave was a drug that makes the immune system a better immune system, breaking the tolerance that many tumors create in a host to protect themselves from the immune system. Breaking that tolerance is hard as the body doesn't like kill off 'self' cells. But it work and better yet, it may even be repeatable.
So yes, I am a science geek and love research almost as much as love my clinical interactions with patients on the unit. I believe that a strong foundation in science, in understand research as the basis for why medicine works and advances is key to being a good clinician. Sure, I am not research emergency medicine and maybe I won't always be research when I reach my goal, but I know that it will help me understand. And hey, in the mean time, I may have just put this drug in the 'to be developed for clinical trials' box. Who ever said research can't save lives :)
Thursday, June 24, 2010
Friday, June 4, 2010
Exhausted
Exhausted.
Three calls back to back. It’s only the start of our shift. And there was a pediatric patient. They always drain me emotionally, even if they are okay the entire time in my care.
Exhausted.
0500 cardiac arrest call. I end up bagging the patient till the medic unit arrives on scene. The sun rises as we leave the scene.
Exhausted.
Filling out application after application to master’s programs. I need to go back to school. I realize this. But I hate writing personal statements. And in some ways it is still admitting defeat and having to deal with realities of screwing up in college. At least I am waitlisted, at least there might be a sense of hope.
Exhausted.
There is an ever growing pile of laundry to do. Dirty to wash so I have pants. Clean to fold so I have somewhere to sleep. We are not even going to into how much I need to clean my desk off.
Exhausted.
Treating mice every single day with oral drugs. For two weeks straight. Three weeks straight. Four weeks straight. On weekends too. Measuring tumors. Trying to finish experiments up. Trying to get everything done and leaving every day thinking I should have done more.
Exhausted.
My brain just wants to shut off and zone out to a book or TV. The sofa is at least a horizontal surface. I wake at 0300, all the lights still on, still dressed in what I wore to work, and all I can do is turn off the lights before curling back up on the sofa and sleeping.
Exhausted.
Medical school applications need to be started. Again. Maybe I will have a glimmer of hope this year. Maybe I will finally at least get an interview.
Exhausted.
House fire. No one is hurt. We check vitals signs and make sure no one is over heating. And we pack hose. Lots of hose. Its actually rather fun. But I am also the smallest person on scene and am seriously lacking upper body strength. I’ll but sore but I will have had a good time.
Exhausted.
Four calls, two back to back and the rest close enough together that sleep is questionable. They are all good calls. They all teach me something. The medic that hops on twice teaches me too. But I have to go to work in the morning and the last call gets me back into the station just at shift change.
Exhausted.
Three calls back to back. It’s only the start of our shift. And there was a pediatric patient. They always drain me emotionally, even if they are okay the entire time in my care.
Exhausted.
0500 cardiac arrest call. I end up bagging the patient till the medic unit arrives on scene. The sun rises as we leave the scene.
Exhausted.
Filling out application after application to master’s programs. I need to go back to school. I realize this. But I hate writing personal statements. And in some ways it is still admitting defeat and having to deal with realities of screwing up in college. At least I am waitlisted, at least there might be a sense of hope.
Exhausted.
There is an ever growing pile of laundry to do. Dirty to wash so I have pants. Clean to fold so I have somewhere to sleep. We are not even going to into how much I need to clean my desk off.
Exhausted.
Treating mice every single day with oral drugs. For two weeks straight. Three weeks straight. Four weeks straight. On weekends too. Measuring tumors. Trying to finish experiments up. Trying to get everything done and leaving every day thinking I should have done more.
Exhausted.
My brain just wants to shut off and zone out to a book or TV. The sofa is at least a horizontal surface. I wake at 0300, all the lights still on, still dressed in what I wore to work, and all I can do is turn off the lights before curling back up on the sofa and sleeping.
Exhausted.
Medical school applications need to be started. Again. Maybe I will have a glimmer of hope this year. Maybe I will finally at least get an interview.
Exhausted.
House fire. No one is hurt. We check vitals signs and make sure no one is over heating. And we pack hose. Lots of hose. Its actually rather fun. But I am also the smallest person on scene and am seriously lacking upper body strength. I’ll but sore but I will have had a good time.
Exhausted.
Four calls, two back to back and the rest close enough together that sleep is questionable. They are all good calls. They all teach me something. The medic that hops on twice teaches me too. But I have to go to work in the morning and the last call gets me back into the station just at shift change.
Exhausted.
Monday, April 19, 2010
For the greater good
Now that I have had a thorough streak of EMS, a little lab divergence is needed, though apologies are needed for the general lack of posting. I am neck deep in work, applications, and the firehouse.
Disclaimer: If you do not want to hear about the nitty gritty of laboratory research with lab animals (aka mice) do not read any further. I have heard and understand both sides of the lab animal argument and this is not a post about that.
When I started my job, my project was heavily focused on bone marrow transplants and finding new pathways/potential treatment options for graft versus host disease, a possible side effect of a non-self bone marrow transplant (if you want to know more about these in general, leave a comment and I will write a post).
Now, my project is focused on non-standard chemotherapy drug screening for cancers. The theory behind it is awesome, as these drugs don’t destroy rapidly growing cells, but instead make the immune system better at fighting off cancer. Now I am talking about small amounts of cancer in the setting of someone who has had a tumor/cancer removed but may be a high risk for relapse. These drugs would help with the relapse (perhaps more, but that will be another post :) ).
In order to have the most clinically relevant results possible at this stage, we decided to give these drugs orally instead of injecting them, as most patients would take the final form of this in pill form, not necessarily an IV drip. So I inject my mice with tumor, wait a few days and then start treating them with my drugs to see if any will ultimately kill the cancer. Easy you think.
Think again.
Giving a mouse a specific amount of a drug orally is no easy task. It involves much dissolving, aliquoting, and mixing of said to start with. Then there is the actual problem of giving the mouse the drug, seeing as just having them drink the small volume will never fly in the scientific world. This leads to EMT GFP taking very small metal feeding needles (they are blunt tipped, not sharp at all) attached to a 1cc syringe and accurately dosing each and every mouse.
After scuffing the mouse so it will theoretically not move.
And navigating a mouse’s pharynx blind to avoid a trachea (hey! its the reverse of intubation! Well kind of) and not puncture the esophagus.
It stresses me out, because try as I might, there is always one mouse that manages to squirm and pull, causing me to tighten my grip and occasionally accidently start to strangle to mouse. The second I see this I always put the mouse down but it still stresses me out that I did it. I think the mice are cute and I don’t want to be hurting them. But they are the ones who are squirming, though I know telling them to hold still does absolutely no good.
And then they pee on me, which, while I am wearing gloves and a gown (and booties and a mask and a hair cover), I still dislike.
Or the ones that try to struggle and struggle despite my good grip on them and freak out like they can’t breath even though I know they have an airway (if you are squeaking, you have an airway).
And then each and every tumor has to be measured. At least twice a week. More when the tumors get big. Not as bad as giving them drugs, but tedious. Oh so tedious and not entertaining as the mice try to struggle. Again.
Bone marrow transplants are so much less stressful…
But, if I can get through these compounds, if I can surviving being a human high through put machine, I may find something that helps. I may find a new drug to fight cancer. And at the very least, I can cure mice of cancer. In the end, it will be worth it.
Disclaimer: If you do not want to hear about the nitty gritty of laboratory research with lab animals (aka mice) do not read any further. I have heard and understand both sides of the lab animal argument and this is not a post about that.
When I started my job, my project was heavily focused on bone marrow transplants and finding new pathways/potential treatment options for graft versus host disease, a possible side effect of a non-self bone marrow transplant (if you want to know more about these in general, leave a comment and I will write a post).
Now, my project is focused on non-standard chemotherapy drug screening for cancers. The theory behind it is awesome, as these drugs don’t destroy rapidly growing cells, but instead make the immune system better at fighting off cancer. Now I am talking about small amounts of cancer in the setting of someone who has had a tumor/cancer removed but may be a high risk for relapse. These drugs would help with the relapse (perhaps more, but that will be another post :) ).
In order to have the most clinically relevant results possible at this stage, we decided to give these drugs orally instead of injecting them, as most patients would take the final form of this in pill form, not necessarily an IV drip. So I inject my mice with tumor, wait a few days and then start treating them with my drugs to see if any will ultimately kill the cancer. Easy you think.
Think again.
Giving a mouse a specific amount of a drug orally is no easy task. It involves much dissolving, aliquoting, and mixing of said to start with. Then there is the actual problem of giving the mouse the drug, seeing as just having them drink the small volume will never fly in the scientific world. This leads to EMT GFP taking very small metal feeding needles (they are blunt tipped, not sharp at all) attached to a 1cc syringe and accurately dosing each and every mouse.
After scuffing the mouse so it will theoretically not move.
And navigating a mouse’s pharynx blind to avoid a trachea (hey! its the reverse of intubation! Well kind of) and not puncture the esophagus.
It stresses me out, because try as I might, there is always one mouse that manages to squirm and pull, causing me to tighten my grip and occasionally accidently start to strangle to mouse. The second I see this I always put the mouse down but it still stresses me out that I did it. I think the mice are cute and I don’t want to be hurting them. But they are the ones who are squirming, though I know telling them to hold still does absolutely no good.
And then they pee on me, which, while I am wearing gloves and a gown (and booties and a mask and a hair cover), I still dislike.
Or the ones that try to struggle and struggle despite my good grip on them and freak out like they can’t breath even though I know they have an airway (if you are squeaking, you have an airway).
And then each and every tumor has to be measured. At least twice a week. More when the tumors get big. Not as bad as giving them drugs, but tedious. Oh so tedious and not entertaining as the mice try to struggle. Again.
Bone marrow transplants are so much less stressful…
But, if I can get through these compounds, if I can surviving being a human high through put machine, I may find something that helps. I may find a new drug to fight cancer. And at the very least, I can cure mice of cancer. In the end, it will be worth it.
Tuesday, April 6, 2010
Lessons Learned and Thoughts Provoked
I was rather excited to discover that my area as a whole may have learned a few things after the Blizzard of 2009 for the Blizzard of 2010. For the large part, no one was out. This is in sharp contrast to the 2009 blizzard in which many people were out driving in cars that could not handle snow and on roads that really were not good for cars, ambulances too for that matter, period. Its was eerily quiet on the medical side of the fence where I was. Unfortunately, I know that our engine had to go out numerous times for downed lines and tree limbs despite the weather. Further, I know several other stations in the area around us were running numerous medical and engine calls in drifts of snow that were waist deep almost the whole blizzard.
Now, right at the beginning of the 2010 blizzard, my crew and I did get a call which made me think. It was after dark and the snow was just starting to really come down. There was maybe four inches of snow on the ground, enough for us to take twice as long getting to the house as it would have normally, even with chains on the tires.
When we get there, we find a patient and his wife in the bedroom. He hasn't been feeling well and was throwing up a bit earlier. His vital signs were stable and he had been able to keep some water down earlier. Now, I am no doctor but I was fairly confident that he was not about to code, have serious dehydration, or die on us in the next hour at the very least. In fact, he looked rather good for being sick, maybe a bit warm and a bit weak, but that is expected if someone if fighting off the flu, be it regular or stomach.
Now here comes the sticky part, when we look out the window, its snowing cats, dogs, mice, rabbits, and maybe a few horses thrown in for good measure, significantly heavier than when we had arrived at the house. Now, we had no qualms about transporting the patient to hospital, but we were worried about his ability to get back home after he was discharged. If this was the "nice" end of the storm, the middle was sure to be horrible (and it was, nearly white out conditions by morning. They actually stopped plowing a bit at one point) and driving was going to be nearly impossible.
After some conversation and discussion about what we could and could not do (sorry, we can't treat you, we really only can transport you as an Basic unit and even an ALS unit could not have done much more for you but have your tried calling your doctor or pharmacy?), the patient decided that it was probably best to wait out the night and see if he felt any better in the morning. He would call us if anything got worse, encouraged by us really to call if anything got worse, and call his doctor in the morning. I don't like refusals in general, as I feel that if someone called 911 there probably was a reason, but I did agree with this patient that perhaps the risk of leaving his house was greater than staying in with a currently non-life threatening illness.
This is where I do truly envy the system over in the UK where medics are able to contact other forms of medicine than just the ER to help their patients. As an EMT, I can only encourage people to contact their doctors, not call one for them. It would be great to have other options beyond transport or not transport, particularly when the call is not life threatening and the patient really wants someone to help him figure out what to do or just get a ride to the local ER. Particularly in the middle of snow storm!
Now, right at the beginning of the 2010 blizzard, my crew and I did get a call which made me think. It was after dark and the snow was just starting to really come down. There was maybe four inches of snow on the ground, enough for us to take twice as long getting to the house as it would have normally, even with chains on the tires.
When we get there, we find a patient and his wife in the bedroom. He hasn't been feeling well and was throwing up a bit earlier. His vital signs were stable and he had been able to keep some water down earlier. Now, I am no doctor but I was fairly confident that he was not about to code, have serious dehydration, or die on us in the next hour at the very least. In fact, he looked rather good for being sick, maybe a bit warm and a bit weak, but that is expected if someone if fighting off the flu, be it regular or stomach.
Now here comes the sticky part, when we look out the window, its snowing cats, dogs, mice, rabbits, and maybe a few horses thrown in for good measure, significantly heavier than when we had arrived at the house. Now, we had no qualms about transporting the patient to hospital, but we were worried about his ability to get back home after he was discharged. If this was the "nice" end of the storm, the middle was sure to be horrible (and it was, nearly white out conditions by morning. They actually stopped plowing a bit at one point) and driving was going to be nearly impossible.
After some conversation and discussion about what we could and could not do (sorry, we can't treat you, we really only can transport you as an Basic unit and even an ALS unit could not have done much more for you but have your tried calling your doctor or pharmacy?), the patient decided that it was probably best to wait out the night and see if he felt any better in the morning. He would call us if anything got worse, encouraged by us really to call if anything got worse, and call his doctor in the morning. I don't like refusals in general, as I feel that if someone called 911 there probably was a reason, but I did agree with this patient that perhaps the risk of leaving his house was greater than staying in with a currently non-life threatening illness.
This is where I do truly envy the system over in the UK where medics are able to contact other forms of medicine than just the ER to help their patients. As an EMT, I can only encourage people to contact their doctors, not call one for them. It would be great to have other options beyond transport or not transport, particularly when the call is not life threatening and the patient really wants someone to help him figure out what to do or just get a ride to the local ER. Particularly in the middle of snow storm!
Friday, April 2, 2010
In like a Lion, Out like a... Lion
Seeing as its just now April and the weather has decided to not be lambish, the past few weeks have been interesting. First, there is STILL snow on the ground where there had been large piles and shade, even after warm weather. I was so glad when it transitioned from the grey, cold, rather depressing beginning to March to at least sunlight. I function much better with sunlight. Don’t get me wrong, I love snow, but the weather had been getting to me after a massive snow storm in February and the grey weather to start March.
A few weekends ago when my friends had come in for a visit, the weather was absolutely wonderful, cloudless skies, sunny blazing down and 70 degrees! Of course, this also led to the downside of nearly sunburning myself (hazards of Irish ancestry, I don’t tan well at all, just burn), but it was totally worth it to be outside with friends.
And then last weekend it not only rains, but its cold! As in overnight lows near freezing! I can expect this from central NY, but not down here! Its not supposed to be so cold down here. Needless to say, I am ready for some nice, consistent, warm, spring-like weather. We finally are getting hints at the nice weather but I am holding out my hope till it stays this way for over two weeks before I get my hopes up. This EMT needs her sunlight and warmth! Plus, it means I can stop wearing two to three layers when I go on shift.
A few weekends ago when my friends had come in for a visit, the weather was absolutely wonderful, cloudless skies, sunny blazing down and 70 degrees! Of course, this also led to the downside of nearly sunburning myself (hazards of Irish ancestry, I don’t tan well at all, just burn), but it was totally worth it to be outside with friends.
And then last weekend it not only rains, but its cold! As in overnight lows near freezing! I can expect this from central NY, but not down here! Its not supposed to be so cold down here. Needless to say, I am ready for some nice, consistent, warm, spring-like weather. We finally are getting hints at the nice weather but I am holding out my hope till it stays this way for over two weeks before I get my hopes up. This EMT needs her sunlight and warmth! Plus, it means I can stop wearing two to three layers when I go on shift.
Wednesday, March 31, 2010
The Handover - "Respect" - March 2010 Edition
The Handover "Respect Edition" hosted over at Life Under the Lights
This may have been where I started reading EMS blogs and I love it when it comes out every month. Its a great snapshot of providers from across many a different EMS system.
Go! Read! Enjoy!
Snow Hills
I swear, this is the second to last Winter 09/10 post!
After most of the fire department had been trapped at a fire house for going on two days without relief, I decided to pull an extra shift to help out since I could still get from point A to point B unlike many people.
Just as I walk in from the bay, the tones go off. Well, that was lucky!
I dash out to the ambulance, catching the Captain and the officer I am replacing in the bay and doing a quick personnel transfer. The directions are easy and our driver seems to be doing well despite the poor plowing conditions.
We approach the location, a school, and are greeted by someone who is trying to wave us up a heavily snowed in driveway. No way the ambulance is getting up that. We stay on the street by move closer down to the entrance to the patient.
Its dusk as the friend leads us past the school to the back field and down a very steep hill. I am eternally grateful that instinct my told me to grab the Reeve’s stretcher when we found out this was outside. We start a quick assessment and discover that the man got his foot stuck under the inter-tube he was sliding down on, leaving him with significant pain in his ankle. I can’t see much since he has rain boots on, but its very painful to movement.
Our driver has to tell the surrounding sledder to NOT sled down by us, seeing as if one wears reflective clothing, one will have people draw to the reflective tape.
A quick transfer later, me, the driver, and my partner are trying to get this man up the sledding hill. The driver is a good sized fire fighter. My partner is barely larger than me and I am pretty small when it comes to hauling people up snow hills. Halfway up we finally get the attention of some bystanders who are willing to help, thus filling the handles from three people to six. Much better. The girlfriend is ahead carrying the tablet that is making an amazingly good flashlight.
Once in the ambulance, my partner gets vitals as I cut open the boot and socks to find his foot completely flopped over to the side and a grapefruit sized swelling an inch or two above the ankle joint. Yes, that would be broken. Feet simply do not flop to the side like that with the knee strait up and facing the ceiling.
I wished I had been able to give the man painkillers in the ambulance, but I am just a Basic. We did try to avoid as many bumps as humanly possible on the way to the hospital, but it was rather difficult with the poorly plowed roads.
Not the way one wants to end the day on a snow hill.
After most of the fire department had been trapped at a fire house for going on two days without relief, I decided to pull an extra shift to help out since I could still get from point A to point B unlike many people.
Just as I walk in from the bay, the tones go off. Well, that was lucky!
I dash out to the ambulance, catching the Captain and the officer I am replacing in the bay and doing a quick personnel transfer. The directions are easy and our driver seems to be doing well despite the poor plowing conditions.
We approach the location, a school, and are greeted by someone who is trying to wave us up a heavily snowed in driveway. No way the ambulance is getting up that. We stay on the street by move closer down to the entrance to the patient.
Its dusk as the friend leads us past the school to the back field and down a very steep hill. I am eternally grateful that instinct my told me to grab the Reeve’s stretcher when we found out this was outside. We start a quick assessment and discover that the man got his foot stuck under the inter-tube he was sliding down on, leaving him with significant pain in his ankle. I can’t see much since he has rain boots on, but its very painful to movement.
Our driver has to tell the surrounding sledder to NOT sled down by us, seeing as if one wears reflective clothing, one will have people draw to the reflective tape.
A quick transfer later, me, the driver, and my partner are trying to get this man up the sledding hill. The driver is a good sized fire fighter. My partner is barely larger than me and I am pretty small when it comes to hauling people up snow hills. Halfway up we finally get the attention of some bystanders who are willing to help, thus filling the handles from three people to six. Much better. The girlfriend is ahead carrying the tablet that is making an amazingly good flashlight.
Once in the ambulance, my partner gets vitals as I cut open the boot and socks to find his foot completely flopped over to the side and a grapefruit sized swelling an inch or two above the ankle joint. Yes, that would be broken. Feet simply do not flop to the side like that with the knee strait up and facing the ceiling.
I wished I had been able to give the man painkillers in the ambulance, but I am just a Basic. We did try to avoid as many bumps as humanly possible on the way to the hospital, but it was rather difficult with the poorly plowed roads.
Not the way one wants to end the day on a snow hill.
Sunday, March 28, 2010
Drunk or sick, do you really have to?
Case One:
Its late in the evening, even past midnight maybe, and my pager goes off. “Campus safety requesting EMS transport to the hospital from stair well in Any Dorm.” While this might be interesting, it probably means that I have again acquired a drunk. Its policy that if campus safety encounters a drunk student who vomits, its automatically an EMS transport so that the patient’s airway will be protected, even if it would be shorter to transport by campus safety.
After clambering to the top of the staircase, we find one very drunk kid, a distressed friend, a few campus safety officers, and a pool of vomit. I quickly start an assessment as I send a fellow crew member down for the stair chair. Looks like the guy nearly got to his room on the fourth floor before alcohol won, no trauma and he wasn’t passed out yet so I at least had an airway.
With a bit of struggling with the rather limp patient, we get him into the stair chair, where he promptly vomits again. Judging by the volume of vomit everywhere, that probably was the last of his stomach. We got lucky though, he missed the chair. Four flights later, we have him transferred to the stretcher and he begins to perk up just enough to half answer our questions and start swearing us out. All the short way to the hospital.
Case Two:
Evening again, (seeing the theme of night shifts yet?), and we get a call at the Local Apartment Complex for a sick person. Okay, cool, not unheard of in our district as we all hop in the ambulance. I read through the dispatch report. Patient age: 27. Oooookay, that one is a bit odd. Not in College Town anymore and my demographic is predominately much older.
We get to the apartment door, knock, and give the customary “Fire Department, did someone call 911?” to be greeted in under five seconds with the door opening, young man walking out and nearly sitting on the cot without us taking off the bag.
“S*** man! I’ve been throwing up and I need to go to the hospital NOW!”
My quick scan of the patient lets me know he is not faking it, pale, sweaty, and generally looks sick. I promptly get the guy strapped into the stretcher and we get back towards the ambulance with history questions bouncing around as we go. My guess is food poisoning or stomach virus with how suddenly it sounds like it hit.
In the back of the ambulance, I let our newest recruit take the vitals as he needs the practice and while this patient is sick, he isn’t urgent yet. The recruit tries once, not rolling up the sweat shirt sleeve the patient is wearing. Our patient is doing his best not to vomit and failing, half screaming as he does vomit. The recruit misses and tries again, sleeve up, as I call in the patient to the hospital. He misses again.
“F***! I just want to go to the hospital!”
My older partner turns to him promptly and in a surprisingly calm manner responds. “Hey man, we are working as fast as we can. I am sorry we can’t give you anything but we are going to get you to the hospital.”
~~~~~~~~~~~~~~~~
I have always wondered why when someone is sick, the need to swear comes up. Drunk I can almost excuse because the patient may not be in full control of themselves, but the sick? You called us, we are trying to help you.
In both cases, swearing continued to the E.R., which promptly ended up with a swift reprimand from the nurses, which works. Now, this may be in part because I am female and don’t get overly demanding of my patients, but then again, our food poisoning patient didn’t even listen to my older, male partner. Patient seem to respond better to the nurses in the E.R. than to those of us in the ambulance. The lack of respect for those working on an ambulance is rather sad, as we are the ones coming to take care of you. I may not be a medic, a nurse, or a doctor, but I am the one getting you to the care you need. A thank you would be nice once in a while but in the mean time, I’ll take solace in the fact that I know I did the best that I can for you.
Its late in the evening, even past midnight maybe, and my pager goes off. “Campus safety requesting EMS transport to the hospital from stair well in Any Dorm.” While this might be interesting, it probably means that I have again acquired a drunk. Its policy that if campus safety encounters a drunk student who vomits, its automatically an EMS transport so that the patient’s airway will be protected, even if it would be shorter to transport by campus safety.
After clambering to the top of the staircase, we find one very drunk kid, a distressed friend, a few campus safety officers, and a pool of vomit. I quickly start an assessment as I send a fellow crew member down for the stair chair. Looks like the guy nearly got to his room on the fourth floor before alcohol won, no trauma and he wasn’t passed out yet so I at least had an airway.
With a bit of struggling with the rather limp patient, we get him into the stair chair, where he promptly vomits again. Judging by the volume of vomit everywhere, that probably was the last of his stomach. We got lucky though, he missed the chair. Four flights later, we have him transferred to the stretcher and he begins to perk up just enough to half answer our questions and start swearing us out. All the short way to the hospital.
Case Two:
Evening again, (seeing the theme of night shifts yet?), and we get a call at the Local Apartment Complex for a sick person. Okay, cool, not unheard of in our district as we all hop in the ambulance. I read through the dispatch report. Patient age: 27. Oooookay, that one is a bit odd. Not in College Town anymore and my demographic is predominately much older.
We get to the apartment door, knock, and give the customary “Fire Department, did someone call 911?” to be greeted in under five seconds with the door opening, young man walking out and nearly sitting on the cot without us taking off the bag.
“S*** man! I’ve been throwing up and I need to go to the hospital NOW!”
My quick scan of the patient lets me know he is not faking it, pale, sweaty, and generally looks sick. I promptly get the guy strapped into the stretcher and we get back towards the ambulance with history questions bouncing around as we go. My guess is food poisoning or stomach virus with how suddenly it sounds like it hit.
In the back of the ambulance, I let our newest recruit take the vitals as he needs the practice and while this patient is sick, he isn’t urgent yet. The recruit tries once, not rolling up the sweat shirt sleeve the patient is wearing. Our patient is doing his best not to vomit and failing, half screaming as he does vomit. The recruit misses and tries again, sleeve up, as I call in the patient to the hospital. He misses again.
“F***! I just want to go to the hospital!”
My older partner turns to him promptly and in a surprisingly calm manner responds. “Hey man, we are working as fast as we can. I am sorry we can’t give you anything but we are going to get you to the hospital.”
~~~~~~~~~~~~~~~~
I have always wondered why when someone is sick, the need to swear comes up. Drunk I can almost excuse because the patient may not be in full control of themselves, but the sick? You called us, we are trying to help you.
In both cases, swearing continued to the E.R., which promptly ended up with a swift reprimand from the nurses, which works. Now, this may be in part because I am female and don’t get overly demanding of my patients, but then again, our food poisoning patient didn’t even listen to my older, male partner. Patient seem to respond better to the nurses in the E.R. than to those of us in the ambulance. The lack of respect for those working on an ambulance is rather sad, as we are the ones coming to take care of you. I may not be a medic, a nurse, or a doctor, but I am the one getting you to the care you need. A thank you would be nice once in a while but in the mean time, I’ll take solace in the fact that I know I did the best that I can for you.
Wednesday, March 24, 2010
Lab Zen
There are two basic kinds of lab work, wait, no, make that four, and some are more desirable more than others.
There is the tedious work, such as analyzing samples. If I am running flow cytometry, all I do is take my prepared samples, hook them up to the machine, and hit start. I get maybe two to five minutes of run time before enough is collected and then I repeat with the next tube. I can’t do anything but stare at a computer screen and wait. Even the down time between samples is not enough to do anything significant. It get, well, boring.
There is the work that takes just enough brain power that I have to pay attention to what I am doing but the work itself is repetitive and stressful. When I have to hold a mouse with one hand in a scruff while treating or measuring a tumor. The mouse squirms and I really have to focus on not letting that mouse move to get everything just right. Or I am pipetting samples into a 96-well plate where each well has something different in it and I cannot cross contaminate anything or I will lose the whole experiment. This work is taxing and stressful; it doesn’t tease the curious brain cells, but does require focus whether or not it is interesting.
Then there is the work that requires massive amounts of brain power. I have to set up an experiment, calculate cells and titrate dyes while making sure nothing gets cross contaminated. Or I am trying to understand results that are just not making sense and all the possible why’s are running through my brain.
Finally, there is the work that is repetitive but not stressful. I get into a rhythm as just enough of my brain stays around to make sure I do not cross contaminate anything but otherwise it gets to wonder. There is usually a phase of random thoughts, which leads into a battle with my inner demons, which can be fairly stressful and self-destructive, but once that passes my brain finally relaxes and is blissfully peaceful. No stray thoughts, no what ifs, no doubt, just simple peace.
That is my favorite kind of work, the work that leads to lab zen.
There is the tedious work, such as analyzing samples. If I am running flow cytometry, all I do is take my prepared samples, hook them up to the machine, and hit start. I get maybe two to five minutes of run time before enough is collected and then I repeat with the next tube. I can’t do anything but stare at a computer screen and wait. Even the down time between samples is not enough to do anything significant. It get, well, boring.
There is the work that takes just enough brain power that I have to pay attention to what I am doing but the work itself is repetitive and stressful. When I have to hold a mouse with one hand in a scruff while treating or measuring a tumor. The mouse squirms and I really have to focus on not letting that mouse move to get everything just right. Or I am pipetting samples into a 96-well plate where each well has something different in it and I cannot cross contaminate anything or I will lose the whole experiment. This work is taxing and stressful; it doesn’t tease the curious brain cells, but does require focus whether or not it is interesting.
Then there is the work that requires massive amounts of brain power. I have to set up an experiment, calculate cells and titrate dyes while making sure nothing gets cross contaminated. Or I am trying to understand results that are just not making sense and all the possible why’s are running through my brain.
Finally, there is the work that is repetitive but not stressful. I get into a rhythm as just enough of my brain stays around to make sure I do not cross contaminate anything but otherwise it gets to wonder. There is usually a phase of random thoughts, which leads into a battle with my inner demons, which can be fairly stressful and self-destructive, but once that passes my brain finally relaxes and is blissfully peaceful. No stray thoughts, no what ifs, no doubt, just simple peace.
That is my favorite kind of work, the work that leads to lab zen.
Sunday, March 21, 2010
From the Other Side of the Stretcher
I was visiting my sister, I had come up with my mother and we three were all going back to her house. It was late, dark, and the streets were virtually empty. We weren’t going fast, there was no hurry, just everyone getting home since we all had to be up early the next day.
I remember our lights suddenly reflecting off of a very solid car in front of us. The glow was rather eerie as I remember not even having enough time to say anything as they pulled out and kept pulling out in front of us from their stop sign like we weren’t there. It was a T intersection and we had the right of way. It still is mind boggling to me that they just kept pulling out as if we weren’t there.
The crash, the noise, the smell, the silence. I know I closed my eyes before we hit but after that all I remember was that my sternum hurt. It really, really hurt. Now, I can handle a lot of pain, but the sudden shock of this pain compounded with the fact that it now really hurt to breath scared me. I couldn’t take a deep breath.
The acrid smell of air bag is something I will never forget as my mother tried to get me out of the car, thinking it was on fire. I refused to move. I hurt and I didn’t know why, all of which screamed to me to hold still.
I really had been holding a plate of cupcakes and to this day I don’t know if the plate landed perfectly on the folded up seat next to me or if I had put it there in the first moments after the crash, I really don’t remember.
The police officer checked my pupils, making sure I was conscious, talking, and without the immediate signs of a head injury. Fire was next on the scene, apparently they had just gotten off of a call on the campus and were very close. The irony was that I had just watched that company hang lights on their fire house earlier that night from my hotel. They were really nice, though I do think the guy who took C-spine really did kneel in a cupcake. We found them all over the car the next day.
The medic was very nice, quickly assessing I was probably not as injured as dispatch had told him, though I don’t know what it was dispatched as, just that I had told my mother to tell dispatch that I had midline sternal pain. The EMT and the fire fighters got a good practice at a KED and backboard extrication thought while I learned that lowering the backs of seats can be very handy if they will move.
I felt so bad that I was shaking uncontrollably not because I was cold, perhaps something closer to the simple shock of being in an accident. The 12-lead must have looked horrendous, though somehow he was able to tell it was normal sinus. We really did have a good talk in the back and it helped in getting my nerves and adrenaline down enough to feel slightly more coherent. I wish I had gotten his name before he had handed me off so I could send him a thank you.
The hospital must have been having a slow night with the relatively short amount of time it took to get me off the board, out of the KED, and out of the collar. Surprisingly the thing that hurt the most was the KED against the back of my head.
Numerous questions, an X-ray, and a CAT scan later, it was determined that I had in fact not cracked my sternum like the X-ray was alluding to and I did not have a pneumo in the top left part of my chest. Though both would have been possible seeing as my lack of other seatbelt bruises indicate I took the full force of that crash across my sternum and only across my sternum. Also, I do remember holding my breath right before we hit, which is a paper bag lung in the making.
I count my lucky blessing that I was not hurt worse, that my family was fine, particularly my sister on her birthday, and that the other driver was surprisingly unscathed. My mother’s car may have been totaled, but no one was seriously injured.
Saratoga Springs Fire and EMS services, thank you for all that you did that night. It may not have required extrication and cutting up cars, but you made me feel well cared for and in good hands during a very rattling experience.
I remember our lights suddenly reflecting off of a very solid car in front of us. The glow was rather eerie as I remember not even having enough time to say anything as they pulled out and kept pulling out in front of us from their stop sign like we weren’t there. It was a T intersection and we had the right of way. It still is mind boggling to me that they just kept pulling out as if we weren’t there.
The crash, the noise, the smell, the silence. I know I closed my eyes before we hit but after that all I remember was that my sternum hurt. It really, really hurt. Now, I can handle a lot of pain, but the sudden shock of this pain compounded with the fact that it now really hurt to breath scared me. I couldn’t take a deep breath.
The acrid smell of air bag is something I will never forget as my mother tried to get me out of the car, thinking it was on fire. I refused to move. I hurt and I didn’t know why, all of which screamed to me to hold still.
I really had been holding a plate of cupcakes and to this day I don’t know if the plate landed perfectly on the folded up seat next to me or if I had put it there in the first moments after the crash, I really don’t remember.
The police officer checked my pupils, making sure I was conscious, talking, and without the immediate signs of a head injury. Fire was next on the scene, apparently they had just gotten off of a call on the campus and were very close. The irony was that I had just watched that company hang lights on their fire house earlier that night from my hotel. They were really nice, though I do think the guy who took C-spine really did kneel in a cupcake. We found them all over the car the next day.
The medic was very nice, quickly assessing I was probably not as injured as dispatch had told him, though I don’t know what it was dispatched as, just that I had told my mother to tell dispatch that I had midline sternal pain. The EMT and the fire fighters got a good practice at a KED and backboard extrication thought while I learned that lowering the backs of seats can be very handy if they will move.
I felt so bad that I was shaking uncontrollably not because I was cold, perhaps something closer to the simple shock of being in an accident. The 12-lead must have looked horrendous, though somehow he was able to tell it was normal sinus. We really did have a good talk in the back and it helped in getting my nerves and adrenaline down enough to feel slightly more coherent. I wish I had gotten his name before he had handed me off so I could send him a thank you.
The hospital must have been having a slow night with the relatively short amount of time it took to get me off the board, out of the KED, and out of the collar. Surprisingly the thing that hurt the most was the KED against the back of my head.
Numerous questions, an X-ray, and a CAT scan later, it was determined that I had in fact not cracked my sternum like the X-ray was alluding to and I did not have a pneumo in the top left part of my chest. Though both would have been possible seeing as my lack of other seatbelt bruises indicate I took the full force of that crash across my sternum and only across my sternum. Also, I do remember holding my breath right before we hit, which is a paper bag lung in the making.
I count my lucky blessing that I was not hurt worse, that my family was fine, particularly my sister on her birthday, and that the other driver was surprisingly unscathed. My mother’s car may have been totaled, but no one was seriously injured.
Saratoga Springs Fire and EMS services, thank you for all that you did that night. It may not have required extrication and cutting up cars, but you made me feel well cared for and in good hands during a very rattling experience.
Friday, March 19, 2010
Cupcakes
Its 2300, maybe closer to 0000 on a dark but clear night in early December. Call goes out for a motor vehicle accident with one injured. Its back in NY so ambulance and engine are separate but everyone is going lights and sirens to the scene.
Its behind the college, two cars involved, a CRV T-boned a sedan. It doesn’t look bad, though the radiator has sprung on the CRV. The engine and PD are already on scene with one guy in the back of the CRV holding C-spine on our patient. Its a bit odd that its the passenger in the back of the CRV, not the driver of the sedan who got hit, that is our patient. Everyone else is out of the cars, looking a little dazed and the mother rather worried about her daughter now held in C-spine. The police officer and fire department are checking on the driver of the T-boned car and mother who had been driving the CRV who hit the sedan.
“I think I am kneeling on a cupcake,” comes the voice of the fireman in the back as the medic starts talking to the patient. And indeed, there is an empty plate sitting perfectly on the raised and folded seat that is the other side of the CRV. The smell of deployed airbag is strong as I can hear a bit of conversation from the passenger, saying how they didn’t know how the plate got there, just that they had been holding it before the crash, and yes they had a seat belt on. It seems that it was hard for them to breath because their chest hurt so much but they otherwise looked stable. No blood, no broken bones, no distressed breathing.
We get a collar and a KED on her before getting her on a backboard. There is back pain in addition to the chest pain, though its not midline or spinal, probably just muscle injury from whiplash or the likes. Its cold out but the patient is quickly moved to the ambulance so that the medic can finish his assessment. We quickly get a 12-lead on because of the chest pain and he listens to her heart. He doesn’t hear anything unusual though the 12-lead is virtually unreadable because she is shaking so much. Mom is in the front as we head to the hospital.
The medic strikes a friendly conversation up with the patient as we go, quickly establishing that the patient is okay mentally, rather shaken up and still has pain in their chest. They are sorry because in the end they are probably just freaking out over the chest pain but they are an EMT too and had just taken ITLS and of course the first thing through their brain after the accident was injuring their heart.
The patient is an EMT.
The patient is me.
Its behind the college, two cars involved, a CRV T-boned a sedan. It doesn’t look bad, though the radiator has sprung on the CRV. The engine and PD are already on scene with one guy in the back of the CRV holding C-spine on our patient. Its a bit odd that its the passenger in the back of the CRV, not the driver of the sedan who got hit, that is our patient. Everyone else is out of the cars, looking a little dazed and the mother rather worried about her daughter now held in C-spine. The police officer and fire department are checking on the driver of the T-boned car and mother who had been driving the CRV who hit the sedan.
“I think I am kneeling on a cupcake,” comes the voice of the fireman in the back as the medic starts talking to the patient. And indeed, there is an empty plate sitting perfectly on the raised and folded seat that is the other side of the CRV. The smell of deployed airbag is strong as I can hear a bit of conversation from the passenger, saying how they didn’t know how the plate got there, just that they had been holding it before the crash, and yes they had a seat belt on. It seems that it was hard for them to breath because their chest hurt so much but they otherwise looked stable. No blood, no broken bones, no distressed breathing.
We get a collar and a KED on her before getting her on a backboard. There is back pain in addition to the chest pain, though its not midline or spinal, probably just muscle injury from whiplash or the likes. Its cold out but the patient is quickly moved to the ambulance so that the medic can finish his assessment. We quickly get a 12-lead on because of the chest pain and he listens to her heart. He doesn’t hear anything unusual though the 12-lead is virtually unreadable because she is shaking so much. Mom is in the front as we head to the hospital.
The medic strikes a friendly conversation up with the patient as we go, quickly establishing that the patient is okay mentally, rather shaken up and still has pain in their chest. They are sorry because in the end they are probably just freaking out over the chest pain but they are an EMT too and had just taken ITLS and of course the first thing through their brain after the accident was injuring their heart.
The patient is an EMT.
The patient is me.
Tuesday, March 16, 2010
In the Cloudy Future
You will have to pardon the lack of posts thanks to the lovely rainstorm that romped across the East Coast, knocking out phone and internet at my house. I will spare the detailed gripes about how if someone doesn't have a cell phone how on earth are they supposed to call for help since you are not fixing this till Thursday of next week at best. Thus the only internet I have is the firehouse or occasionally at work.
Anyways, my life is currently consumed by applications. After another fruitless round of medical school applications (though a very productive month in lab), I am doing applications again. Not just for medical school, though that will be happening come May, but for master's programs of various sorts. I have to have something to do in the fall, and as much as I would love to go to paramedic school, it may make getting into medical school harder (unless I can get a nice master's packed into it too), not to mention most of the schools around me require anatomy, which I have oddly not taken yet.
I honestly don't know what I would like a master's in other than molecular biology and immunology are currently on the top of the list. Not having GRE's is becoming frustration, as many programs require this, though the ones that accept MCATs are becoming my saving grace.
I have also come to the unfortunate but probably for my own good decision that I need to take the MCATs again. Not because my score is bad, but because I know it can be better and so that if I end up in a two year master's program I will still have a valid/active MCAT score for medical schools.
This is not where I wanted to be in my life but it is were I am, so much better at anything practical than book work, but determined to not give up yet.
Anyways, my life is currently consumed by applications. After another fruitless round of medical school applications (though a very productive month in lab), I am doing applications again. Not just for medical school, though that will be happening come May, but for master's programs of various sorts. I have to have something to do in the fall, and as much as I would love to go to paramedic school, it may make getting into medical school harder (unless I can get a nice master's packed into it too), not to mention most of the schools around me require anatomy, which I have oddly not taken yet.
I honestly don't know what I would like a master's in other than molecular biology and immunology are currently on the top of the list. Not having GRE's is becoming frustration, as many programs require this, though the ones that accept MCATs are becoming my saving grace.
I have also come to the unfortunate but probably for my own good decision that I need to take the MCATs again. Not because my score is bad, but because I know it can be better and so that if I end up in a two year master's program I will still have a valid/active MCAT score for medical schools.
This is not where I wanted to be in my life but it is were I am, so much better at anything practical than book work, but determined to not give up yet.
Saturday, February 27, 2010
Blizzard of Winter 2009
Like any good fire department, we not only staffed and overstaffed equipment when the snow storm hit last December, but we held a training too. I have to say, snowball fights in the middle of our parking lot in between apparatus training (we could only drive one at a time so there was some down time) was awesome! It was great stress relief and I discovered that my EMS gear is fantastic for the snow, keeping both the cold and the snow out.
It was also very nice to get a better grasp at how to drive some of the special apparatus. I know believe that yes, if needed, I could take this piece out and do some rescuing instead of just looking at it and thinking it is a pretty piece of equipment. If there ever is an emergency on a trail, I am confident I will know what to do!
The downside was the lack of preparation. I realize that where I live on the East Coast does not see this amount of snow often, but it does see snow. So why is the concept of plowing while it is snowing not done around here? Coming from central New York state, we never had issues with the snow on roads because whenever it snowed, the plows were out treating the roads and removing the snow. Perhaps it is just a difference in opinions, but when people can cross country ski in the middle of main thorough fairs there is a problem.
I will give the plows a shout out though because once they got to plowing, they were doing a good job at clearing the roads.
It also confuses me when people with cars that clearly should not be driven in deep snow (we had well over a foot and half on the ground that morning) not only drive on the roads, but then up a hill where traction gets even worse, I can’t help but shake my head at those who get stuck. I had made a point to borrow my sisters all wheel drive CRV that had snow tires (she’s up in NY and had come down for the holidays) for just this reason.
It was also very nice to get a better grasp at how to drive some of the special apparatus. I know believe that yes, if needed, I could take this piece out and do some rescuing instead of just looking at it and thinking it is a pretty piece of equipment. If there ever is an emergency on a trail, I am confident I will know what to do!
The downside was the lack of preparation. I realize that where I live on the East Coast does not see this amount of snow often, but it does see snow. So why is the concept of plowing while it is snowing not done around here? Coming from central New York state, we never had issues with the snow on roads because whenever it snowed, the plows were out treating the roads and removing the snow. Perhaps it is just a difference in opinions, but when people can cross country ski in the middle of main thorough fairs there is a problem.
I will give the plows a shout out though because once they got to plowing, they were doing a good job at clearing the roads.
It also confuses me when people with cars that clearly should not be driven in deep snow (we had well over a foot and half on the ground that morning) not only drive on the roads, but then up a hill where traction gets even worse, I can’t help but shake my head at those who get stuck. I had made a point to borrow my sisters all wheel drive CRV that had snow tires (she’s up in NY and had come down for the holidays) for just this reason.
Thursday, February 18, 2010
Hospital Blues and Delights
Let me preface this post by saying this, all that snowfall that has been being dumped on the East Coast since December? Yeah, I have gotten ALL of it. Perhaps not always the worst, but I believe I have officially seen more snowfall accumulation this winter than I did in four years living in central NY state. Its been interesting to say the least, but more on that later.
The lab that I work in shares the building with a specialty hospital, allowing the doctors I work under to be both MD and research scientist. Its a wonderful set up with great people and the chance to really see the “bench to bedside” effect in clinical research. Normally there are very few downsides.
It was late, as in well past 2000 with few researchers left in the building. I was done with work but had stayed at my desk to finish up a school assignment (yes, I was working a full time job and taking nigh classes at a local college).
Poof! I am consumed by darkness, only the eerie red light of exit signs illuminating my lab followed a chorus of emergency alert beeps from our refrigerators, -20 C, and -80 C freezers complaining that they had no power. And a dead computer with a very lost document.
Needless to say that ended my evening at work, and the snow hadn’t even started!
I had known that the building was going to be testing their generators that evening, its required for buildings that hospitals are in, I just hadn’t thought it would have been that early in the evening. It was also supposed to have been Saturday, but with an impending December snow storm, they decided testing before the snow was a better idea.
Now while my Friday night had a bit of a damper after having to be up till 0000 finishing said assignment, the weekend held a bit of a surprise, and I am not talking about the feet of snow we got.
I had to come in both days of the weekend to treat mice. If I didn’t I would lose two weeks worth of an experiments and that was not on my list of things to do. Well, much to my delight, the roads and parking lots around my building were beautifully plowed and very much drivable, unlike the rest of the county. I was impressed. The hospital is a specialty hospital, no emergency room, but they had planned ahead, knowing that people would still need treatment and made sure access to care was not a problem. Or in my case, access to my mice.
The lab that I work in shares the building with a specialty hospital, allowing the doctors I work under to be both MD and research scientist. Its a wonderful set up with great people and the chance to really see the “bench to bedside” effect in clinical research. Normally there are very few downsides.
It was late, as in well past 2000 with few researchers left in the building. I was done with work but had stayed at my desk to finish up a school assignment (yes, I was working a full time job and taking nigh classes at a local college).
Poof! I am consumed by darkness, only the eerie red light of exit signs illuminating my lab followed a chorus of emergency alert beeps from our refrigerators, -20 C, and -80 C freezers complaining that they had no power. And a dead computer with a very lost document.
Needless to say that ended my evening at work, and the snow hadn’t even started!
I had known that the building was going to be testing their generators that evening, its required for buildings that hospitals are in, I just hadn’t thought it would have been that early in the evening. It was also supposed to have been Saturday, but with an impending December snow storm, they decided testing before the snow was a better idea.
Now while my Friday night had a bit of a damper after having to be up till 0000 finishing said assignment, the weekend held a bit of a surprise, and I am not talking about the feet of snow we got.
I had to come in both days of the weekend to treat mice. If I didn’t I would lose two weeks worth of an experiments and that was not on my list of things to do. Well, much to my delight, the roads and parking lots around my building were beautifully plowed and very much drivable, unlike the rest of the county. I was impressed. The hospital is a specialty hospital, no emergency room, but they had planned ahead, knowing that people would still need treatment and made sure access to care was not a problem. Or in my case, access to my mice.
Sunday, February 14, 2010
Stoplight Fire Drills
It was night time, some time around 2100 on a warm summer evening, and we were on our way back from a good intent call sitting at a stoplight. I was in the back again because my partner was training to drive and the real driver had to sit in the front. I was actually in my final phases of charge/aid training, still a bit nervous when it came to running calls after having taken such a large break from that task.
“County to Ambulance, the PD are requesting you for a mental health call”
Well this would be a first even though after working for three years one would have expected to have this already under the belt. My crew of three then proceeds to do our own little fire drill, me moving to the front, our real driver moving to driving, and my partner getting into the back. I wish there had been a video of us, it would have been priceless.
A quick lights and sirens trip later we are going down a friendly neighborhood street, looking for the address and a police car. About this time I start noticing residents standing on the side of the street. Well that is a little odd.
I finally see the blue and red lights of a police car, switching from navigator to EMT, going over my check list in my head. I take a closer look at the police car, or I should say cars, ahead of us blocking the street. I lose count at eight as we park and and I am immediately greeted by an officer who proceeds to rattle off what they PD has done so far. Tasered and maced? Multiple times? Without flinching?
As we tromp down the street, I find my patient pinned to the ground in a front lawn by no less than seven police officers. Apparently he had been running down the street. As I start my assessment, I find him conscious with no airway or breathing issues and only minor cuts. And that he is hand cuffed, shackled and has taser prongs still in his back.
Oh, did I mention he is completely naked too?
After taser prong removal by the PD and a quick packaging in the Reeve’s stretchers, my partner and I climb in the back with an officer to start getting vitals. Or at least trying. His carotid was surprisingly hard to find seeing as he appeared to be healthy and in good shape, though the high pulse rate somewhere around 130 bmp played into this, and his blood pressure was not possible unless a limb was uncuffed. I was not really willing to do that with only one officer in the back. By the way, pulse oximeters work on toes.
A quick call to the Hospital later with a request for security at the door, we were on our way, lights and sirens courtesy of our driver not wanting this trip to take any longer than necessary, both for our and his sake.
His eyes were wide and excited as I kept him focused on me as I tried to ask questions between his professions of “I love you, I love you, I love you” in whispers to me and comments about “Daddy” to either my partner or the officer. Had he taken anything this evening? I got an ever changing list of drugs. Where was he from? Florida! Why was he here? School! What school? We got about five, all in the area.
His mental status was definitely altered, most likely because of any combination of drugs he was on and from our guess it was something pretty strong. With a high pulse and what was becoming very flushed skin, I was beginning to get worried that he would need more than just a night in the hospital to come down, but something stronger to keep him from overheating, having a sky high heart rate, or seriously injuring himself by struggling at some point.
We roll into the Hospital, met by the security and immediately get a room, which is nice change of pace, even if the circumstances are not. The hand off goes smoothly as I give my report, safely delivering my patient with no more injuries than when I first found him. It occurs to me then that this could have been much worse for both of us. Not once during the time we were on scene or when we were in the back of the ambulance did he struggle, lash out, or fight. He was utterly calm and with what drugs I was thinking he was on, its impressive that he did not have an outburst in our presence. I am not sure three of us could have held him down if he had gotten off of the stretcher and I am sure the process would have injured him too.
As I finish my written report, I overhear the doctor talking to our much calmed down and almost alert patient.
“What did you take?”
“Mushrooms.” By the way, this was not one of the drugs he told me he had taken.
“Did you know your dealer?”
“No.”
“You might want to know your dealer. You got more than just mushrooms.”
I really do hope he felt better the next morning.
“County to Ambulance, the PD are requesting you for a mental health call”
Well this would be a first even though after working for three years one would have expected to have this already under the belt. My crew of three then proceeds to do our own little fire drill, me moving to the front, our real driver moving to driving, and my partner getting into the back. I wish there had been a video of us, it would have been priceless.
A quick lights and sirens trip later we are going down a friendly neighborhood street, looking for the address and a police car. About this time I start noticing residents standing on the side of the street. Well that is a little odd.
I finally see the blue and red lights of a police car, switching from navigator to EMT, going over my check list in my head. I take a closer look at the police car, or I should say cars, ahead of us blocking the street. I lose count at eight as we park and and I am immediately greeted by an officer who proceeds to rattle off what they PD has done so far. Tasered and maced? Multiple times? Without flinching?
As we tromp down the street, I find my patient pinned to the ground in a front lawn by no less than seven police officers. Apparently he had been running down the street. As I start my assessment, I find him conscious with no airway or breathing issues and only minor cuts. And that he is hand cuffed, shackled and has taser prongs still in his back.
Oh, did I mention he is completely naked too?
After taser prong removal by the PD and a quick packaging in the Reeve’s stretchers, my partner and I climb in the back with an officer to start getting vitals. Or at least trying. His carotid was surprisingly hard to find seeing as he appeared to be healthy and in good shape, though the high pulse rate somewhere around 130 bmp played into this, and his blood pressure was not possible unless a limb was uncuffed. I was not really willing to do that with only one officer in the back. By the way, pulse oximeters work on toes.
A quick call to the Hospital later with a request for security at the door, we were on our way, lights and sirens courtesy of our driver not wanting this trip to take any longer than necessary, both for our and his sake.
His eyes were wide and excited as I kept him focused on me as I tried to ask questions between his professions of “I love you, I love you, I love you” in whispers to me and comments about “Daddy” to either my partner or the officer. Had he taken anything this evening? I got an ever changing list of drugs. Where was he from? Florida! Why was he here? School! What school? We got about five, all in the area.
His mental status was definitely altered, most likely because of any combination of drugs he was on and from our guess it was something pretty strong. With a high pulse and what was becoming very flushed skin, I was beginning to get worried that he would need more than just a night in the hospital to come down, but something stronger to keep him from overheating, having a sky high heart rate, or seriously injuring himself by struggling at some point.
We roll into the Hospital, met by the security and immediately get a room, which is nice change of pace, even if the circumstances are not. The hand off goes smoothly as I give my report, safely delivering my patient with no more injuries than when I first found him. It occurs to me then that this could have been much worse for both of us. Not once during the time we were on scene or when we were in the back of the ambulance did he struggle, lash out, or fight. He was utterly calm and with what drugs I was thinking he was on, its impressive that he did not have an outburst in our presence. I am not sure three of us could have held him down if he had gotten off of the stretcher and I am sure the process would have injured him too.
As I finish my written report, I overhear the doctor talking to our much calmed down and almost alert patient.
“What did you take?”
“Mushrooms.” By the way, this was not one of the drugs he told me he had taken.
“Did you know your dealer?”
“No.”
“You might want to know your dealer. You got more than just mushrooms.”
I really do hope he felt better the next morning.
Vanishing Act
So December and January have been pretty hard months for me. Work has exploded in terms of the sheer number of experiments I am doing all at once and life, well life has been interesting. Needless to say, cars and I have a new relationship, I have seen more snow in the past month than I have in four years at college (where there is supposed to be snow), and my family has gone through some troubling times.
I will endeavor to get back on track and build some stock posts up for times when my muse has left the building screaming.
I will endeavor to get back on track and build some stock posts up for times when my muse has left the building screaming.
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