Friday, April 25, 2008

Love and Loyalty

I just finished reading Marley and Me by John Grogan, and while I'm not going to write a review like I typically do (there are already thousands out there and by the way, it's a fantastic book) I'd like to share how it's affected me.

I've written a few times before about me own lab puppy, Boomer. She's a handful, as most puppies are. Destructive, playfully rambunctious, and fully of life. I love that dog, sometimes against my better judgment. I was working the office a few days ago and Boomer was in the hall chewing on something. Now, I should know better by now that more than half the time, she's chewing on something she shouldn't be. When I got up to go downstairs, there Boomer is, happily thumping her tail against the carpet while she is shredding my uniform hat to pieces. The bill was completely shredded, the sweat band gnawed on, and the plastic snap adjuster was gone all together.

Boomer looked up at me, those puppy eyes of hers saying "hi dad! Look what I found!" I was upset, but only a little because obviously I'd left the hat someplace it shouldn't have been and she found it. But now I have to take the shredded evidence into my boss and explain to him how my dog ate my ball cap and I need a new one.

The point though, by reading Marley and Me about John Grogan's struggle with his ill behaved lab, I've come to accept that this is how Boomer is. She's a lab with tons of pent up energy and usually no place to channel it. I love that dog no matter what she does. And I see that love and loyalty reflected in her eyes every time she looks at me.

I'm a dog person, and as a whole, we have a place in our hearts for dogs in need. Several years ago, shortly after I became an EMT, I responded with my fire department to a fast moving grass fire on the beach with at least one injury. The fire itself turned out to be small and fairly slow, so I was tasked with taking care of the gentleman who had tried to put it out--and was consequently responsible for setting it in the first place.

After lighting a cigarette, the man had carelessly dropped the match into the dry beach grass, setting it ablaze instantly. Alarmed, the man tried to stamp out the fire, but the fire jumped to his denim jeans and began burning at his lower legs. Running out from the immediate area of the fire, he tried patting out the flames on his jeans with his hands and was eventually successful.

As we arrived on the scene, the patient was on the promenade, smoking another nervous cigarette, with scorched and tattered jeans and burns to his hands and lower legs. What struck me the most though, was how he tended to his 3 month old black lab puppy. There was no doubt this little pup was this man's whole world, in a very literal sense. He was a transient, without insurance, and unwilling to go to the hospital to be treated. It wasn't the inability to pay that was keeping him from going though, it was his unwillingness to leave his pup behind. This man's love and loyalty for his pup was so great that he would put up with the pain of 1st and 2nd degree burns rather than leave his pup behind. We made a rare exception for the man, transporting him and his pup to the hospital, as he was in urgent need of medical care.

For me, a dog inspires such a rare type of love and loyalty between master and pet. In reading Marley and Me, in my interactions with my other volunteers, coworkers, and patients, I've come to learn that I'm not the only one that feels this way. I love my pup for who she is and I look forward to her growing up, and her ever present love and loyalty.

Sunday, April 13, 2008

My Storm Story, Part II

My Storm Story, Part I

“What?” was my immediate response. Stopping cutting operations was just not an option. “Who ordered it?”

“Chief says we get off the highway until morning. We won’t be cutting until then.” The district’s fire chief, who’d I’d seen and talked to when we picked the patient up, were ordering his men off the highway. The plan was to park us at the nearest fire station about a mile back, and wait out the worst of the storm.

The cell towers were still operational so I placed a call to my supervisor at the other end of the county and gave her a report: the fire department had stopped cutting and we were returning to their station.

My supervisor, for her part, would do her best to put together a plan for us. For me, my priority was my patient. I advised the receiving trauma hospital that we were delayed indefinitely and that they could release their trauma team until we radioed another update.

My partner turned the ambulance around and followed the fire department’s brush unit down the highway. We turned down a short gravel drive and approached the little 3-bay station. They would leave the brush unit out so we could occupy the bay. The three firemen followed us into the bay and then closed the door behind us. It was the first break we’d had from the storm since we’d pulled the patient out of the house almost an hour before.

The supervisor called shortly after and told me that a plan had come together. The paid firefighters from the west end of the highway (the other side of the downed trees) would be working with a number of Pacific Power crews to clear the road and get us home. The work would be slow as Pacific Power estimated over 50 trees down in just the few miles back into town.

So we waited. The patient was stable and resting comfortably with the morphine. The supervisor was calling every twenty minutes to give me updates, check on the patient, and try to keep our morale up.

We spent over two hours at that little station, during which time a tree came down on the brush unit that was parked outside and the battery on the ambulance died, requiring a jump. Eventually though, the bay door rolled up and there stood the Pacific Power crew and the crew sent from Astoria Fire, decked out in storm gear and helmets. While there was only one Pacific Power truck outside, I would later learn that they had diverted numerous crews from repair work to come cut us out.

My partner made the radio call to dispatch that we were continuing and I called in to the receiving hospital with another update. By this time, the storm had reached a slight lull and the trip into town, lead by Pacific Power and Astoria FD, was easy going. Power was out throughout the city and the hospital was running by generator when we pulled in. The entire trauma team had been released and we were met only by the ER physician and nurse. Uneventfully, we turned the patient over and returned to quarters.

For the rest of the shift, we listened to the wind batter the station. 911 service in the county was sketchy so we had to scan with portable radios for calls coming from our dispatch and fire dispatch. If there were other calls that night, I don’t remember them.

I was off shift on time at 0800 the next morning, relieved by a crew who had slept the whole night in their own beds. The storm had calmed, but I didn’t have to drive more than a block away from the station to see the damage.

Tree debris covered the roads, houses were missing whole sections of roof, and trees still blocked side roads. I made the usual twenty minute commute in double that time. I was concerned about my wife whom I hadn’t spoken with in 12 hours. I was worried about our house. And I was worried about the guys on my fire department and how they’d survived the night.

More to come…

A Perfect Morning

I awoke this morning to the first perfect spring morning of the year. The sun was rising over the hills, casting a wonderful pink-purple glow. It was already warming outside, 60 degrees or better at seven in the morning. The air had a fresh, warm, clean smell to it, just like my favorite summer mornings always do.

Boomer was following me through the house during my morning routine. She waited outside the bathroom door while I was in the shower, sat and gazed up at me with quizzical brown eyes as I packed my lunch, happily wagged her whole body when I took her outside, then bounded up onto the bed when I kissed my wife goodbye.

With my uniform on and day bag packed, I grabbed my Oakleys and got into my car. Driving to work this morning, the 45-minute commute to Station 1, didn’t seem so bad this morning. I had a smile on my face for the first time in months when I walked into the station to relieve the previous shift.

Sunday, April 6, 2008

My Mistakes

I'm a new paramedic, still in my first year in the field. I've made mistakes, some big and some small. I misdiagnosed a failing pneumonia patient as CHF and gave lasix, further worsening the problem. I've asked stupid questions in front and patients and firemen. I've rolled into the ER with cardiac patients that aren't on oxygen.

Today, I've had a difficult shift. I can't start an IV to save a life. I forgot to check a blood sugar on a fallen diabetic. My partner and I (with the fire department) had to inadequately c-spine a 300 pound patient strictly because of his size.

I've been reflecting on my mistakes today because I've been feeling down. My favorite ER nurse told me that I'm just being too hard on myself--and maybe that's all it is. Sometimes it's easier to focus on the mistakes than the times when I "got it right."

Seaside Fire Rescues One

I'm so proud of my fire department. Yesterday morning at 0430, the Seaside Fire Department was dispatched for a structure fire with victims trapped. The first arriving truck company effected a rescue of a woman from a second floor window. Check out the full story here.

Tuesday, April 1, 2008

The 10/90 Theory

I have this theory about EMS that we respond to 10% of the population for 90% of our calls. While I have no statistical data to back up the actual numbers, I do believe that we respond to a narrow margin of system abusers, frequent callers, and high-risk patients for a majority of the calls that we run.

A perfect example of this is an adult care facility, one that we respond to on a daily basis. Almost every patient living at one of these facilities is high-risk due to their medical history. We know many of these patients by name because we run on them so often, we know their medical histories, their primary care physicians, and their dog's name. This small population accounts for a high margin of calls.

System abusers and frequent callers are just as bad. I grew up in a household where I never went to the hospital. The thought of calling an ambulance for anything was just unheard of. But I can't tell you how many times I go to a frequent caller's home because they believe they are having a medication reaction (they aren't) or that their blood pressure is too high (it's not).

It is not unusual for me to run half a dozen calls in a shift and have 5 out of the 6 be patients I have seen before... frequently. 10% percent of the population 90% of the time. The other 90% of the population is too healthy to need an ambulance, will drive themselves to the ER in a crisis, or understands what the purpose of an ambulance truly is: a means of emergent transport.

My paramedic preceptor and I had talked about this during my internship and it continues to be a topic of conversation when we help Ms. Jones back into bed for the fourth time in a week.