New adventures, Familiar Place

So I have alluded to a new job several times in the past few months on here. And I figured it’s past time to talk about it. As you can tell from the new banner, I have TX and NM represented in that star of life. That’s because I’m now, once again, workin in the state of Texas.

Some of you might remember that three years ago I worked in a small rural TX community as an EMT-I. Well, now I’m back in the same community working as a Paramedic :). I work 7 days on/7 days off. It actually works out well for me. I’ll go into some detail as to what it’s like down here too. But suffice to say, it’s one of my dream jobs. And I’m having a lot of fun overall.

When I worked here before, it was a city run, third service, with pretty typical protocols for this area of Texas. Now, I’m working under flight protocols on a frontier 911 truck. We have some of the broadest sets of guidelines outside of my good friends to the south in Presidio. As a Paramedic I have free reign to use clinical judgement and best practice to deviate from our guidlines, and out critical care medics (more on that in a bit) can perform CVC placements, pericardiocentesis, chest tube insertion, and several other things. The running train of thought is that we can do more in the short term than our little community hospital can, and that they only do scans and give blood (the two things we can’t do at this point).

We regularly transport straight to the airport from scene to meet up with one of our company’s fixed wings for transport of hte patient to a tertiary facility or trauma center (nearest major hospital is a level 2. Closest Level 1 is over 200 miles in any direction). The flight team runs under our same protocols, so in this instance, the flight team doesn’t bring any additional tools (except they carry an ultrasound, ours are coming for ground) or skills to the patient. We use them strictly because we are so far from definitive care.

We also fly out quite a few by rotor. Part of this is that we cover 3000 sq mi of territory, a lot of it is pretty rugged desert. We also have one major interstate running through our county. One of our most common reasons for flying people out by rotor is that we just can’t get safely back down the road the patient is on with any sort of speed, like an oil rig lease road. We have one of the highest numbers of oil rigs in the state of texas here in my county. And with all this, I haven’t seen much abuse of air medical, it’s pretty typical for frontier Texas.

One of hte nice things about our company is that they want all medics to be certified as critical care. And we are 90% paramedic agency (we only have a handful of EMT-I and EMT-B providers. Once myself and four others go through the critical care class, we will be at 100% of paramedics certified as critical care. And I’m in that weird spot because I’m currently an FP-C, which is generally considered critical care level. And the best part is the company will pay for the critical care training. And with the schedules we work, an extra class (like UMBCs 2 weeks course) are easy enough to do trades togo to.

All-in-all I’m excited to be back here. It’s a great place to learn, and I get to play sometimes as a flight medic on our fixed wings. It’s already making me a better provider and it is my favorite type of EMS, rural with great protocols. Plus we have a great crew here. I can’t wait to see what my future holds down here.

Ow

I’m still alive, I promise. Although with how I spent last night I was wishing I wasn’t. Have you ever noticed that medical providers are the worst patients? Well, I know I was last night until they could get me to stop throwing up and ease my pain a little bit. Fast forward to about 6 this morning and I’m told that I have an even bigger gallstone than they’d seen the last time. Guess one of the things on my list to do is try to eat better and eat more regularly.

So… because of that I missed class this evening. I’m still feeling like crap. But I’m getting better. I’m gonna try to make that long drive down to TX tomorrow to make it to Friday’s class. I hate missing time in class for stupid stuff like this. But I have gotten some homework done today. It’s trauma sessions in class this week and next week, then we have a weekend PHTLS course which sounds like a lot of fun 😀

But I also keep getting distracted by CoEMS (FRN.tv) Seat at the Table which does me no good getting things done :p But hey, I’m still expanding my education. Just not quite in the way my instructors even think in. Or the majority of my classmates for that matter.

All of you CoEMS/EMS2.0 types out there reading this, any tips on how to get instructors to acknowledge that newer information than our text books is out there?

Well anyways, I’m gonna go read again. I’ve got about 3 quizzes to get done before tomorrow. And I’m really hoping I’ll even make it down there tomorrow for class. At least the new car is fun to drive.

Ya’ll have a good one. Class then 36 on a bus 😀

Memories, and new beginnings?

I’ve never like Albuquerque, not since before I moved here for school. When I left last March for Colorado, I thought that was it. I swore I’d never willingly move back to Albuquerque. But somehow in the course of talking to you the NEXT March… we agreed to find a place together in Albuquerque, and I would have been so very content to stay here for the next 18 years with you if you’d have had me. That’s when it hit me. You were what was missing the first few years here. Even staying at your parents (which I’m still so very grateful they put up with me :p), being with you felt like home. You were my home, the place I felt the safest. The place I felt most comfortable. The person I loved being with so much.

Now Albuquerque is a bunch of memories, of things we did. Of places we visited. Unfinished plans that we made together. Albuquerque feels empty to me now. Worse than before you, it’s now a black hole that seems content to suck out any happiness or wanting to do anything. This is not my home any longer.

I guess that’s why when this hospital district offered me the opportunity to come out and test, I took it without a second thought. I knew you would have been ok with it. That’s why I bristle a little when people accuse me of trying to run away from my problems here and run there. And to be honest, that thought gave me a panic attack on the drive back today.

For a little bit, I didn’t know why I was doing it. Was I really running away? Or was I doing it because it’s something I wanted? Because it’s something I thought would be the best idea for me? I really didn’t know. That made me feel horrible. Then I thought about it. Both of us loved travelling, granted you hated TX, but we both had plans to move as much as we could. And this would really be a good opportunity for me. Maybe I’m doing it for a little bit of all of those reasons? But you know what, if it’s better for me in the long run, who cares right this second why I’m doing it?

But that means I need to try and put some things behind me. Sweetheart, losing you is something I’m still having a hard time dealing with. I listened to a song on the way home and these were part of hte lyrics

“I don’t wanna not remember
I will always see your face
In the shadows of this haunted place
I will laugh
I will cry
Shake my fist at the sky
But I will not say goodbye”

That’s rather how I feel towards you. The last month I’ve gone through so many emotions… Gods know that there have been times I’ve been so very pissed off at you. Pissed that you left me alone here, pissed that you wouldn’t talk to any of us, pissed that you were gone. Pissed in general. But it reminded me too that I wouldn’t have been anywhere near that mad if I wasn’t in love with you.

What I can do, though, is remember the memories. Remembering you so many years ago, walking into the interview for that trip with me. I saw you back then, braces, frizzy hair, and all, and it was like something inside me clicked. Like my heart went “Oh! Hi! I’ve been waiting for you!”

And that trip was amazing. I know you had some rough spots during it, and so did I. And I’m sorry I ever took it out on you then. But we enjoyed each others company so very much. And I loved squirelling a smile out of you when you were in a bad mood. It helped my mood so much too. And then  when we got home… This blushing little girl, so cute and innocent looking, walking up to me and kissing me on the cheek, then walking away. You left me standing there breathless and staring. I still smile when I think of that memory.

Then we had some bad times. I was dating the one-who-will-never-be-named (yes she is that much of an evil bitch that she would give Voldemort a run for his money) and she took great exception to the fact that I might have been falling for someone that wasn’t her, or that I was even talking to someone that wasn’t her. So she took it upon herself to make sure we’d never talk again… and for several years we didn’t. I remember spending hours trying to find you online, looking for any sign of you. And come to find out you were doing the same thing to find me.

I remember the first day I saw you again. It was after you and my mother realized who each other was. I came down from ABQ for just a chance. We called each other when I got on campus and left my mom’s office. And in a typical Zita moment, and Nate moment for that matter, I look ahead of me and see someone talking on the phone… making arm motions that looked very familiar. I asked you what you were doing and you told me walking. I was smirking to myself the entire time, and I asked you to turn around. God, seeing your face for the first time in years was amazing. You had just gotten even more gorgeous and grown up from that little girl I remember. The smile on your face when we both realized we’d been on the phone with each other from about 20ft away is still one of my favorite memories.

Remembering how you smiled at me this past Valentine’s day when I surprised you with flowers at your parents. You were always so hard to surprise because you hated them and tried to get all the info you could before it happened. That’s why I’m amazed that me and your mother managed to pull off me sneaking by without you knowing. The happiness you had on your face when you saw me walk through the door was amazing, and then the surprise and smile when I handed you flowers. I was hoping that flowers to you on V-day would become a normal tradition with us, the first time I’d ever enjoyed that day at all.

Or how a month or two later when I walked into your parents house again on a mini-vacation from TX. I had been working up the courage to ask if I could kiss you on that trip, so can you imagine how surprised I was when the first thing you do as I walk in is kiss me on the lips, kiss me very soundly? Heh, I think it was almost a repeat of the airport and me just standing there. You smiled so sweetly and just giggled at me. That was the turning point of us becoming an ‘us’ even if we didn’t want to admit it to anyone.

Those are just a few of my favorite memories of you and me. And kind of why I think I might be running away from ABQ… there are memories of you, of us, of all three of us, everywhere in this state. And I really am having a hard time dealign with it. I still wake up and expect to be looking into your gorgeous hazel eyes, or hear you giggle at me whenever I do something stupid. I miss your gentle touch when I’m upset, and boy, lately, I could have used that wonderful touch so often. I miss just being able to cuddle you to me when you were upset. All in-all… I miss you honey. Miss you so much that the pain makes me want to curl up into a ball and stay there.

I think what really gets me… is that we didn’t really have a chance. We were good together for the short time we had, and it kills me that I’ll never know how we would have turned out. I think it would have worked, but now I’ll never know… and that, to me, is one of the things that makes this so hard.

So, yea, maybe I am running away. But I’m also trying to move on. You would want me to move on. You’d want me to become a better man. You knew of my love for EMS, and you told me shortly before I lost you that you could never tell me you wanted me to give it up. So here I go. I’m trying to get on with one of my dream services (the only one I can get on with as an EMT-I as opposed to a medic). I’m trying to become that man you would be proud of. I’m just hoping you keep watching over me. Keep visiting me in my dreams, for that’s the only way I can see you now, and gods know that I miss you. I still think of you every second of every day, and I can’t see how that will change any time soon. But for now I just need to keep pressing on. Keep trying  to push forward. It’s what you would have wanted for me. and it’s what I would have wanted you to do if the situations would be reversed.

I know I still can’t tell you goodbye. Like I said earlier, I don’t know if I’ll ever be able to tell you goodbye. But I will not, cannot, ever forget you. You’ll stay in my heart forever. And I think you took the best part of me with you when you left, so at least you have some company. Until I see you again lover, watch over me and help keep my dumb ass safe when I do something stupid.

“The blackest night must end in dawn, the light dispel the dreamer’s fear.”

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So… I just got back to NM last night. I left NM on sunday to go to SE Texas to test for a large hospital based agency. From everything I have heard, they are in the top three services in the state of TX and they’ve always been one I wanted to work at. But man it was a long drive. 15 hours or so from here.

The hiring process consists of a written test, three practical tests (airway incluiding pedi and adult ETI, vital signs, and LSB), an interview, and a PAT. I passed the written with an 88%, passed all three practicals with only one retest (vital signs?! I think I just got nervous and started counting my own pulse), and had a great time on the PAT. It was actually a very fun PAT, and one of the few for private, non-fire EMS that I’ve seen that has you do a full course, not just a stair test. The interview I think I did ok on too. Now I just have to wait till Friday to hear if I got the job or not. If I did, orientation will start on July 18th.

And it’s not just orientation. They run a 3 week academy followed by 4-6 weeks riding third before you’re released as a probationary crew member under a mentoring medic.  I love the idea of the way they do new hires. So… fingers crossed that I’ll get the call once I get off duty on Friday. I go in for a 36 down here in ValCo tonight. I’m hoping I’ll have a resonably busy shift.

It’s like a roller coaster.

The last two and a half weeks have been both the best weeks and the worst weeks of my life professionally and personally.

It all started on what was supposed to be a 36 hour shift over New Years Eve and New Years day. Great time to work EMS right? Good calls, fun times.

Well it didn’t quite work like that. First few calls of the shift were all routine. A drunk or two, a minor MVC or two, a drunk doing CPR on a fully alive drunk person (“Sir, if the patient is saying ‘OW!’ every time you compress his chest, he DOESNT need CPR!”), and then it started to get interesting.

We worked a nasty tractor trailer rollover about 15 miles from town. We get on scene and see a pretty much demolished tanker truck laying on it’s side. The roof of the cab had been peeled back by the wreck and the patient was laying about 10 yards from the truck. He was laying on the ground moaning but not really responsive to us at all.

We quickly get him collared, boarded, stipped, and strapped and then haul into the bus. Just a quick look at him showed what looked like a grossly deformed femur, shattered left arm, distended neck veins, and no breath sounds on the right. Left pupil was sitting pretty at about 4mm and slow to respond while the right was about 2mm and non-responsive.

Our second bus pulled up on scene as me and my medic were getting him situated in the back. We pull the medic from the second truck to come with us while her basic drove. A PD officer drove our second truck back into town. It was decided by my medic that we would call the local fixed wing transfer service to get them ready and just meet them at the airport to get the guy to the Lvl 1 200 miles away from us, since the rotor would take at least a half hour to get to us, and the airport was in town.

We took off towards town and started our thing. Pads and electrodes on, 1 14g in the good AC, an EZ IO in the good leg. Started giving him a fluid bolus cause his pressure was in the dumps. My medic darted his chest and got a little air out, but not much, which led us to believe maybe a hemo. I cleared his airway with suction and tossed in an NPA, then tried positioning and tossed in an OPA.

I noticed his breathing was getting more and more ragged and irregular, so I double checked with the medics and grabbed a scope and ET tubes. Snap on a Mac 3 and grab a 7.5 w/ stylet. Go in and take a look and I can’t see crap. I suction him out some more and still can’t see anything. Ask for cricoid pressure and finally see that white winking of the cords. I sink the tube, pull the stylet.

Grab the slipstream, hook it up and start bagging. Listen to lung sounds? Yep they’re there. ETCo2 looks good too. I look over the patient, who is looking more like a train wreck every minute. His femur that’s deformed looks like it’s quickly collecting tons of fluid, which between that and the chest would very easily explain his low BP. We get about to the airport when I notice that I can’t feel a pulse in his neck anymore. I look quickly to the monitor and notice flatline (like the monitor making all sorts of noise doesn’t clue us in). My medic starts CPR just as the back doors to our bus open up and the flight team hops in.

Since we’re not sending him by flight we beat feat to the ED and get him in there as soon as we can. They work him for another twenty minutes but never get any organized rhythym, let alone pulses, back.

We take our time cleaning up from that call and get paged out to an 911 hangup call that PD went to and then called us out on. The PD officer sounded frantic which made us wonder what was really going on. We get on scene and find something that goes down as the worst call in my career so far.

“PD, Medic 4, we’re pulling up now, does the officer have an update for us?” I casually ask into the mic, wanting to make sure the scene is still safe for us to enter and see what we might need.

“Medic 4, PD 214, get in here quick, young child unresponsive, trauma related!” This PD officer used to be one of our EMTs back when we were a volunteer agency, or so I’m told, so we know we can usually trust his judgement. Hearing him that upset rattles us a little bit though.

We bail from the unit, grabbing our pedi-board, collar, first in bag and toss it all on the cot. As we get inside we get the story from the officer.

“The husband and wife were apparently having an argument, and the kiddo dropped and broke something. So because the father was upset and the kid broke something he beat the kid until the kid was quiet. Wife called 911 then hung up after she thought better of it,” The officer tells us. We take a look at the kid and my vision goes red.

He is completely unresponsive to us as we get in there. He has bruises already forming on his face and neck, along with old bruises that we reveal when we start cutting into his clothes. He has several lacerations to his face, along with several to his forearms that look like they are defensive injuries. His face appears to have several fractures, but we can’t tell just how bad.

My medic and I work quickly and silently as we get the little boy packaged up onto our board and call our local fixed-wing service to get the boy transferred up to the childrens Lvl 1 250 miles+ away from us. I drive the bus so the medic can be in the back with the kiddo but we wind up staying in the ED to help prep the kid for the flight out. During transport my medic had intubated the kiddo because he had stopped spontaneous respirations, and reported that the kids’ pupil was blown.

The kid was transferred to the flight crew without any more problems and flown to Big City Hospital Lvl 1. I’m still waiting to hear more, I would love to hear that the kiddo would be ok, but I don’t know if he is. He is still on my mind and I can’t get him out of there. It’s just… I don’t know…

Seeing that just shook me to the core. I don’t like kids, but I want them eventually. My ex-fiance and me were supposed to have one, but working in the field made her miscarry, at least that’s what the docs said. There’s another little girl that I would help take care of in a heartbeat if the mother decided she wants to come out here with me. I love them both more than anything and I haven’t even met the little one yet.

What makes this even more like a roller coaster is the fact that the call that I term as the best call of my career. I had my first delivery in the field as a lead EMS provider. It was the most amazing experience I’ve ever had. I helped deliver a healthy little girl into this world without any problems for her or mom. I.. I can’t even begin to put into words how this felt. It felt like it made up for all the bad calls I’ve had since I moved here, all the bad stuff I’ve seen since I became an EMT 3 years ago (BTW, I realized that earlier this month marked my third year anniversary as a certified EMT). It has given me the energy and drive I need to push me forward, to continue on and keep going. To keep on riding hte bus day after day.

Then again, life is like a roller coaster to begin with, and EMS just exemplifies this.

Who are we?

I was watching the movie Across the Universe a week or so ago. And one of the quotes from the movie struck my interest when it comes to EMS.

Uncle Teddy: Because, Maxwell, what you do defines who you are.

Max: No, Uncle Teddy, who you are defines what you do, right Jude?
Jude: Surely it’s not what you do, but it’s the…the way that you do it.”
That symbol up there should be familiar to almost everyone who reads this blog. It’s the Star of Life. The symbol most used to represent the prehospital medical profession. We most likely see it daily. On our uniforms, our ambulances, our equipment, and even sometimes on ourselves.
So I’m going to turn that quote around a little bit. What do you think? Does that symbol define who we are, since so many of us are so passionate about what we do? Or do we help define what that symbol means to the public at large? I know if you show some member of the general public the ‘Maltese Cross’ (which really isn’t a maltese cross, but that’s a whole nother topic) the first image that strikes them is big fire trucks or firefighters with air packs running into a burning building.
Personally, for the past 3 years, that blue star has helped me define who I am. I’ve had some rough points since basically flunking out of college in my first year, and since then I’ve been able to dive into EMS to forget about bad things that happen. From day one in EMT class I knew I’d found something I loved, even to the point of getting a blue star of life tattooed on the back of my shoulder the week after I got my state card in the mail.
So, yes I am a little bit defined by what I do. I love helping people, I love working with people and getting to know them so well they are just like family, I love the feeling of actually belonging somewhere. And I also love the feeling of brotherhood that does tend to crop up from time to time. Due to the splintered and fragmented way EMS is provided in this country it’s not a thing like fire departments or police departments have, but it’s there in it’s own way. EMTs come together when one of our own is in need, and that’s good enough for me. I’m proud to be part of such a family.
But at the same time, also feel that one of our duties is to be the ones to define our jobs. A lot of our newer EMTs (which I’m not so far removed from. I still feel like a baby EMT at times) come into this job expecting lights, sirens, explosions, blood, and guts every shift. Those of us who have been around a little longer know better. Those calls are fun, but they can also be the cause of a lot of our nightmares.
The truth of our services is that the majority of our calls are ‘sick’ calls. That can range anywhere from a 21 year old with a low blood sugar to a 91 year old woman having an acute cardiac event. None of these calls are as glamorous as I’m sure the newbies have been lead to believe, but they are essential in shaping EMS into what we want it to be seen as.
Those younger EMS providers like me, @EMTGoose, @MsParamedic, among lots of others out there, are the ones who are going to be responsible for shaping EMS into what it hopefully will mature into. Our profession is still a young one, and we are having our share of growing pains. But when you’re out on a call, think. “How do we define what we do, because of what we’re making it?” and try to act like you want to make this a respected career in the medical field.
So, for now yes. I am defined by what I do, and I’m proud of that fact. I’ll continue to get called an EMS Nerd and try my best to soak up every bit of knowledge I can for the good of my patients. But on the other hand, I AM EMS. Every single one of us out there riding the trucks and walking into the scenes are EMS. Maybe Jude had the right of it. It’s really not what you do, it’s how you do it that’s the most important.
And lastly, just like each and every one of you out there reading this (I hope), I am EMS 2.0 just like each and every one of you.

Yay… new year… new challenges

Well, another year is over. I’ve noticed a lot of bloggers looking back on the last year, and figured I might join in. But, take note, that I hated 2010 for hte most part, so there will be very few good things I can say about it.

Last year:

My ex-fiance got married to my ex-partner,

I quit my job and moved to CO on the promise of a job (which never materialized),

found a job at a private IFT ambulance, then promptly got fired for doing something stupid.

Fell BACK in love with a girl who had been out of my life for years, had my heart stomped on in front of me, set on fire, and then the ashes scattered by said girl.

Moved back in with my parents,

Spent a lot of the rest of my money that I had saved applying for state certs in bordering states and going to places for interviews.

Got a job in BFE TX on a 911 truck (probably the highlight of my year)

Applied for, and get accepted to, paramedic school in the City.

Strengthened a lot of ties with #CoEMS friends and other great friends I’ve made on Twitter. I’ve found out who really will be around when I need a friendly avatar to talk to.

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Yea, that’s my list of 2010. This next year will hopefully be easier to make better. I’ll have new challenges. Like working FT, PRN, and being a full-time paramedic student. But I know I can make it through everything that gets thrown at me. I’m used to being on my own, and I’ll prove that I can make it all on my own.

Although the year is off to a rough start with us here in BFE. I pulled what was supposed to be a 36 hour shift over NYE and NYD. It wound up being a 24 since we had a busy day and 1 really bad call. We worked 3 major MVCs and one of those turned into a trauma arrest while we were transporting to the airport to meet a fixed wing to get him to a Lvl1 Trauma in Big City 250 miles up the road.

Curiously I didn’t really feel anything with any of those patients. Sure it was sad they got into accidents over a holiday weekend, but I just did my job and walked away with no questions in my mind or doubts about why stuff like that happened.

For the most part, calls that day had been routine calls. Headache, dizziness, drunk, the usual for a holiday weekend. No suicide attempts or people doing grossly stupid things… Until we got the call that got me sent home early.

We got dispatched out secondary to PD for a 911 hangup call. They got on scene and sounded pretty damned flustered when they were calling us, so we got there relatively quickly.

Now, keep in mind, I hate kids. With one very large exception I don’t want them. And the person that I would have helped them raise their daughter… well, long story. Longer than I wanna go into. That and kids on calls scare me, since I don’t deal with them well.

Anyways, we get on scene and find a kiddo that has been beat to within an inch of her life. Why? Because her low life dad was a fuckign drunk and apparently she had dropped something that broke. His solution? To wail on the kid until she was quiet. The mom called, then apparently ‘thought better’ about it and hung up.

I don’t wanna talk too much abotu that call, since I know it’s already going to give me nightmares. But yea, this year is not off to a good start.

So anyways… new year, new challenges. Let’s hope things go well. School, work, work, school. That will be my life this next year, and I can’t say I mind. Keeping busy is good. Keeps me from thinking too much. As I’ve found out this past year, thinking hurts in more ways than one.

Oh and I decided to not give up caffeine like I was planning this year. That would be suicidal I think. So I decided to just give up carbonated beverages (like my Monster  O_O), with maybe the exception of a beer a week if I ever am off duty long enough to have one. So, the drinks and losing weight are my only new years resolutions other than rocking the paramedic course and earning my disco patch by the end of the year.

What’s the worst that could happen?

First off, a note to everyone. This post has been written over several days, so I apologize for any rough parts. This isn’t quite where I pictured this post to going, and there will most likely be a second part coming eventually. But first, I’ve got a post for The Handover to get done, and a blog game that our lovely Cicatrix posted up that she gave me permission to use. So without any more rambling, the post:

Ok, to my two or three readers who expect something EMS, you’re mostly going to be dissapointed. That little difference in rural EMS of not running calls compared to urban EMS has reared it’s ugly head. My service is not running too many calls right now, it seems my black cloud has slightly worn off. Hopefully that changes for my next shift.

So other than that, it’s been a busy weekend for me. I worked a 12 on Thursday during the day and an on call shift that night. From my opening, I’m sure you can probably guess how many calls we ran on that one. Yep. Just one. And we were canceled before we even hit the scene. So I was actually able to get some sleep, which was a good thing, cause Friday was a long day.

Friday consisted of trying to get my car inspected so I can get it registered here in TX. It’s actually kind of nice to not be afraid of getting pulled over cause my tags were two months out of date. I’ve been procrastinating for some time about getting it done, but since I was going to spend the majority of Friday and Saturday driving, I figured it was about time to do it, especially since I was going through the only little town I’ve ever seen that ticketed my while driving an ambulance.

Why would I be spending most of my weekend driving you ask? Well, I had to drive to Clovis, NM on Friday. My New Mexico state EMT-I test was at 0900 on Saturday morning. I figured that even though I am working in TX, my proximity to NM and maybe working part time just across the border might make it a handy time to have my full NM EMT-I cert (I’ve had a provisional EMT-I cert in NM since I did the transition course this summer, but as I found, no one will hire you with a provisional certification). And if those reasons aren’t good enough, I had already paid to take the state test :) So I might as well.

Have you ever driven in West TX/East NM? No? Well let me describe it to you. Lets start with the landscape. Flat. With a primary color of ‘dying plant brown’, but some ‘puke green’ highlights here and there. Then toss in ‘towns.’ I though I lived in a small town, but a lot of these places you literally can blink and miss them. Then lay down the road. Almost all straight, but with exactly 9 slight curves on the trip up there. I think I counted 14 stop signs/lights during the trip too. I could almost lock my steering wheel straight ahead, and take a nap for the duration of the trip. So when I say it’s a boring drive, trust me, it’s really^3 boring.

So I get up there and into my hotel. Figure I want to hunt around for a beer and a burger so I can study some more. I found out my ex-fiance and her husband, my ex-partner are both going to be there. She was testing for recert for her NM EMT-B since she let it expire. That’s another reason for the beer. It’s really going to be the first time I sit down and talk with them after everythign that has happened in the past.

So I eat, and drink, and study, and drink. Finally I decide that if I don’t know this crap by now, I’m not gonna pass anyway. So I took out the studying bit and just went to surfing the net and drinking beer. Hey it worked. And I relaxed a bit.

But people, if you have to take a major test the next day, don’t get too drunk that you wake up feeling like your head is going to explode. It’s not a good frame of mind. I went to the hotel’s complimentary breakfast to try and eat something pretty bland, when I see the couple I didn’t want to see till after the test walk in. I had no idea they were staying at the same hotel I was. This was going to be a more interesting day than I had originally thought.

I say hi to her, gave her a hug. I ignore him. I’m still hurt by what I see as him betraying me, his partner. We worked together for months and he managed to stab me in the back. Me and her talk a little, just small talk about how her parents are doing, how’s my old service treating people, the coming test. That sort of thing. Soon enough the time has come for us to head over to the local community college to take our state tests.

It all seemed like a blur, but I walked out of the test feeling good about it. That could be a bad thing, since every time I felt good about a test in P-school, I wound up not getting very high marks on it. But maybe this will be a good start to this next batch of learning and testing I’ll be doing with my second go about medic school.

I find myself sitting across the table at an iHop from them a few hours later… Just like old times when we all worked together. It’s an odd feeling. We talk about what we want for our futures. I find out that my ex and her husband are trying to have a baby, and she is talking about going to school for her Doctor of Oriental Medicine. He is still talking about Medical School, and one in NM has pretty much already accepted him.

We started talking about what I wanna do. They both were happy to hear me decide that I wanted to do the BS-EMS Critical Care at UNM. Then he said something that stopped me in my tracks, “You know, that degree was made so UNM could try to attract more EMS providers into their medical school. Have you thought about going on to that?” I couldn’t say much, just shook my head no. I just told him that I didn’t think I could do it, that it was just a dream I had.

“After working with you for almost a year, I think you can do it. There’s no harm in trying. Talk to your old hospital, they have been having trouble keeping Emergency Medicine docs in their Emergency Departments. What’s the worst that could happen?” Hearing those words come out of the mouth of a man that I dislike, who dislikes me just as much made me stop and think about it. After all, if someone who doesn’t even like me, but knew what I could do thought I could do something like this…

It’s a similar situation like a fellow blogger had. She was talking to a friend at work and the same thing hit her. I don’t know what to do at this point. I did call my old hospital to talk to their ED director. He told me that they could very well work out a deal with me if I get undergrad out of the way and get accepted into the City Medical School. I’m just flabergasted that anyone would think I can do it.

I love being a field provider, a ditch doctor as some people call EMS. But the idea of being able to get to the top of the system and try to get change to happen for the field I love is a strong pull to doing it.

After all, what’s the worst that could happen?

98% sheer boredom, 2%…

I’m starting to think that down here my most used sentence on calls is “Does anyone here speak English?” Makes me realize that for the communication portion of my AAS I’ll definitely be taking Spanish to at least get some basic conversational skills to help me out in the field.

We had a call the other night that highlighted the fact that there is a large percentage of our population here in BFE that has never bothered to learn to speak English. We get called out for a simple fall out of bed. Should be nothing major, right? Well, we get waved down at the address (Ah the infamous Bystanders Sign language) and start to head in. We leave the cot in the bus for a bit, and just take the first in bag with us.

I walk into the door, still pulling on my gloves, and just about stop in my tracks as I see the patient. Something just doesn’t look right.”Hey there,” I say to the husband, “What seems to be the problem tonight?” As if I can’t see that his wife is sitting on the floor after falling out of bed. Never hurts to ask anyways.

“Umm… No English,” Were the only words that he said. Great… I think to myself, this is going to be an interesting call, since the old man doesn’t speak Spanish either. I kneel down beside the woman on the ground. She’s pale, diaphoretic, and just seems to be flailing around. She can’t focus on me at all, and just withdraws a little when I give the webbing between her thumb and index finger a pinch. I do a quick trauma sweep and don’t see anything that could cause too many problems.

“Lets get her on the bed so we can take a look at her.” I tell my partner, who technically is the senior of us two since he’s a medic, plus the senior medic at the service. But he seems to be letting me run the calls more and more and just getting involved when something needs done that I can’t do. I don’t really mind that too much since I need the contact hours since I’m starting medic school in a month or so.

He just comes around to grab her under the arms while I grab her legs, and we heave her up onto her bed. With her on the bed, she’s in a little bit better light, and I can take a quick look at her. She looks even more pale with full light hitting her, so I look at my partner and ask him to bring the cot in.

I break open our first in bag and quickly pull out a pulseox, BP cuff, and the glucometer. I look at the husband and, knowing it might be useless, ask, “Does she have any medicines? Umm… Pills, shots… Medicinos?” I fall back on the old joke in NM of adding ‘o’ to the end of every word to make it Spanish. Amazingly enough this time, it works. He gets a big smile on his face and goes into the kitchen and starts rummaging around like he’s looking for something.

That never works, I think to myself, shaking my head. Oh well, maybe I’ll have some good luck on this one. I quickly inflate the BP cuff to my usual 150, and slip my stethoscope in and listen. I immediately hear the heartbeat in my ears, so I keep inflating until I hear nothing.

Uh oh, 190. Not good. I think as I slowly let air out and listen for the change in sound to let me know I’ve got a full blood pressure measurement. 190 over 110… This doesn’t look too good for her right now. Look down at the sat, it doesn’t look too bad. 96% on room air, pulse showing as 95, and a quick grab at her wrist confirms it to be in about that area.

I hear the husband still looking for whatever he thought I asked for, hopefully it’ll be the medications she’s on, so I can have some idea of her medical history. Right now I’m wondering if she might have a history of hypertension or heart troubles, since right now my number one concern based on her presentation is a stroke. I hear my partner get the cot in the front door and we quickly move her over to the cot. I let him know what I’ve got, and he agrees with me about my concern. Looking her over again it almost looks like she has some facial drooping on one side, but since we can’t get her to do the other parts of the stroke scale, it’s kind of hard to say for sure if that’s what we’re dealing with.

The husband finally comes out of the kitchen clutching a little soft sided cooler, like the ones I brought my lunch in every day for my first try at medic school. He smiles as he hands it to me, and I open it up in a rush to see just what conditions she might be dealing with. As I look into the bag, I feel like an idiot. A bottle of Metformin and a Novalog pen are staring up at me from the very top.

I snag the CBG kit from where my partner had left it, without getting a sugar I guess, and quickly grabbed a sugar level from the patient. Yea, 20… That might explain some of these signs.

Digging again into the jump bag yields a little white box, which I toss onto the bed, along with a syringe and a couple of needles, and an alcohol prep. I drag the vial of sterile water up into the syringe and inject it into the vial of powdered Glucagon. The old man sees what I am doing and grabs out a bag of NS and a line set and gets it set up and looking for a vein on his side.

I get the newly reconstituted Glucagon all ready to go and as I’m switching needles so I can give it to the patient I notice my partner has gotten a line and is taping it down. Once I stab the syringe of medication into her arm, I toss him a box of D50 and he goes to work pushing it.

Within 30 seconds of the start of the D50 being pushed, she starts to come around. She has that very confused look on her face that a lot of people experiencing hypoglycemic incidents get when they wake up to several strange men standing around their living room. As we’re trying to explain what happened, our other truck shows up, with one of the crew able to speak Spanish.

Great timing, why couldn’t you have been here ten minutes ago?! Oh well, at least now we know she’s telling us she doesn’t want to go with us. After all, kidnapping is highly frowned upon by the authorities.

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And by the way, the high BP was cause by non-compliance with HTN meds… and for the record, don’t take your AM dose of insulin at night with your nightly dose because you forgot it in the morning. Do that and pretty good chance you’ll be waking up to strange people staring over you when you wake up.

All in all the last week has been a good week. I’ve had good calls, including one ROSC code, that have helped me remember why I love my job. I love the challenge of figuring out why someone is down and out, of trying to get someone out of a car without hurting them too much and get them to the hospital safely, of helping family understand what we are doing to their loved one and why. The days of constant waiting, of cleaning trucks and stations with nothing to break the boredom, I can put up with those kinds of days because of days like this. Good calls that get me thinking and working hard. Calls that make me put the knowledge I have to the test, and look up more after calls to double check that I know the latest on treatment modalities. And of course, calls like I’ve had, where I can’t do what I know is needed to be done because I’m not a paramedic… They just spur me on more to keep going and get more education. And I’m counting down the days until I can be back into that classroom and start on the #questforthediscopatch.

Wait… Already planning again?

I’ve been here in BFE, TX for about two months, yet I’m already looking at planning my next move. Actually my next two at least. Maybe being single actually a good thing… Since I apparently have a problem settling down and staying in one place for very long.

I plan on staying here in BFE for at least 2.5 years or so. Long enough to get my AAS in Paramedicine and my Paramedic License (not cert) here in TX. Plus it’ll give me good experience working in a 911 system, and prove to myself that I can handle being definitive care for a long transport until I can actually get them to a hospital. That means a lot to me since I’ll actually have time to see my interventions make a difference or not, instead of dropping off the patient after only being with them for 10 minutes or so.

It’s ok living here, but it kinda sucks to have to drive at least 70 miles to do anything. I guess while I like living in a small town, there’s a limit on just how small. The town in NM that I lived in HS was just barely larger than here, but it had a college and a few things to do at least.

After I finish up my AAS and get some experience, I’m looking at moving back to NM and going to the University there and going for my Bachelors of Science in EMS on the Critical Care track. There are a few services I can work for down there that I am pretty familiar with, plus my old service down there if I really wanted to.

Some people have asked why I would make a move in the middle of going to where I really want to work at just to go to school for another two years, especially since I’ll already be a paramedic. Well… because I believe that more education is essential in this field. I want to have as much education as I can so I can better serve the patients who trust me with their care. The fact that they don’t get to pick and choose who responds to their calls makes me want to work that much harder to make sure I’m the best provider I can be and see if I can help change the system from the inside out.

I figure I’ll stay there for a few years (as short a time as I can manage while getting my degree) and then get ready to move again. I really don’t want to do career EMS in Albuquerque, just not that fond of the system there. I’ve been looking at various systems that I would love to spend my career working in and I’ve come up with three of them. One is Austin/Travis County, of course. A great third service in a good system. I’ve heard only good things about them, but heard they might be going to a P/B or P/I truck instead of the P/P trucks like I’ve heard they run.

My second option is Wake County EMS. This one appeals to me due to the fact that they have a community paramedicine program. That type of work really makes me happy to think about. I’d love to do it.

And the last option I’ve thought of so far is back to Denver to work for Denver Health Paramedics. Primarily a Paramedic agency with very few BLS trucks. I love the area up there and the agency didn’t seem too bad when I was there.

So those are my rough plans for the next 6 years or so of my life. Lets see how much life will throw at me and force me to change those plans. :)

Well, I’m on shift now as well, so it’s time to watch some more TV unless I find something else to ramble on about! Ya’ll stay safe out there.

The Handover is still going…

But it needs your help!

It seems like with so many people out there trying to save the world and make a difference in EMS, no one has any time to pound out a short post for the Handover. I’ve always loved it since it’s a great way to find new blogs and see multiple peoples viewpoints on one topic. But the participation lately has been lacking.

I’d love to see it if it can get back up to a couple dozen bloggers all coming together for one topic. I know there’s tons of us out there, and we all like attracting new readers. Well, this is one way to do it.

This month it’s being hosted over at my fellow primate’s blog, the Rescue Monkey, and the topic is one all of us can relate to. Burnout. It’s something that a lot of us have had to deal with at one point or another, me included even though I’ve only been doing this for 3 years or so.

I’ve asked to host the January edition, and the wonderful @JustmyBlog is hosting the December edition, so lets see if we can drum  up some more posts for the next three months :) After all, who doesn’t like to get new readers and talk EMS with all of our wonderful EMS bloggers?

My post for this edition of the Handover is coming soon, so keep an eye out for it. And I hope to see ya’ll put up some good posts as well.