When Things Go Badly

For ethics class I'm writing up a case study of a patient who is brain dead, but whose family does not believe in brain death as a criterion for determining "actual death". This is the sort of thing that is quite tricky in modern medicine- after all, "brain death" never used to happen: as soon as your brain lost control of your breathing center, YOU DIED. We never used to have the problem of a dead brain with a body kept more-or-less fresh with Science. While the part of me that LOVES a little Mad Science thinks that this is actually pretty nifty in a Frankenstein's Monster sort of way, the part of me that hates to see wasteful useless medicine practiced cringes at the thought that people are "maintained" on ventilators when they are actually corpses, all because the family simply does not believe that they are gone.

Plus- if they're DEAD, who is PAYING for all these interventions? Probably not insurance, as I'm fairly certain that they stop paying for procedures for deceased people.

Its not an easy decision though, because families may have valid religious reasoning behind their views on death, but that should never trump the fact that we CANNOT allow ONE person to be dead and ONE to be alive under the same conditions and circumstances. Death HAS to be universally applied, or things go downhill fast.

De-Escalation and Defense

Today we learned how to (WITHOUT hurting the poor "innocent" patient) get out of holds when people are trying to grab, choke, pull your hair, or bite you. Normally, I'd respond by doing whatever the hell is necessary to keep the person from killing me...but this is psych, where apparently pushing on somebody's jaw hinges to get them to release your ARM from their TEETH is "assault". Whiskey. Tango. Foxtrot. If somebody is BITING ME, I think I'm allowed to poke at them a little.

BTW...I RULE at making people stop, according to this class.

But you know what my number one self defense technique is? NOT LETTING PEOPLE GET BEHIND ME OR NEAR ME!

Things That Make Life Harder

I am not a large person. I am, in fact, rather short and curvy. This makes things like 1. lifting a stretcher with a 250 pound person up to its full height 2. reaching the turnout gear in the TOP compartment of the back panel of the ambulance 3. climbing into the driver's seat without hopping like I'm on a vaulting horse VERY challenging, and sometimes near-impossible.

What do you do? You put up with being laughed at by your fellow EMTs every time something like this is required, try to get somebody else to pick up the stretcher for you, and pretend NOBODY saw you almost catapult off the ambulance seat.

Tomorrow is psych clinical again, and lets hope I set my alarm properly. Last week I managed to set it to PM instead of AM- this clock doesn't do a 24 hour clock, which i use on EVERYTHING else, so I didn't notice- and wake up at 645, when I'm already supposed to BE at clinical. The only reason I am still breathing and did NOT get a nasty note in my file is that, by some grace of some deity, my instructor lost track of time, and was LATER THAN I WAS! Coincidences like this do not happen more than once to a student, so I'd better not screw up again!

You Know You're in EMS When...

You're out bowling with your entire squad, somebody's HOME pager goes off, and 20 people bounce to their feet, reaching for their hips, to see WHO is getting called out. Additionally, half the people look really disappointed that it wasn't us.

Then today was our Mock DUI demonstration, for which we had 7 fire/ambulance apparatus, and PENNSTAR!!!! We landed them right in the middle of campus, and the pilot buzzed us first, which is one of the single coolest things EVER. Just to make it look even COOLER, they let us climb inside, AND i'm going to get to do a fly-along!

God I love helicopters!!!

Special Olympics

This past weekend was...intense. So intense that posting has taken me a few days. I pulled Friday night 18 hour shift, and before that did Golfcart Standby crew for the beginning of the Olympics, as well as pulling for the Opening Ceremony. And as a result I am in love...or at least the victim of a massive crush on my overnight partner. It's been a LOOONG time since I dated anybody, but for this guy I'd make a serious exception. ~deep girly sigh~

So we had two Olympics-related calls in the evening, which resulted in me nearly getting into a fight- with the "Medical Coordinator", a nursing student a year behind me. The patient was post-ictal, known seizure disorder, but, you know, they CALLED THE EMTs, so I had to EXAMINE AND SPEAK TO THE PATIENT. This girl refused to let me speak to the patient, OR give me her written medical history. Why? Well she didn't want me to "upset" the patient by asking her questions, and as to the medical history? SHE WAS USING IT TO FILL OUT PAPERWORK.

After those two it was just drunks. And I'm only JUST recovering my energy.

Florid Psychosis

Yesterday my partner and I did the nursing intake assessment on a new patient to the adult unit. The nurse's advice? "Be CAREFUL girls! Don't let him get between you and the door, he's got a history of violent outbursts, isn't medicated, and is bigger than you".

Because that's going to make us feel REALLY comfortable.

So we sat down, carefully, and began our assessment. "You two are students?" he asked. "Yep!" I replied, knowing that Truthfulness Is Important, "GET OUT WHILE YOU STILL CAN" he said, admirably demonstrating pressured speech and delusional ideation. "THEY MAKE YOU KILL PEOPLE!!! AND THEY GIVE YOU MEDICATION THAT MAKES YOU NOT LIVE FOREVER WE CAN ALL LIVE FOREVER YOU KNOW" he said, at the top of his lungs.

A few minutes later, we were done, worried, and sent to keep the rest of the ward from hurting each other.

It's quite a rotation...

Over My Dead Body

Today we are learning, in Trends and Professional Nursing class, about how IMPORTANT it is that we practice "Consumer Centered Care", where the "client determines quality". Man, SCREW THAT. Ive had plenty of patients whose idea of "quality" would be higher thread-count sheets, perrier water, and me, running to cater to their every whim no matter how sick my fellow patients were. This should determine my practice? MY practice is based on providing safe and effective care to my patients, with their physical wellbeing placed FAR above any stupid ideas of customer satisfaction. You may hate me for not giving you water, but I dont care- if you're fluid restricted, you are not getting extra water. You may WANT it, you may DESIRE it, but you could go into a CHF crisis. The consumer is not always right, and pretending that the patient should run our units is dangerous and unsafe.

Just my student opinion, but it feels WRONG.

Its the Pandemic, Stupid!

Today I learned that a colleague on the campus EMT squad pulled an 18 hour shift last night with what is almost certainly an active case of H1N1. Without a mask. She was running a 103 degree fever this morning, according to her. She said "i didn't want to get people mad by calling out of my shift". Oh I'm mad as HELL now! She exposed another medic (one of our FIVE current drivers, due to how long our training program for driving is) AND her probie AND her observer/student to H1N1. If they catch it they'll ALL be unable to pull duty.

I am SO pissed at this! I'm stuck here with bronchitis, unable to think clearly for longer than 10 minutes at a time, and she's out there making people sick, and I can't STOP her without exposing MORE people to this bug! GAAAH!

Please people- if you're sick, dont hurt other people. Find an excuse to wear a mask if nothing else. Really. Just...wear a mask. This winter is going to be hellish enough for a HEALTHY squad- and we're dropping like flies here.