Thursday, January 28, 2010

Variety

I worked in Newton yesterday. As 24 hour shifts go, it wasn’t especially horrible. For that matter, I haven’t worked an especially horrible shift since I’ve been there. On average, over a 24 hour period we’ve been doing between 5-8 calls per ALS truck and maybe slightly less than that per BLS truck. Moderately busy, but not killer. Not like I expected it would be. But then it is winter, after all. And there have been some interesting calls that I’ve been on. Some of them even worth talking about.

First, I have to talk a little about my partner, Keith. He’s been a Paramedic for a really long time – probably 14-15 years of experience. He’s also a part-time supervisor, which is unique. Two senior-level medics on a truck is a a bit of a novelty in itself, but it works really well. We don’t waste time on calls, we back each other up, and we provide, at least in my estimation, good care. Plus we have a good time.

One cannot ask for much more than that.

Every one of Cataldo’s ALS-level 911 trucks has a Zoll Auto-Pulse on board. For those not familiar with it, the Auto-Pulse is described by Zoll on their web site as a “non-invasive cardiac life-support pump.” It is minimally apt description of the device, and the reason I say that is because of the manner in which it works. Basically, it is a short board with a band that is attached underneath and around it. The band itself attaches to a wheel of sorts that spins in alternate directions in high speed, providing the ability for the band to constrict around the patient’s chest. And the way it does, at first glance, looks absolutely barbaric.

But it works.

A couple of weeks ago we got dispatched to a residence for a cardiac arrest. Arrived on scene, found a 75 year-old male lying on the floor of his bedroom, not conscious, not breathing, no pulse. His sister, whom he lived with, reported that there was maybe 10 minutes of down time. There was a houseful of responders, from the two police officers initially on scene to the engine company who responded with us as well as Keith and me. There were probably 10 people there and the potential for it becoming a mess was actually pretty high. Keith had brought the Auto-Pulse in with him and I had the monitor as well as the first in bag. The first thing we did was got him placed on it. Prior to our arrival the officers had put him on their AED and were able to get a shock in. When we got there, though, he was asystolic.

When we got him placed and set up on the Auto-Pulse, we turned it on and let it do its job. And, as I said, initially it is a rather barbaric thing to witness if you’ve never seen it in operation. But the good things it does include squeezing the whole thoracic cavity and not getting tired. Except when the battery runs out, of course, but the life of the battery can be anywhere from 30-45 minutes.

So we got him out of the house with the Auto-Pulse working, Keith intubated him, and I placed two IO lines. I did this because in getting medical history I found that he was in End Stage Renal Disease – he had a tesio catheter implanted into his chest, and there wasn’t any way I could access it. First, they’re out of bounds for other than dialysis use because they are a twin-catheter system; one lumen goes into the venous circulation, the other into arterial circulation. Second, even if accessing something like that were in my scope practice and allowed by protocol, I wouldn’t have a clue what to do with it. He had nothing to speak of for peripheral vascular access, which is pretty typical for renal patients, so I really didn’t have much choice.

The IO’s worked flawlessly, though. We got everything done within 10-12 minutes and were on the road. He got 2 rounds of medication on the way, and by the time we got to the hospital he had pulses return.

He lived for short time – maybe 1 or 2 days – but ultimately he did pass away. We found out a couple of things that nobody made us aware of after the fact, also. First, he had a DNR. It would have been nice to know that, obviously, but we didn’t have that information. Second, he was a retired chaplain for the Boston Fire Department. A Catholic priest. Which makes sense in hindsight; between the San Damiano crucifix and the byzantine-style icons hanging in his bedroom and the fire helmet on the shelf I should have figured that this or something like it was the case.

Regardless, it was amazing to see a device like this work so efficiently. And there are many cases where recovery was full and complete.

Not all of our calls have been so intense, though. It seems we’ve transported a large number of older people, but there is a good share of the not so old as well. Like the 19 year-old male we transported this morning with nausea and vomiting as well as some increased respiratory effort over the past 4 days. A history of asthma plus what I suspect is a virus of some sort that won’t shake itself loose. He needed anti-emetics, so he got Zofran from me during transport. Clear lung sounds but some discomfort on inspiration and no abnormal respiratory effort. This made me suspect something viral even more.

It’s a really interesting place to work. An affluent community that at the same time is somewhat needy, for lack of a better word. Starting a week from this Saturday I’ll be in Newton full-time as I’ll be working on the other medic truck on that day. While I’m looking forward to it, I’m going to miss Jenn, my partner on the Boston truck. But she doesn’t need me anymore. For that matter she’s never really needed me. I was in the right place at the right time to help her with confidence.

But I’ll still miss her.

Monday, January 25, 2010

A Sketch Of My Friends

This is something that happened a very long time ago – I think this call occurred in 1998 or 1999; I’m not certain which - and the reason I’m writing about it is not so much because of the call itself. Instead, I wanted to talk about the makeup of the crew. The guys I worked with on this call were a really good team. I was privileged to go with them most of the time as a third wheel.

Andy and Tommy were both considerably younger than me. Tommy lived just up the street from me – he was married to a very pretty young woman and had an 8 year-old daughter. Andy was even younger than Tommy, probably by 4 or 5 years, I’m guessing. I’d first encountered him when he was a fire explorer, and he had the job in his blood.

We had all gone through the EMT-Intermediate course at the same time, and Tommy and I had taken and passed the exam and became certified. Andy was not so lucky; while he passed the practical, he failed the written exam and had to re-take it. And while Tommy and I were not firefighters, Andy was; he still is, for that matter. But more on that later…

It is important to note that back then the Fire Department ran EMS service as a call function – much different than how it works these days. All of the members had pagers, and if a call was dispatched, the duty crew for the ambulance being dispatched would respond out from their homes. That meant members could have emergency lights in their personal vehicles, which was an indication of the level of whackery said members had. I was no different; I also had lights on my car. Thinking back, it must have looked pretty funny to see a box on roller skates with red lights and alternating flashers heading in the direction of the fire house.

But I’m digressing. Back to the story.

It was a rather cold evening in mid-January, and we were dispatched to a home on the town line of Goffstown and New Boston for a well-being check. The three of us were on the duty crew, so we showed up at the fire house within a couple of minutes of the dispatch and got under way. When we arrived at the address we were being sent to, there was nobody else around. The lights were off in the house, and police had been dispatched but not arrived yet. Also, because we were automatically dispatched into another town, the ambulance from New Boston had not arrived by this time, either.

Because we were the only ones there, and not knowing what we potentially could be dealing with, we had some decisions to make. While none of us were technically in command, someone had to take charge. For whatever reason, Andy stepped up and got us going pretty quickly, telling me to bring in what I thought we’d need for medical supplies. We got out of the ambulance and grabbed not only our first-in bag and an Oxygen bottle (I had those), but Andy and Tommy grabbed tools out of the extrication kit. Andy had a Halligan bar and Tommy had a mid-size sledge hammer.

As we approached the house a police cruiser from New Boston showed up. He got out of the vehicle and asked us what was going on. Andy said, “we don’t really know. We got sent here for a well-being check and this is what we found. We’re bringing the tools in case we have to force the door, and we’re glad you’re here now. Just in case, of course.”

At that point, Tommy asked him if there was any family available that might be holding keys. The officer said, “do you know the owner? Her son owns the garage right next door and we’re trying to get a hold of him now.” Turns out the auto shop next door was owned by a friend of mine named Rob. I should have realized this, but it didn’t occur to me until right then that I knew the owner of this house. An approximately 70 year-old female with a cardiac history that I not only knew personally but I’d also transported her to the hospital more than once. Each time I’d transported her was from her Rob’s, and I had no idea that she lived at this house.

It was really bizarre; the guys must have sensed my own feeling of urgency because all four of us starting moving very quickly towards the front door. When we got there, I tried it; no luck. It was locked. We looked around to see if there were any windows that were ajar, and the officer went to the side door and tried that. It was also locked. Andy looked at us and said, “we have to force the door.” Tom and I both agreed as it appeared that nobody was going to open that door any other way.

So we did. Andy braced the Halligan’s blade as much as possible up inside the door frame and Tommy hit the opposite end of the bar twice. Really hard.

On the second blow the door flew opened. Some chunks of the door frame went flying on the movement of the door, but we were inside. The first thing I noticed as we walked in was that it was really cold in the house. I took the lead as we fanned out through the house. When we found her, it was apparent she’d been dead for a while; rigor had already set in. She was fully clothed and lying on her bed. There was nothing we’d be able to do for her.

Maybe 5 minutes after we found her, both New Boston’s ambulance and her son Rob – my friend – arrived at the house. While New Boston’s crew (the EMT in charge was and is still a good friend of mine as we were in Paramedic school together) found me with the body doing the last of the checks that I needed to do to confirm death, Andy and Tommy spent time calming down my friend.

I was pretty impressed with the way they handled Rob; they were really good at both talking to him and listening to what he was saying. He said he knew that something was up because he’d spoken with her the day before. She told him she wasn’t feeling well and was going to rest. As for the temperature of the house, she ran a pellet stove and hadn’t refilled the hopper. That explained why it was so cold there…

We stayed with Rob for quite a while. Actually, Andy kept him company while Tommy and I brought the ambulance back to the firehouse then we drove back up in our own cars to stay. He didn’t ask us to but we felt like it was the right thing to do. And it was.

That simple act of wanting to stay and help has always stuck with me. Shamed me a bit at the time, too, mainly because I felt bad that I didn’t think of doing that first. But it really doesn’t matter; what was really important being there for my – our - friend. And we stayed until the funeral director took her out of the house.

Today, Andy, as I said, is working as a member of the Manchester Fire Department. Tommy is living down in Tennessee working as a Physician Assistant. His daughter is 19 and in her second year of college. And his lovely wife died of breast cancer two years ago.

Both Andy and I wished we could have been there for Tommy.

Sunday, January 24, 2010

“The Americans Are Coming”

I’ve been known to become annoyed with CNN’s reporting of the news from time to time. Anyone who has read this blog now and again certainly has seen this. Part of the reason I get so frustrated is not because of the reporting; it’s because of what I feel is a sense of incredible pickiness. It sometimes doesn’t seem to matter what happens. Whatever the reason, it seems that the underlying cause is because an incident or problem that has occurred somewhere else in the world is the fault of the United States. Plus, the reporting tends to lean a little more to the left than I am able to tolerate. The same could be said of MSNBC and also of Fox. The difference is that Fox leans a little more to the right rather than the left.

Whatever happened to balanced journalism, anyway? It seems that reporters opine instead of report. And that’s not right.

However, once in a while, those who are supposed to opine make a point in their published view that is hard to ignore. Sometimes they even say something nice. And I read one today that managed to accomplish both of these things.

Bob Greene, a contributor to CNN, posted an opinion piece today online that I really thought was worth reposting. It isn’t necessarily a “feel good” piece, but it points out something that perhaps many people have forgotten. It is as follows.

There was a phrase, or so we have long been told, that was heard in occupied Europe during World War II.

It was often said as a whisper, the story goes. It had the sound of a prayer.

The words were so simple, but to people who were feeling utterly abandoned and who needed help, those words meant so much.

Four words:

"The Americans are coming."

Sometimes we forget about the power of those words, and about how, for so long, they defined the real meaning of what this country, at its best, could be.

Sometimes, in the midst of all the bad news, in the midst of the mistakes this country inevitably makes, we lose sight of how much the people of the United States are counted on by those in need.

Which is why the humanitarian efforts in Haiti this month, in the wake of the earthquake, have been a reminder of who we are when we strive to find our finest selves.

The relief efforts have been an international undertaking; the heartache on the streets of Haiti has summoned compassionate and heroic assistance from around the globe, all of it deserving of praise and gratitude.

But the United States has been at the forefront, as it has so often seemed to be in so many places when hope was in short supply. It is almost beyond imagining to think what has been in the terrified minds of the citizens of Haiti who have been without water, without food, without a way to rescue their trapped and dying children. When there is nothing left to depend on, when all is desolation and despair, what must the hungry and the hurt wish for as they look into the empty distance?

Someone to care.

Someone to travel many miles, with the will and the means to heal.

The slowness with which medical supplies and water and heavy equipment have reached the people of Haiti has been thoroughly reported. Some of the results of the relief effort have been troubling, beset by bottlenecks and breakdowns under arduous conditions. But this is not about the frustrations in getting the job done. It is about the American impulse to help.

There is nothing particularly controversial, these days, about pointing out the failings of the United States. You can say just about any derogatory thing about the U.S., and it's not especially shocking. We're used to hearing it.

Already, as the tragedy in Haiti continues to unfold, there have been pockets of harsh criticism of America's efforts to help. French Cooperation Minister Alain Joyandet alluded to the United States "occupying" Haiti instead of assisting it. It is not the first time the United States has been chastised, and it will not be the last. The history of the U.S. involvement in Haiti has not always been a happy or unsullied one.

But perhaps we can take just a moment to think about the honor that is inherent in being the ones who, at junctures like this one, are counted on -- the ones who show up, every time.

During World War II, those four words -- "The Americans are coming" -- referred to the armed forces who had traveled across the ocean to liberate the people the Nazis had enslaved. In times of natural disaster, the context is different.

In Haiti the words refer to the 82nd Airborne, yes, but they also refer to the American doctors who are volunteering their time and risking their own safety to soothe the pain of people they had never before met. The words refer to the American volunteers assisting at Haitian orphanages, not giving up on the children who have no families to comfort them. The words refer to the American search-and-rescue teams who work past the point of exhaustion as they seek signs of the living among the rubble, and they refer to the Americans back home who, during difficult economic times in the U.S., have donated their money to help people who, for now, have no way to say thank you.

The focus of the news will shift soon enough -- that shift has already started. There will be other crises, other major stories. We, as a country and as individuals, will continue to be imperfect.

There will be political squabbles and high-decibel partisan fights. We will at times focus on the trivial and the coarse.

At such times, we might do well to pause and recall the sound of those four words.

And to let the words remind us that, when we set our souls to it, we still can aspire to be the hope of the world.

Friday, January 22, 2010

Spring Semester

It started for me today. Anatomy and Physiology II got underway tonight.

I know – another Friday night class. But this semester is actually going to be a little easier to handle since my work schedule changed. What was really nice is that the vast majority of people who were in the class last semester are back for this semester. There are a couple of new faces, but it will be okay because in a relatively short time we’ll all be blended again.

Tonight we got right into it – started on the endocrine system. We’re halfway through the lecture notes and there is lots of material to cover. Next week we’ll finish it and over the two weeks following we’ll be covering blood and then the heart.

Finally! Some things I can sink my teeth into!

I think I’ve talked about the instructor in the past. He’s a chiropractor; that in itself is unusual but very interesting. He’s a relatively young guy (late 30’s) who is quite knowledgeable and also really fair. And he does a good job with the class. At one point I had some difficulty with him last semester due to problems I was having with microscopes. But we were able to work through it. I’m hoping that I can handle them this semester; I know that there will be some histology involved and I’m expecting it to be a pain like it was before. But I’m going to do my best to get them right.

Tonight the lecture not only covered the major glands that make up the endocrine system but also an extensive list of hormones secreted by the glands. There was a lot of information already – not a problem as far as I’m concerned – and I believe, if it’s like last semester, it’s going to be another information monster. How could it not be?

The one benefit of taking A&P has been, as I’ve said before, an excellent review of concepts that I was exposed to while I was in Paramedic school. The details have been being filled in which I’m finding extremely helpful. And this in itself has really aided in, simply put, understanding the human body better as well as what happens when the body doesn’t function the way it is supposed to.

I expect this to continue. And either this coming summer or next fall. And I’m happy about it.

Wednesday, January 20, 2010

The Upset

Well, it’s official. Republican Scott Brown beat out Democrat Martha Coakley in the Massachusetts US Senate race.

I was a little surprised at the outcome. But knowing what was happening in the polls prior to the election, I probably shouldn’t have been. One of my friends commented to me that, based on the negative ads being shown, Coakley should have been beaten because of the negative tone she took. In my previous post, I’d commented that I thought both sides were taking a fairly negative tone towards each other. I’ll stand by that at least to a degree, but in retrospect maybe Brown’s ads were not as harsh as Coakley’s.

With that said, I have to say that it makes things much more interesting with respect to healthcare reform. Because now there is no filibuster-proof majority for the Democrats in the Senate. Further, I have to believe that whatever comes will certainly affect negotiations with the House. But the thing that get my attention more than anything else is that it will cause all kinds of disruption with the other parts of the Democratic agenda. Like jobs and the economy, for example. I could be wrong, but won’t this make things more difficult for the Democrats on those items as well?

As for the other item I wrote about, I did get an opportunity to read the actual article in Sunday’s paper regarding the efforts a group of greater Manchester residents are making to stop the affiliation between CMC and the Dartmouth-Hitchcock Health system. I’m glad I did read it because I didn’t have all of my facts straight. First, the group of people involved numbers thirteen including two priests. One of the priests is the current pastor of Ste. Marie Parish (located right next to CMC) and the other is the former pastor of Ste. Marie, now the pastor of St. Michael’s in Exeter. The rest are area Catholics from different parish communities, and they are working with a canon lawyer from Ohio who, among other things, is trying to make the case that CMC is violating canon law because the CEO of the hospital is not a Catholic. And from what I understand, the action is being filed with whichever administrative body/dicastery in the Vatican that is responsible for dealing with issues such as this.

I made a reference to the opinion given on this issue by a Manchester attorney in my previous post. Now, I don’t have a clue if this opinion would hold any weight in ecclesiastical circles, mainly because it was written by a secular attorney who was working with concepts found in US and New Hampshire law. But it wouldn’t surprise me terribly if this is something that is used as a defensive tool by the Diocese of Manchester if it comes to that.

I would suggest reading the opinion as, at least to me, it was an eye opener. I can’t say I’m totally sold on the idea of affiliating for reasons of my own, and they have nothing to do with the current debate. But this opinion is clearly written and it simplifies the issue to where the main points are made reasonably clear. It can be found here. I’d recommend it regardless of one’s position on this issue. And I’m definitely not saying it has to be agreed with. But it should at least be considered.

I also got served with a summons to appear for jury duty back in November. Yesterday was the first of three mandatory days that I have to go, and it was an interesting experience if you take the horrible weather and road conditions we had into account. I’ve been a juror before; about 20 years ago I got summoned by the Federal system and served at the US District Court in Concord. One of the things I can say is that the basics aren’t much different regardless of whether it is Federal or State courts. The faces are different, though, and the types of cases can be somewhat different as well.

The panel I was part of picked jurors for a murder trial. A man accused of stabbing his wife at an area campground about 18 months or so ago. I was not picked, and I was glad of that because I have little doubt that I would have not been able to serve due to conflicts; I knew about the case beforehand, plus I know the police chief in the town where it occurred. Also, one of the defendant’s attorneys was defending someone I testified against in a different criminal trial in September of 2008. I have no doubt this attorney would have remembered me as I helped send her client to prison. So that in itself might have caused a problem…

It will be interesting to see what happens when I go back in two and four weeks, respectively. While I don’t mind doing what’s asked of me, in criminal matters I’m not confident that there wouldn’t be some level of conflict present. But the best I can do is simply see what happens.

I can’t do any more than that.

Monday, January 18, 2010

Verities And Balderdash ( With Apologies to Cat Stevens)

I’ve been doing a lot of thinking over the past few days. And for those of you who know me well, I’m sure you can attest to this being a scary thing. And with that said, I’m sure some of the things I’m going to talk about will cause some upset among many of you who read this blog. For that, I’ll apologize in advance. However, in my mind there are some things that need to be said, and if they’re not said by someone else then I will say them. If nothing else, I wouldn’t be surprised if some of what I have to talk about cranks up a lively discussion.

Truthfully, I hope it does.

First, there is a US Senate race happening in Massachusetts. An election is set to take place tomorrow, and the winner of that election will be sent to Washington to take the seat of the late Senator Edward Kennedy.

Of course, many of you who live in the New England states are aware of this, I’m sure. It has been a topic of local and regional news reporting since before Christmas, and the political advertising has been nothing short of vicious on both sides of the race. The contenders, Republican Scott Brown and Democrat Martha Coakley have been battering each other for the seat, and depending on what you read and when you read it, the opinion polling puts it as a neck-and-neck race.

Personally, I’m not terribly excited about either of these candidates. While they both have pros and cons associated with each of them, I’m simply not impressed by them because of the beatings they’ve been giving each other. Further, neither of them in my view really is running an issue-related campaign. They’re doing what is done in so many political races: they’re going after each other’s character, and they’re playing on the emotions of their prospective voters. This is especially evident based on the the campaign ads I’ve seen; they both are going after what are core voter concerns: the economy and healthcare reform.

Now I understand why they each campaign in this fashion; as I said, it’s a tried-and-true method of political warfare. And – this race doesn’t directly affect me; since I don’t live in Massachusetts, I really have no say about the outcome of the election. I don’t truly care, either, as the fighting that goes on over politics happens up here also, and it can be incredibly competitive. That said, however, it indirectly affects each of us because of the issues that they have chosen to run on.

On top of that, there are charges that an outsider from New Hampshire is campaigning illegally for Scott Brown. Bill Binnie, a New Hampshire businessman who’s planning to run for the Senate seat soon to be vacated by Senator Judd Gregg (the lone Republican in the New Hampshire congressional delegation), aired ads on Boston television in favor of Scott Brown’s candidacy. The Democratic Senatorial Campaign Committee in Massachusetts is crying foul over Binnie’s ads, saying they’re illegal. And the Brown campaign has stated that they didn’t ask for any help from outside.

So who do you believe?

As for Martha Coakley, she had President Obama campaigning for her in Boston yesterday. I thought that was interesting, but if you look at the exigent circumstances around his visit, it makes sense that he would be doing that. After all, if Brown wins the election, it puts the Obama plan for healthcare reform in jeopardy because it gives the Republican minority the power to filibuster, and ultimately block the votes that are needed for the legislation to pass.

Again – does this affect those of us who do not live in Massachusetts?

Directly? No. Indirectly? Absolutely – it affects every American. How does it affect us? That’s easy – it depends on where you stand and what you want. If you’re in favor of the legislation passing and changes in how healthcare is delivered in this country, then you don’t want Scott Brown to win the election. If you are not in favor of the legislation, then you don’t want Martha Coakley to win.

It seems pretty simple. But, like anything else, it is surely not so.

Another item: I read in yesterday’s Union Leader/Sunday News that a number of Catholic priests of the Diocese of Manchester are filing a lawsuit intended to stop the proposed action of affiliating Catholic Medical Center with Dartmouth-Hitchcock. I’ve written about the situation here, so it’s not as though I haven’t talked about it. But – there is more. There is always more, and this is no different.

When I read about this lawsuit, it occurred to me that this could be considered an act of disobedience towards the Ordinary of the Diocese. As I thought about it, though, perhaps it isn’t so much because the vows that a Diocesan priest take of obedience to his Bishop have to do with matters of faith and morals. Some, I’m sure, would say that this vow relates to all matters, but I’m not so sure of that.

I did a little bit of research on the subject of obedience recently. From what I have been able to determine based on some of the reading I’ve done, I was able to confirm what I said in the previous paragraph. What I was not able to determine, however, is whether or not obedience extends beyond the issues of faith and morals. My suspicion, based on that, is that it does not. And if that’s true, then the Bishop of Manchester is going to have his hands full because of this.

One of the main reasons cited by the priests who are filing the lawsuit is the fear that the Hitchcock folks would pressure CMC into providing services that are “not in accordance with Catholic teaching.” I suppose in the view of the priests who are involved, as well as the pro-life community in and around Manchester, this seems appropriate. However, I suspect that legally the claims that are being made will not have a leg to stand on. I say that because of a report that I read that was released recently regarding the status of affiliation between CMC and the Dartmouth-Hitchcock system.

Walter Maroney, the attorney who investigated the proposal and its details, did what appears to me to a painstaking analysis of all of the things that could go wrong as well as what happened in the past regarding Optima Healthcare. From what I have read, at least initially, it appears that things are being done differently with the express intent of avoiding a similar set of circumstances. However, it is not done yet. Because of this, it’s possible that things still could be changed in the proposal that, when it’s a done deal, could cause the affiliation to go horribly wrong. And the only way to see if this happens, unfortunately, is for it to go forward.

I would be interested to see whether or not the parties filing the lawsuit have an analysis or information of their own supporting their case. Not that I have any expertise in the law, but it is making for a very interesting set of problems that need to be solved before anything is finalized.

Then there is the question of whether the pro-life community will ever be satisfied with this. My feeling is that the only way something like this could happen, honestly, is for the affiliation to not go as proposed.

That said, I believe that some parties are going to be unhappy when it’s a done deal. I just don’t know who those parties will be…

Saturday, January 16, 2010

A Road Trip

I took one yesterday. I traveled from my house in Goffstown to Damariscotta, Maine for a class.

Now some people would ask me why I would drive so far for education. I’ve actually talked about this in the past, and I’ve stated that I am not averse to traveling to learn. This was no different, but I wasn’t really sure what to expect. As it turned out, I’m really glad I went.

The class was a PHTLS refresher. PHTLS – stands for “Pre-Hospital Trauma Life Support." – is one of the “alphabet certifications” that some people inside the EMS community talk about. There are people that talk about these types of certifications (they include not just PHTLS but also ACLS, PALS, PEPP, AMLS, at the like) with a level of derision as some of these folks think they’re simply not worth the trouble, or they’re not good classes. Others speak highly of them; these people have said that they are worthwhile resources for reinforcing knowledge and skills.

In this case – at least right now – I’m leaning towards the second point of view. And I’ll explain why.

A part of the reason is the content. There are actually three different programs that all sort of dovetail together all dealing with trauma: PHTLS, ATLS (Advanced Trauma Life Support, taught to emergency physicians), and TNCC (Trauma Nurse Core Curriculum, taught to ER nurses). They all cover the basics for trauma resuscitation and management. And while I had been certified, it was really nice to have the review as it made the stuff that I’ve been doing since the last time I had the class all come together.

Another part of the reason was the instructor. His name is Rick Petrie – works for Kennebec Valley EMS. He’s also involved with the EMS administration at some level in the state of Maine. I was incredibly impressed with his level of knowledge plus his ability to communicate in the classroom. And I really got a lot out of it.

There is also the people who were in the class. It was a small class – total of 6 of us that were there. All nice people, and when we were done I was invited back anytime. That was nice.

The ride up involved me driving on US Route 1 for a bit longer than I expected. I picked Route 1 up in Brunswick and drove approximately 35 miles into Damariscotta. Not an especially long distance, but it was slow because of time of day and road conditions. it took me a little longer to get to where the class was because of this. But I got there okay. The total time I spent between driving and class time was a little over 14 hours.

A long day. But a good day.

Wednesday, January 13, 2010

To One In Paradise

Sad but lovely just the same…

Thou wast all that to me, love,
For which my soul did pine-
A green isle in the sea, love,
A fountain and a shrine,
All wreathed with fairy fruits and flowers,
And all the flowers were mine.

Ah, dream too bright to last!
Ah, starry Hope! that didst arise
But to be overcast!
A voice from out the Future cries,
"On! on!"- but o'er the Past
(Dim gulf!) my spirit hovering lies
Mute, motionless, aghast!

For, alas! alas! me
The light of Life is o'er!
"No more- no more- no more-"
(Such language holds the solemn sea
To the sands upon the shore)
Shall bloom the thunder-blasted tree
Or the stricken eagle soar!

And all my days are trances,
And all my nightly dreams
Are where thy grey eye glances,
And where thy footstep gleams-
In what ethereal dances,
By what eternal streams.
 

-- Edgar Allan Poe (1809-1849)


 


If I could see the sky above
And my mind could be set free
As wild white horses reached the shore
I'd stand alone and oversee


And if the bush before me burns
Should I turn my eyes away
And still the voices I can hear
As clear to me as light of day


I believed in my dreams
Nothing could change my mind
Now I know what they mean
How could I be so blind


Cold sands of time
(Winds that blow as cold as ice
Sounds that come in the night)
Shall hide what is left on me
(Come from Paradise)


I've been through times when no one cared
(Words that were mine)
I've seen clouds in empty skies
When one kind word meant more to me
(Shall last as a memory)
Than all the love in Paradise


I believed in my dreams
Nothing could change my mind
Till I found what they mean
Nothing can save me now


-- Alan Parsons, Eric Woolfson (1945-2009)

Sunday, January 10, 2010

Stupid People…

I’ve dealt with numerous examples of this over the past couple of days, both indirectly and directly. The direct ones are those that I personally witnessed and had to handle. The indirect were what I either observed or what was told about.

First, the ones I witnessed. Well… One of them…

Got sent to the Veterans Administration Medical Center in Bedford, MA, for a patient transport to the VA Medical Center in West Roxbury. No other information than the patient was on Oxygen and needed cardiac monitoring. At the time (approximately 2230) we were doing coverage in Newton. But I’ll talk a little more about that later. We got cleared from the coverage and made our way from Newton to Bedford, a trip that took approximately a half-hour. In the dispatch we were told we were going to Unit 4A. As neither my partner nor I had any idea where in the complex that was we figured we’d start at the admissions office.

When we arrived and told the people at admissions where we needed to go, we were told that Unit 4A is a long-term care unit – in essence, a nursing home floor. We were also told that we needed to go back to the entrance we came from and go around part of the building to get to the unit. My response was simple: no way. It was below 10 degrees Fahrenheit outside and we needed to find another way to the unit. So they sent us through the tunnels in the basement of the complex. That in itself was not a big deal; the directions we were given, plus the signage, was actually reasonably straight-forward. However, when we got to the elevators we discovered that they were secured, policy there from 2300-0600. A silly policy, in my opinion, but there you go…

Eventually we were able to get access to the elevator – it took an additional 15 minutes to get this done, but we got to the unit and located the patient, an 88 year-old male status-post placement of what is known as a PEG tube, or a feeding tube surgically inserted into the stomach. His problem was that he’d developed a fever and had bleeding from his mouth and around the insertion site. When the nurse who transferred care to me told me what was going on (I think she expected me to just take the patient without asking any questions or gathering information) my initial thought was that an infection had developed. I also noted that he had an extensive medical history, including a below-the-knee amputation of his right leg from complications of diabetes as well as cancer to his head and neck.

The stupid part of this situation was two fold. First, the charge nurse on the unit gave my partner a hard time because of the amount of time it took us to get on the unit. She responded to this by telling the nurse about the delay in getting the elevator – a problem that was beyond our control. Then as we were loading the patient for transport, she made a comment about it being the next day (it wasn’t; it was about 2330 at that point) and how it was costing her “taxpayer dollars”, or words to that effect. This remark was a little more than I could stand, and I responded to her with, “it’s my tax money too, ma’am, and by the way: I rate services in this hospital. I’d hope I’d get decent care in circumstances like this.”

She stopped talking at that point. Now this could go one of two ways: either I made my point or she’s going to complain to our management and I’m going to be spoken to. Either way, though, I really don’t care.

The other part was when we got to West Roxbury and transferred care to the single nurse in their totally empty area that serves as an Emergency department. One of the other nurses who was working there came in while we were cleaning up and I finished documenting, and he started giving us a hard time. Apparently they got the notification from Bedford at around 2130 and he was complaining that we got there so much later. I stopped him cold at that point. Told him that we didn’t get the call until an hour after that plus we had to cover distance to get there. I didn’t even bother to get into the problems we had getting to the unit or getting the patient ready to go. And he was just a nasty person; a fairly common occurrence whenever I have to deal with the VA.

The indirect occurrence has to do with my mother-in-law. She is in rehab in one of the Manchester skilled nursing facilities after surgery to her back in December. The quality of care she’s received in the SNF has been less than stellar. So much so, in fact, that Martha has filed complaints with both the administration at the SNF and with the State of New Hampshire. And even after going through all of this, the people that are working on the unit there are still making stupid mistakes.

It’s ridiculous. And although I know this is supposed to be a temporary stay for her, I really hope the people supposedly doing their jobs can get their act together. These problems are simply making us nuts.

Wednesday, January 06, 2010

Newton

This is my second shift working on one of the Newton 911 medic trucks. Before starting this post we were out on a call – fairly straight-forward stuff. A 47 year-old female having what appeared to be an allergic reaction to anti-biotics. She had the typical symptoms, including systemic erythema (red skin), some difficulty breathing, and some nausea. She’d taken some Benadryl before we got there and it helped her. Over the 15 minutes or so she was with us she became markedly less nauseous and her work of breathing was much easier. And, as a precaution, we transported her to the hospital.

So far, I think I like working here. I’m located at Station 4 at the corner of Crafts and Watertown Sts. It is, from what I’m told, one of the better stations to work in because of the crews and their close-knit nature. My partner, Keith, is also a part-time supervisor – he covers Saturdays in Newton and Boston – and working with him is a good thing for me. I don’t have anything to worry about in terms of clinical stuff, but I’m learning the geography of Newton, and it is tricky. Lots of multiple street names, as I think I’ve mentioned before. And traffic is always interesting. One thing I have been told is to “drive it like I stole it”, for lack of a better term. Apparently the drivers in Newton don’t really have much regard for emergency vehicles. So it’s as though you have to nearly push them out of the way.

Kind of reminds me of Manchester, in that regard. But I know Manchester like the back of my hand. I don’t have anywhere near that level of confidence in Newton. But it will come; it will just take lots of time.

I am still working on the rehab class I talked about previously. It’s kind of tedious because of the amount of material involved. But it is coming along. I’m going to attempt to get it finished by the weekend so I can teach on Tuesday.

As I think, more will follow. It’s been a long day.

Monday, January 04, 2010

Inflammation

I'm dealing with some of that as I write this post. All because my face hurts.

And no - it's not because someone punched me or I fell on it. I have a sinus infection. Went to see my PCP this morning to get looked at for it, and I got in to see his Nurse Practicioner instead. Not a problem - I've known her for quite a while and she's quite good. Her assessment skills are better than those of some docs that I know, in fact. Anyway, my suspicions were confirmed by her, and she prescribed Amoxicillin and Flonase for the inflammation. Told me that I'm probably looking at 2-3 days more misery before I start to feel better. I expected her to say that, in fact; it usually takes a couple of days for anti-biotics to do their job. Then you have to stay on them for a while so that they get all of the nasty bacteria out of your system. And some of them have undesirable side effects. Knowing this from personal experience, I am generally much more careful now about what I am prescribed, and I make sure that whatever I've been given is going to do what is intended.

So now I'm at work in Goffstown, doing what I have to so that I can stay warm, and just generally making sure I don't do much. I really don't want to go out on any calls if I don't have to, simply because it's cold. Really cold here, in fact. The temperatures are sitting in the mid-teens, but at least the wind has died down. That's a blessing in itself.

Worked in Boston on Saturday, and on the overnight we had a rather challenging transport. At 0230 we got sent to Logan Airport - in a snow storm with low visibility and high winds - to pick up a patient coming in from Mexico with third-degree burns over 60% BSA (or "body surface area"). A 12 year-old female, got too close to some pyrotechnics that caught her clothing on fire. Burned her legs, arms, and abdomen. The difficult part of the transport was getting this child off of the aircraft; she came in on a Gulfstream with a physician, a flight medic, and her mother. The doctor's English was quite good, the medic's was decent, but the patient and her mother spoke virtually no English. So communicating was tough. In addition, it was extremely cold and quite windy, and no person should have had to be out on an open tarmac with the conditions as they were. We really had to hustle to get this girl off of the plane and loaded aboard the ambulance as quickly as we could just because it was so nasty outside.

She went to the Burn Center rather than to Children's. That makes sense - after all, where else can you get top-notch care at virtually no cost? And the people there are quite good at what they do. Because of that, I'm inclined to believe that this young girl has a chance at a good recovery. At least I hope she does...

Yesterday Martha and some of Kerry's friends put on a baby shower for her. I was quite surprised at the number of people that showed up. Pleasantly, of course, but I was blown away at the number of people that can be shoe-horned into an area that is maybe 800 square feet. There were probably 25-30 people in the rooms (living room and kitchen area) at one time, and everyone seemed to have fun. I know Kerry did. And - it's a testament when you know who your friends really are. I think Kerry got to see some of that yesterday.

I have to get back to work; I'm putting a class together on Rehab at a Fire Scene that's going to include some pathophysiology of Carbon Monoxide exposure as well as some familiarization to one of the devices Goffstown Fire uses to assess patients who have exposure. The device, a Massimo RAD-57, allows measurement of Oxygen Saturation as well as Carbon Monoxide saturation; it will do either one. Bear in mind that it's a tool and at least can give a baseline or a reference point. I would think a more accurate measurement would be from an arterial blood gas measurement, usually on someone who's gotten really seriously exposed.

When I was in Paramedic school a number of years ago we had a patient who was brought into the Emergency room with a big case of CO poisoning. It was a suicide attempt; this person apparently had been given a diagnosis of a terminal illness of some sort not long before this happened. He went into his work shed and started up his lawn mower. Left it running. Probably thought he'd die a peaceful death. As it was, a member of his family found him, and he ultimately ended up in a Hyperbaric chamber. And I was tasked to monitor him during the dives.

It was actually really interesting, and I learned a lot about how Hyperbaric chambers work. And the patient did survive. How long he lived after the fact is something I was never able to find out.

To be honest, I'm glad I don't know.

Friday, January 01, 2010

Happy New Year

Indeed.

Today is the first day of 2010 – already proving to be an interesting weather day in my corner of the world. I’m watching snow fall on the pines from my perch in the living room, and it looks like the kind of snow that could stay with us for a while. Not too fluffy but definitely visible as it comes down. A west wind appears to be moving the snowfall as it is coming down at an angle.

I can’t really complain about it. After all, we are officially in winter now, and what good would it do? So I’m going to sit back, watch it fall, and just enjoy it.

I am hopeful that 2010 will work out to be a better year than 2009 was. Between all of the misfortune felt by so many and the personal tragedies that went along with that, I’m really not sure that it could be much worse. I know just from my own perspective that 2010 will be a better year – it has to be. As of right now, I’m healthy (as are my family) and i and mine are doing well overall. I’m going to be a grandfather for the first time soon – perhaps a little sooner that I would have liked, but that’s okay. After taking time to get used to the idea, I’m looking forward to it.

Anyway, I hope and pray that all of you who read this blog will have a happy and peaceful New Year.