Thursday, April 10, 2014

The Night Shift - Round Two

Another mobile post on the overnight shift. It is interesting being the first person people see when they walk in. Regardless of who they are and why they come, in principle all should be treated the same way. Sometimes, however, it's difficult to do that, mainly because the people who come are not always forthcoming with the truth. When that happens, my inner cynic wakes up, and the voices in my head become loud indeed.

Some general observations I've made:

1. The sickest people don't come on their own. And usually they don't want to come here if they can help it. Those are the ones you know will die without help.

2. Those people who could stand to wait until normal business hours to be seen inevitably show up at 3:00 in the morning. And it is usually for problems that don't need intervention then and there.

3. Those who are homeless that are seen here, if it's cold or the weather is inclement, will inevitably try to hide out in the waiting room so they don't have to go outside.  That happened last night, in fact; a patient who had been seen for a couple of different issues managed to get under the radar for a couple of hours before she was discovered.  Clearly she was stalling; her plan was to get admitted so she would have a place to sleep. But that didn't work out for her. And I discovered her at 6:30 yesterday morning...

4. The people who deserve misfortune the least seem to be the ones who suffer the most, no matter what the reason is.

5. Time flies when you're busy.

Some of these observations bleed over into my work in the field as well. The thoughts I have in the end don't always fit precisely into the same mold, but they are close enough.  And I'm sure I'll come up with more as time goes by.

Tuesday, April 08, 2014

Hands Free

I'm trying something new. Rather than use a keyboard, I'm going to compose this with my voice rather than with my fingers. My new phone has hands free capability. My old phone did as well, but I never used it because I didn't think I could. Also, I didn't realize the phone had it until it finally died. 

The only thing that I'm having trouble figuring out is how to insert carriage returns or extra spaces or any specific punctuation. I know that if I say certain words like the word "period" or "comma" they will insert automatically. However, I don't know how to plug in other types of punctuation or anything that is special in terms of text. But I'll figure that out as I go.

Between insanity at work and being sick, it's been a rather interesting week. This past saturday wound up being a 20 hour work day. It was mostly do to a lot of volume, but there was a very interesting call that came in from overseas involving a child, a stressed out international medical team, and a big time crunch. That ended up keeping me busy for a lot longer than I planned. In the end, however, it worked out just fine. But it did take a lot out of me. Plus, there were internal shenanigans at the end of the tour that kept me on the clock for about three hours extra. By the time I left it was almost exactly 3:00AM. That made my day twenty hours long instead of the normal sixteen.

On Sunday and yesterday Martha and I were dealing with either an intestinal bug or we ate some bad food. I suspect the former semi colon if it were bad food I believe we both would have had similar symptoms but they were just a bit different. And I was able to go to work yesterday. Martha stayed home and slept because she really needed it.

As I compose this post I am multi-tasking. I'm working on household chores. That means doing dishes , laundry, and the general pick up of household that has a small child living in it. And that work seems to never end as the girl is a four year old tornado. Because she is such a lovable child, though, I overlook a lot. That's tough for me to do because I am somewhat obsessive-compulsive, and seeing anything out of order makes me insane. But I really work at understanding that she is learning about how to avoid entropy in her own time. And hopefully she'll be a lot more casual about it than I am.

Tonight is an overnight shift in the emergency department.  Considering how things are, I'm sure it will not be boring. And I have no doubt I'm right about that. As for the hands free writing, I got about three quarters through. The last couple of paragraph so are typed. Not perfect, but it's something new to learn how to fo. It will get easier over time.

Friday, April 04, 2014

A New Toy

I had to replace my phone. I was having trouble with applications crashing regularly and with the phone running out of memory. It was starting to become a real issue as this is how most people I know contact me. Plus I wasn't due for an upgrade until October.

Last night Martha surprised me with a new phone. A Samsung Galaxy Note 3. I had an idea she was getting it for me but I wasn't entirely sure. But she showed up at work last night with a Verizon bag in her hands. In the bag was the phone. The tech at the store got the number activated but left the rest for me. I was absolutely fine with that because I am somewhat particular about how I wanted it configured.  I have it mostly the way I want it now. With a bit more fine tuning I should be good to go.

As I already have a Galaxy Note 10.1 tablet as well this will be a solid complement to that. I really like Samsung products; they are well designed and very friendly, not to mention powerful. So far I'm very happy with it. And today I put the phone in an Otter Box Defender case as well as a screen protector. This should support the phone quite completely.

This post is coming from the phone, in fact. It is proving to be very easy to write. And I expect to be able to do this more frequently now that I have such a good tool for the job when I'm out and about.

For now, I'm going to recuperate from some long work days before it starts again tomorrow.

Monday, March 17, 2014

The Night Shift

About six weeks ago I started working in the Emergency Department at one of our hospitals. I work up front, greeting patients and doing the first step of triage. In a nutshell, that is the core of the job. It is not that difficult, but the key skill someone in this position has to have is the ability to discern who is really sick and needs immediate care as opposed to those who can wait. Most of the time it isn't difficult. Sometimes it is; it depends on the volume and the circumstances.

Most of my scheduled shifts are overnight, from 10PM to 8AM. Occasionally, however, I'll pick up other shifts as well. I work approximately 24 hours a week in this job. I find that between this, my job in Boston, and my shifts with the Fire Department keep me plenty busy.

Right now I am sitting in the greeter chair. I've been here for a couple of hours and it has been a little bit busy. We see mostly minor stuff, but as I said, it can get hairy from time to time. The last tour I worked here had that quality, especially near the end. We'll see what happens here as the night progresses.

I am back here tomorrow, eight hours after this tour ends, but only for six hours instead of ten. That will give me enough time to get some breakfast, take a nap, and do it all again. The good thing is that it is not sixteen hours in a row; I did that yesterday.

It is hard to believe that it is nearly Spring because it is so cold outside. I know the weather will change and start to warm up. Right now it is a waiting game; what I suspect will happen, and always seems to, is that the change of season will occur in the blink of an eye. And people will complain about Summer showing up out of nowhere. But I expect no less.

At the moment I have nothing to pontificate about. But give me time; I will come up with something.

Friday, February 07, 2014

Four Degrees

That is the current temperature outside as I write this post. Nearly 1:00AM and I am still awake. What a surprise.... I suppose that has become the new normal over the past few weeks. Probably due to the changes in my work schedule; I have no doubt that the modifications I've made recently have contributed to the weird hours I keep these days.

One of the changes is relatively recent; I started working in the Emergency Department at Catholic Medical Center in Manchester a couple of weeks ago. I was hired for 24 hours per week to work up front, and I am orienting in the department now. It will take me approximately 5-6 weeks to get through the department orientation, but I think once it is done it should be a pretty interesting job. It will certainly add to my experience, and that is something I look forward to. More learning, but it is good to learn new things. Learning is like exercise; the more you learn, and the more different things you learn, the more well-conditioned the brain becomes. And I believe the folks at Lumosity have gotten it right, in terms of the word "neuroplasticity"; the neural networks we possess expand exponentially when they are stressed. And that is as it should be.

We got a load of snow out here yesterday. My back step had a total fall of approximately 10 inches, which was more that what was predicted. And the temperatures reflect the snow counts as normally when there is no snow the air is a bit warmer. Not now, I'm afraid; it is simply cold. But it is winter in New England; shouldn't it be cold? And this one is as I remember it when I was growing up.

As I write this I am working. Not a surprise there; it is technically Friday morning, and I have been here for a bit shy of 7 hours. We got in from a call a little while ago: an elderly male with mental status changes. Hallucinations and visual disturbances, to be more accurate. Pretty interesting and diffucult at the same time. History of end stage kidney disease - he is supposed to have a dialysis shunt implanted soon. Maybe that will take care of some of the issues, but it is hard to know. Also a diabetic; this always compounds things because of the nature of diabetes. It is an insidious, vicious disease that destroys organ systems over time because of the damage done to peripheral nerves if glucose levels are not controlled. And there is no such thing as age discrimination as it can affect anyone no matter how healthy the person is. But it has to be tough to deal with when you're already compromised metabolically, not to mention physically. And the damage to his kidneys is already pretty much complete. Between the two pathologies that are present, he will likely continue to have a rough row to hoe as time goes on.

I am hoping not to have to deal with the cold again tonight. Hopefully I'll be able to get a nap in. But anything can, and usually does, happen, so if I expect crazy things to happen I won't be disappointed when they do.

Tuesday, January 21, 2014

No Color

Or at least very little....

I took this photo right outside of my front door. The only real color that is present is in three distinct areas. The first is the fire hydrant at the bottom left. The second is the stop sign. The third is on the building across the street.

They are splashes, at best. Note that there is really not much else in the picture. The white SUV in the middle of the shot was accidental; I couldn't have planned that if I tried. All I wanted to do was capture the dirty whiteness of the old snow on the ground, the deep gray of the pavement, and the off-gray in the sky. The white building across the street actually jumped out a little more than it usually does because of the lack of color present.

I took this shot because of the conditions of the day. It is roughly 10 degrees Farenheit outside as I write this. Actually, 9 degrees according to the digital thermometer outside my door. There is a major winter storm on the way. Depending on who is providing the forecast, those of us in Southern New Hampshire fortunate enough to live here can expect to see anywhere from a dusting to about 10 inches (25cm for my Canadian and European friends) over the next 24 hours. It is12:45PM as I look at my clock. Snow hasn't started here yet, but I expect to see it anytime.

I am worried a bit about Martha; right now she is in a meeting with a client in Brattleboro, Vermont. She had to cross both Temple Mountain and the Monadnock Region of New Hampshire to get there, not to mention the Connecticut River. I truly hope she gets a head start on the snow. And I don't expect to see her for the next 3-4 hours, depending on what other work she might have to do.

So I found an outlet for my frustration about not being able to start PA school. One of my friends told me about a website that is a hub for online learning, mostly at no cost. So I investigated it, and discovered there were some things I could do to at least keep my mind from withering on the vine. The site is called Coursera. The course offerings are varied as are the institutions offering them. It is all online. And while the courses themselves are provided at no cost, to get what they term "verified certification", or actual proof of completion, there are nominal fees for that if one so chooses to go down that road. I haven't decided about that yet, but we'll see how it goes and whether or not I like what I get out of it. I don't know if any of these can be used for credit or not. That, in itself, doesn't concern me. Right now I have close to 170 hours of undergraduate credit under my belt; I don't think I need any more. But it would be good to know if that is an option. If I become so inclined, I will check that aspect of it out.

I had forgotten how much pleasure I take in writing for its own sake.  I have been told that I write well and that I express myself better than most. While I truly appreciate the compliment (and I really, really do), the real reason I write is because it is an outlet for me. Plus, it is a way that I can organize the absolute spider's web of stuff in my mind by putting it down, looking at what I said, re-arranging it in a way that makes sense, looking at it again, then letting it sit. Sometimes I go back to it, look again, discover that I either misspelled a word or two or repeated a phrase, and fix the errors. It is good exercise for the mind.

In some ways, it is sort of like prayer; once I put whatever is on my mind out there, I can let it go. And I find that if I write to pray rather than speak to pray, it is easier for me to do that. I tried to explain that to a priest friend of mine once, and he understood what I meant, but he is really old school; he didn't agree with me. We ended up having a rather spirited discussion where my point was made by using the following teaching of Jesus as an example: "but when you pray, go to your inner room, close the door, and pray to your Father in secret. And your Father who sees in secret will repay you" (Matthew 6:6 NAB). While writing for an audience is not the same thing by any means, there is a parallel. If I kept a private journal - sometimes I consider that in addition to writing this, but I don't think it's a good idea simply because it would be duplication of effort - that could be considered a form of writing that is in secret, like prayer. And that was the crux of the discussion. I don't think he will ever agree with me on this, but that's okay; he knows where I stand, and I feel like maybe that is enough. And I will still ask him to hear my confession from time to time...

On that note, and at the risk of running the battery on my keyboard down, I think this is a good place to end it for the day. More to follow on the weather. And think about the lack of color in the photo. It makes me want to see Spring really soon....

Sunday, January 19, 2014


I hate writing hard posts. Unfortunately, this is one of them. While I haven't written one like this in a long time, I find that doing so helps me work through the difficulty I have dealing with what is in front of me. And this is one of those times where I feel a real need to do that.

This past Thursday I worked one of my shifts at the firehouse. Normal, not too difficult. Went out once at 7:15PM-ish for a call. Chris, my partner, and I had planned grab dinner, but we got sent out. I forgot to mention that we had a third rider, a department member that has ridden with me in the past. Andy - nice guy, really bright, but needs to get some more experience. I like him; he simply needs more grooming.

Anyway, we went out to do this call. Ended up taking care of a fall victim. We got back, were finally able to get a bite to eat, and we were for the rest of the evening. We were up until 11:30-ish. Our third rider headed out at that time, so Chris and I settled down to try to get some sleep.

We were woken up at a little before 4:00AM. We were sent to one of the assisted living facilities in town. Fall victim. We arrived on scene, and the patient - a 75 year-old male -  had fallen out of bed. As we were walking up to the room our patient lived in, we heard the cries of, "Help! Help" coming from inside. We found our patient sitting on the floor next to his bed. The one thing I thought was interesting was the posters on the walls. All from Broadway shows. Plus, a very extensive collection of CD's and DVD's. Show tunes. Broadway soundtracks. Plus the DVD's were musicals, movies, etc.

We checked on our patient; he wasn't injured, but he couldn't get up. The house custodian told us he was down on the floor for probably 15 minutes before we arrived on scene. So we got him off of the floor. His legs were underneath him; I suspect they had fallen asleep. When we got him on his feet, he was able to move around without difficulty. And he didn't want to go to be evaluated. That was fine; he wasn't injured. So he signed a refusal of treatment and transport, and we were on our way.

Got back to the firehouse about 4:40. I attempted to sleep until my alarm went off 40 minuts later. I packed up and got ready to end shift.  As I was walking into the day room, I caught some radio traffic on the police department channel that got my attention. The dispatcher said, "we got a medical call coming in from __ _________ St. I can't understand the caller; she sounds pretty hysterical." About 10 seconds later we got an incoming call tone.

"Respond to __ ___________St. Echo level medical call. Individual not conscious, not breathing. PD en route."

As soon as we got on the road, about a minute later, dispatch came on the air and asked us to call. When I did, I was told that we were headed to the scene of a suicide. We just needed to declare death and help establish a time. When we arrived, we were directed to the basement of the house where we found a man hanging. It was easy to confirm death as he had all of the obvious signs that I was looking for: rigor mortis had set in, there was dependent lividity (pooling of blood) showing in his hands, he was pale, and he had an angle of about 45 degrees at his neck.

Police officers on scene had his information, and when I asked for it and was given his name, it was like I got hit in the face with a brick. This person was somoene I had known for close to thirty years. I hadn't seen him in a very long time, and I didn't recognize him. Plus, this was someone that others I know also knew well.

I spoke with his wife prior to leaving the scene. Apparently there had been an argument the night before. Not the first, from what I gathered. And it was pretty intense. Intense enough, in fact, where she was scared for her safety. She had planned to leave him, and whether or not she intended to follow through with that, he must have gotten scared himself. On my part, however, that is purely conjecture. I have no idea what was in his head. But that doesn't matter now.

I feel badly for his family. Really badly. And while I am less upset than I was before, I am still pretty angry. But it doesn't matter what I feel or think.

If this were someone I didn't know, it would still be difficult, but when it is personal, it is much harder.