Closer to home

First let me apologize for the last 2 post being published late, just meant to write/add to them later and ended up forgetting that they were not published. Anyways this happened last night, my family and I were up at my aunt's house and my dad told me that he was having chest pain pointing to his left side. I was naturally concerned as my dad is well on in years and has high cholesterol, anyways, he described his pain as coming and going and tried to see if his pain was reproducible and thus maybe not cardiac but this wasn't the case he didn't look like any of the people that I had ever seen having a mci before, he was very calm and his vitals that I could take were all normal. But at the same time older people may not feel their pain as strongly and since we were only a couple minutes from the fire station that I work at, I offered to take my dad up to there to get a quick EKG. It is a whole different ball game when its family, it had nothing to do with how serious it was because I wasn't terribly concerned because he really wasn't exhibiting any other signs/symptoms, when we got to the station I just wasn't a very good EMT, I put the leads on my dad but I didn't really do all the other things I normally do like try to tell him to stay very still during when were running the EKG. Of course everything turned out fine I was just very surprised at myself I just didn't feel like I usually do on scenes, I never really understood why people say you shouldn't treat family, I always thought well it be easier for me to talk to them and for them to me. There was just something paralyzing about it that made me not act as well as I could have.

Taking the meaning home with you.

11/25-Today while driving to U of H to pick up my girlfriend, Shinthia, I stopped at a light and there was a man that was going door to door knocking on windows and generally being ignored as is unfortunately the typical response in this world. I was about to do the same thinking he was begging for money, but as he was turning away from my window I stopped and "rolled" my window down, (now that we don't physcially roll our windows down is that still the term? I wonder if that would even make sense to a person born recently) and I called out to him. He stopped and quickly told me his story, he was a diabetic several walking miles from home and a could feel himself a bit low in his blood sugar. He explained that his place was only several miles down the road. Since I was headed down the same way to U of H I agreed to give this elder man a lift. This isn't my first time doing this in fact several years ago a similar thing happened actually in a similar part of town but not the same guy. Anyways I accepted and it was it was almost dejavu from my last hitchhiker, we talked about the missing kindness to strangers that used to exist but was gone from this modern world. He wished me well for my future, and he went inside his house. What made me so happy about this occasion was that I haven't changed I was glad and proud of myself that this part of me had not been turned off or become jaded from the rough environment that I work in. It is so easy to say that it I do my duty at my job and that is my limit and anything outside of that is just beyond your "scope of practice" as it were. But I was just glad to know that so far so good and I intend to keep it that way.

Thankful for Quiet Days

Today was a quiet day not to say I wasn't busy. Today was the firefighter recruit class graduation and the ceremony took place at station 1. So we had did alot of house work and cleaning the place up. A great deal of pomp and circumstance went into the event and we moved all the apparatuses out. In the bay we set up all the tables and layed out the food. Most importantly absolutley nothing happened during the party/celebration. No calls dropped, no patient walked up to the station. Even the weather was great. A great thanksgiving.

Why doctor

It must have been a pediatrics weekend. Sat started with a 7 year old with status asthmaticus, an acute asthma attack that has progressed to the point that it cannot be treated by the standard nebulizer treatments of albuterol. Brave kid just focused on his breathing did not whimper or anything the paramedic rode in gave some solumedrol via IV. We ran to the hospital because he was not responding to the medications (would have ran anyways) and thus he needed intubation to keep his airway from swelling closed. If not intubated he would need a cricotomy/trachotomy. While normally, our ambulances have the capacity to intubate in just such occasions. The pt was still conscious w/ a gag reflex and therefore needed RSI (that's rapid sequence intubation) where a chemical agent paralyzes the pt by inhibits the action of acetylcholine at the neuromuscular junctions (just thought I tie in a little cell bio while we are at it) the side effect of this is that you have just but the pt's life in your hands. The pt can no longer breathe for themselves and thus this must be followed by intubation. While this may sound like a terrible solution, putting the pt in respiratory arrest on your terms is much better than the pt falling into respiratory arrest on his/her own. We made it to the hospital, the pt was able to be intubated, and aside from the trauma to his throat and the tears of a mother, everything turned out ok.

What bothers me is the what if. If we had not made it to the hospital in time, we had the skill level on board to perform RSI (paramedic skill and even I as a EMT-I can intubate) However RSI is not in our protocols, and thus do not have the succs. I am not blaming our medical director for this lacking RSI protocol, obviously, the director's knowledge outweighs mine and the liability and subsequently the choice lies with her. This is part of why I want to be a doctor not being able to do everything I can especially when I know what needs to be done distresses and troubles me to no end. My experiences here at CVFD have made me want to be involved in the teaching/training of other healthcare professionals not just other doctors. Perhaps later as a medical director I can help to effect changes in the prehospital setting w/ research and we can advance the quality of healthcare.

Burn Out

Unfortunately a common problem with EMS providers is burnout. Burnout though not exclusive to the EMS field it is a prominent problem. The most accurate defination I have found of burnout was "unrelieved job-related stress characterized by the person suffering from burnout may lose concern or respect for other people and often has cynical, dehumanized perceptions of people, labeling them in a derogatory manner". Personally I see where the cynicism comes from but for outsiders to the EMS it is probably difficult to imagine why people who dedicate their lives to serving the general public in their time of need can come to hating their job or the people they serve. Apparently it is already starting to effect me according to the observations of my girlfriend, it is difficult to not become angry when people call 9-1-1 for slipping on soap in the grocery store and when you get there they are more concerned with filling out a police report and making sure they get a copy. It is also infuriating when people call 9-1-1 for taxi services people who dont have a car or somehow have no friends, family or neighbhors willing to take them to the hospital 10 minutes away. Instead of calling a cab that would cost money on the spot they call 9-1-1 for an ambulance ride (that will go the same speed as a regular car) and most importantly they will not be seen quicker at the hospital and they wont pay when the bill arrives next month.This is the reason an ambulance ride cost $1500 because some people wont pay. Anyways regardless of  my little rant there, I still demand the most professional behavior of myself when on scene even if I believe that the call is an abuse or misuse of the 911 system. There reason I am writting about this is because I witnessed a senior member act verbally belirgerntly toward a patient, granted the pt was according to herself educated as a nurse, and was having a textbook panic attack, hyperventilation followed by her loosing the feeling in her fingers. The problem with this for my fellow member is that it was 3:00 AM and it was not the first call of the night that had been non-emergency. While that is not an excuse I just wanted to put that in context. Witnessing the behavior of my teammate made me more aware of my own behavior and what feelings to guard against when dealing difficult or frustrating situations.

My first positive experince with Vitiligo

I am not sure if you are familiar with the skin pigment disorder I have, Vitiligo, so a brief overview. It is a skin pigment disorder specifically a loss of melaninocytes loss of production of melanin. The disease is thought to be autoimmune in nature but ultimately idiopathic. There is not a whole lot of research in it because its incidence is less than 1% worldwide, it’s not very noticeable if you are already light skinned and it’s not really all that harmful except for maybe increasing your chance for sun burn. Yes, this is what Michael Jackson had except his was the more severe form of Vitiligo universalis. The treatment is often topical corticosteroids considering how the condition might be autoimmune but that never helped me, anyways I have resigned to it being incurable. Okay enough background; in my experience I have not had one positive thing ever come out this disease. There has been plenty of shame, self-esteem issues, ridicule and pointing fingers of blameless children, that hurt despite their innocent question. Last night I got a call to an assault. The pt had been assaulted by his neighbors, who fled when the pt’s brother had called the cops. Unfortunately the pt under the influence of ETOH was belligerent and noncompliant towards the cops and they hand cuffed him. When we got to the scene, the pt was sitting in the back of a cop car. The pt due to his altered mental status clearly did not understand why he had been tackled and handcuffed and was naturally very upset so much so that it was interfering with me and my colleagues trying to assess him and determine a treatment plan. Eventually when my partners went to go talk to the cops about what had happened, I noticed the Vitiligo on him in almost the exact same places I have it, hands, knees, elbows and feet all scarily similar to mine. I took off my gloves so he could see and that allowed me to distract him from his current situation. He quickly calmed down and I gained his trust. Through his trust I helped him to truly understand his situation and the need to cooperate with the police as well as me, in the end because he had calmed down the cops released him from his cuffs without charging him with anything. All thanks to a common bond through Vitiligo.

Quality vs Quantity

This last shift we had this elderly woman had a vasovagal syncopal episode while going to the bathroom. She also had incredibly overgrown toenails. So that while I was walking her to the stretcher and she had another syncopal episode and snapped her great toe nail off. The paramedic couldn't find a vein to stick,(her arms felt like bags of water absolutly no veins just hematoma after hematoma) her to get blood or to even give any fluids to help raise her blood pressure so she would stop fainting. She did not really want to go to the hospital and probably wouldn't have if it was not for her daughter.  Oh and like most fainting patients she did not believe that she had fainted and was quite sure of herself, Sorry little side vent there it just suprisses me everytime that people expect to remeber themselves fainting. Anyways this patient reminded me about my mortality, which I don't reflect on often even in this field its hard to feel that way about your self especially at my age. Sorry about not having a post for last week didnt have a shift  but I am doing 3, 12hr shifts sat sun and mon this week so I will catch up.

Is health care a right or a privilege?

Today I had one of the saddest calls of my time here at cvfd. I was dispatched to a cardiac arrest. when I arrived I found this 18 year old kid lying on the floor in his room. My heart was already pounding from yelling directions to my third (new student on the volunteer) "grab the lucas, load the stretcher with the suction, lets go" I dropped to my knees and checked his pulse, and I started chest compressions. Before when I had preformed cpr it was always on 40-80 year old. But it was all for nothing, will one of the firefighters was starting to manage his airway but discovered the kid had rigor mortis. He had been dead for too long he was beyond help. Yesterday had been his 18th birthday. His room was filled with empty rum/beer bottles and there was a bag weed, I am not sure how he died but this wasnt a one time event, Actually last week my dept. had responded to this same kid crashing a car into a house completely drunk. No matter what he did or had done with his life it was just a horrible experience, I am not sure which was worse, leaving his cold body on the cement floor or walking past his mother outside the house.
The whole experience brought me back to a debate I had earlier with my friend about whether health care is a right or a privilege. It seems self evident to me that health care should be a right for everyone. But when people deliberately throw away there life repeatedly what do you do. Do you get so many chances? Or is addiction just as much a disease as cancer and just requires treatment through lapses and remissions. But there is an undeniable element of choice in these cases. So where is the line? Is there one?

What I do

Since it was not clear what exactly it is that I do, I thought I would take this post to clarify. I provide 911 emergency care to the people of South West Alief Texas (S.W.A.T.) A large portion of our 3 districts are not wealthy and regardless of  the avg. income of the population, as I have discovered during my time at CVFD, it is often the underprivliged that call 9-1-1 more often. This is often due to the fact that lower income families are unable to afford medications, or delay seeking care via their PCP, if they have one or sometimes just don't have the means of transportation to get to the hospital.
 So let me describe to you my last shift as it was a typical day/night as typical as it can get in the 911-emergency services. My day started at 5:30 pm on sat I was driving to the station and was right in front of station 1 was a Life Flight Helicopter and nearly all of station 1's apparatuses. Apparently a motorcyclist had sustained severe head trauma during a Motor Vehicle Collision (MVC). Anyways so I got to watch Life Flight take off which was a first for me because I the proverbial white cloud but that's another topic. So back to my normal schedule. The first 30 mins prior to shift change at 6, I try to complete my ambulance check off and make sure everything is stocked, drugs, air, gas, equipment and batteries are charged etc. After 6pm the ambulance and it's calls belong to me and my partner. Boy this night was busy we ran all night. All three CVFD stations were busy, in fact we had to do a lot of running between districts. One memorable call of the 6 or 7 calls of that night was at Wal-mart. (It was so much fun getting to the scene because I got the opportunity to drive about 90 mph down west park tollway lights and sirens blaring)  This Wal-Mart greeter who had hit her head on steel pipe and had some loss of consciousnesses (LOC). She was also very hypertensive so eventually we convinced her to go to the hospital with us. She was the sweetest 65 y/o. She kept complimenting me and my partner and to keep her awake I kept asking her about her very interesting life. She used to be married and due to her husband's job she lived every where from Egypt to all over Europe and even some of South America. She was so thankful when we got to the hospital that she wanted a hug before we left. It must have been the great aunt in her. Her appreciation defiantly helped me my patience with some of the other calls that we went to that night. I got to eat dinner at about 10pm unfortunately cold form sitting on the table. And after the 6th call that night at about 4am I finally got to sleep for about 3 hours. Till I was woken up by my new partner for the next shift. Oh yeah forgot to mention I worked a 24hr shift.Thank goodness the AM shift was light compared to the night. I know this blog is a little late and I have so much more to say but I still haven't gone to sleep so it will have to wait. Good night.

Day 1

I have been volunteering as an EMT-I at CVFD since last October. I first started as part of the service learning class of the honors program at St. Thomas. It was very similar to this project we kept a journal during the 100 hr commitment. After the 100 hr commitment was over I realized how much I had enjoyed volunteering for the Alief community. I am getting close to my one year anniversary at  Community Volunteer Fire Dept (CVFD). I hope that reflecting in this blog will help provide insight into the lessons I learn from those whom I serve and work with.