notes to self

I am fairly sure I've mentioned in previous postings that it's generally a bad idea to run from the police. Especially the great big furry ones with doggy breath. I may not have mentioned Zito in particular, but his reputation does tend to precede him; the last bad guy he bit was wedged so far into something that only his face was showing; Zito got the attack command and latched onto the guy's jaw. . .took 81 stitches to fix him up. (actually, it took more than that. . .they just stopped counting at 81.) The current bad guy Zito bit had just sprayed his stepdad in the face with a blast of shotgun pellets and was heading for a toddler when the po po showed up. His teeth numbered higher than his IQ, and that's giving him the benefit of the doubt. After I struggled through the irrigation of his doggie tooth puncture wounds ("ooooohhhh, aaaaiiigh, what's that?" he would scream, poking his filthy finger into the hole I'd just finished cleaning and yanking out pieces of adipose tissue. ""Oooohhh, it hurts so effing bad!" and he'd yank his uncuffed arm away and flail his legs around.) I went outside and loved on Zito, good Zito, sweet great big puppy Zito.

note to self #1: don't run from the po-po. and carry doggie biscuits.

So later on in the day and we're working up a psych patient who, if you didn't know her, seemed fairly lucid. But by the end of her stay she's got the people on the other side of the curtain convinced that they've got brain tumors, aneurysms, and some sort of gangrenous disease that makes their blood float around the outside of their bones instead of living in the marrow where it belongs because she knows just enough medical terminology to be convincing to people who don't know the difference. She doesn't care if you listen to her; she'll start talking like she's got a motion sensor as soon as you walk in the room and she'll just keep talking until she's winds down, regardless of whether anyone's in the room or not.

note to self #2: any information gleaned through the curtain divider of an emergency room is highly suspect.

Just about lunch time and we get a chest pain patient. The guy is in fairly good spirits, points to his inferior sternum, laughs and says yesterday he went to his mom's and had some of the worst coffee ever, and he's been feeling this weird chest pressure ever since. He's 55, fairly active, smokes less than a pack a day but that's his only risk factor. I'm ready to slip a 20g single lumen in his arm when he goes on to say that he mowed his lawn after the terrible cup of coffee and had to quit half way through because he got so worn out. Initial EKG 12 lead says normal sinus rhythm, but I just have this feeling. . .so I trade out the 2o for an 18 and a dual port lock and go to refill my IV tray. 30 minutes later and it's almost break time when lab calls with an "OMFG" troponin, the charge nurse looks up at the monitor at the nurses' station, sees v-fib and says, "is that his real rhythm?" and the wife screams "HAAAAAEEEEELLLP!" out the door of the patient's room. We called a code, as you might imagine. Crazy, though- I've never seen a patient in vfib responsive. . .the guy was obviously alert but understandably panicked. . .the first time we shocked him into a unresponsive PEA; epi shot him back into a conscious torsades that kept slipping back into vfib so we shocked again. He'd look at me with terror and then go into hypoxic seizures. Doc pushed mag and amiodarone and we shocked him one more time back into a sinus rhythm. Repeat EKG showed remarkable ST elevation, as if we hadn't figured that out already. I started two more fatty IVs, talking to him the whole time; we got him calmed down and on the table for a balloon and stent. I went and saw him later and he grabbed my hand and called me his angel.

note to self #3: avoid mom's crappy coffee. Hire a landscaping company to mow the lawn. Pull the tarnished halo out of the coat closet.

and today's job security award goes to the 25 year old male who called from the ER room of the other hospital to see if he might get better "service" from our ER. Turns out he just wanted more narcs to ease the pain of constipation; he turned down the other ER doc's offer to digitally disimpact. He called our ER 5 different times before finally making it over; each time, our doctor informed him that, as our patient, he would get the medical screening due to him by law, but the other physician's work up and treatments and his recent past visits to both hospitals would be taken into consideration. The guy showed up anyway, got his medical screening, and was offered an enema. He declined.

note to self #4: you can't cure stupid.

firefighter girl steps up on the bitch box

The ED is where the maimed, sick, injured and generally decrepit paramedics are put to pasture. At least, that's what I tell patients when they ask me. What I don't tell them is that we are also put in the ED for comic relief, manual labor and general ass-chewing from grouchy nurses. When I'm at work, my nametag says "everybody's bitch." I also don't tell them of the number of times we've saved some not so great RNs from making very bad decisions with their patient care, or that we've had numerous great nurses say that in critical situations they'd much rather have a medic than another nurse in the room, or that "where's my medic?" is one of the first things most doctors will yell upon entering a room and finding a patient in a bad way.

A decade ago, several nurses in the ED where I currently work took offense to the medics' scope of practice in the ED, and fought long and hard to limit it. At that time, the physicians' group petitioned to have control of the medics, but the hospital chose to take it on itself, and the "ED tech" job description was so vague that it left much room for interpretation, so you never knew, really, when you were going to get in trouble for something.

Two years ago, we got a new department manager, and he and I spent a lot of time rewriting the job description of the medics. Somewhere along the way, our little hospital was bought out by a nasty, terrible, horrible company, but things didn't change much in the day-to-day stuff. We continued to flesh out our job descriptions, and had several of the doctors volunteer to be our physician advisor. We were finally starting to feel like more than housekeeping with IV and CPR skills.

And then, a couple of months ago, we get a letter from the nasty, terrible, horrible company stating that ED techs in their hospitals (techs with the same number of years of training as RNs, mind you, with the same associates' degree and prerequisites, but with more clinical hours and more requirements for continuing education) are no longer able to cardiovert, pace, start EJs or IOs, remove sutures or staples, etc etc etc etc. We are, however, now able to digitally disimpact.

rock on.

oh, the shame and embarrassment

I'm a very persistent, stubborn woman. Ask anyone. Especially ask the Rock Star, who actually thinks it's one of my more endearing qualities. So this past weekend was our last for snowboarding, and we headed up to the resort we went to back in February, on Valentines Day, the day I broke a few of my ribs on the left side at the sternum and at the bone/cartilage joint.

Apparently, I didn't do it well enough the first time, so I did it again. First run. It was icy, and I wasn't going nearly fast enough for the turn I wanted to take, and I took it anyway. Stupid of me. I knew it was going to be a hard hit, so I tried to tuck and roll, but I ended up landing on my right arm.

You EMS and medical folk, you know that sound that happens when you're doing good CPR. I heard that sound when I hit the ground. And it's kind of cool on somebody else, but it made me throw up in my mouth a little when I heard it coming from me. Or maybe that was just a normal reaction to the incredible flash of pain that jolted through my body as two of my bones snapped. I stayed very, very still for about thirty seconds, then stood up, assessed, and decided I could manage a few more runs. ("what?!" you say. . . I know, I know, but I was doing really well on improving my turns, and this was a huge group of friends I hadn't seen for a while, and it didn't hurt all that bad, and I'm a master [mistress? matron?] of denial, etc etc etc. . .)

I managed about four more lifts, one of which I rode clean from start to finish (yay me!!), then hit the bar for a much needed beverage and reassessment. I did try one time after the bar, but I was favoring and guarding so many different body parts that I ended up riding sloppy and decided it was quitting time.

After the Rock Star helped me get undressed, he tried to help me into bed. Bad idea. You've not truly experienced crepitus until you've felt it (and heard it, dear lord) on yourself. Even the unflappable Rock Star got a little pale.

It's a little embarrassing to admit that I broke both sides of my rib cage two months apart. And I don't want to hear any "maybe you should quit snowboarding"s, because it's something I love and something I'm actually starting to get better at. Feel free to suggest various forms of protection, however: so far, I've heard some real winners, including chest protectors from super cross racing; pillows, duct tape and baling wire; DDD boob job, and hockey gear. Personally, I think I'll stick with a calcium supplement and not falling anymore. And a lot of percocet and ibuprofen.

i'm such a softie

I may not have mentioned any of this before.

Some time last year, oh, around October, I realized I have this really incredible insurance that I'm paying out the wachoo for every month. And MixMan already got his cochlear implant, and they paid all but around $300 of the $60,000 of that, so I started thinking that maybe I should be taking advantage of that spiffy, pay-out-the-wachoo insurance and get some stuff done. Particularly since you never know when my mouth is going to get away from me and get me fired.

So. Although little Firefighter Girl and Rock Star babies would be beyond cute and incredibly amazing, as far as babies go, after some brief discussion about the possibility of same and then some shared horrified looks between myself and Rock Star as that potential future loomed, and realizing that with Miss Diva turning 7 this summer I am only 11 years from freedom, and I'll be damned if I start over, I decided to get the tubes tied. And one of the reasons I decided, with Rock Star's input, to do that instead of him getting the old snip-snip (which he volunteered to do, and attempted, but because he is still young-ish and doesn't have kids of his own, his doc wouldn't refer him. Feh!) was because I also had really horrid varicose veins on the right leg, and apparently one of them was throwing clots. And you can't really get a doctor to take those out unless you promise you aren't going to get preggers again. So.

Tubal in October, laser ablation at the end of January.

Still had stitches in my right leg on valentine's day, when the Rock Star and I and a few of his friends went boarding. And- funny thing- I was really concerned about hurting my wrists, and even went so far as to check out some wrist guards that I ended up deciding were really pointless. But the wrists, as it turns out, weren't what I needed to worry about. So, second run down, I'm getting a little cocky because my turns are looking beautiful, and I make a turn from toe edge to heel edge and then catch just a little bit of ice on the slope, and suddenly I'm airborne, and then suddenly I'm not. I landed right smack in front of two 16 year old boys who, I notice, are wincing.

I won't kid you, I knocked the air out of myself, and I haven't done that since I was a kid and tried to polish my brother's chin-up bar while it was still mounted in the doorway. I finally rolled over and scooted to the side of the slope, where the Rock Star caught up to me and asked me some standard paramedic type questions. All I knew was that my whole chest hurt like hell, but I figured I'd just end up with bruised boobage. We headed up a different lift and by the time we made it to the top, I was having a hard time breathing because it hurt so bad, and every single turn, bump, and fall was excruciating. I am not proud to say, I yelled at the Rock Star. And his friend. And anyone else who would listen. And then I spent the rest of the time in the bar at the lodge, drinking and seething and hurting and generally feeling sorry for myself.

But it turns out, you see, that when I landed (on my mp3 player that was in my front pocket), I cracked ribs 6, 7, and 8 at the sternum, and then broke ribs 5 and 6 where the bone meets the costal cartilage right under my left breast. I could barely breathe for 2 weeks, and I would wake myself up in the middle of the night trying to roll over. Luckily, I'm mostly healed now.

All of this is a really, really long introduction to tell you that. . .I've gotten a little soft. I haven't run or worked out for months due to surgeries/pain/injuries, etc. And when I got on the scale on Monday, after realizing that my pants were feeling a little tight, I decided that was enough, by gum, and I'm going to become a Jillian Michaels convert.

That's right, people. Firefighter Girl is going to become a Shredhead. Thanks to Motherhood Uncensored for the inspiration.

prepare yourself for some righteous indignation, because I've been stewing in it all night

The ambulance report: a 56 year old female, chief complaint is "generalized weakness and depression." We roll our eyes at each other, certain that we know what we'll see when the patient rolls through the door. And sure enough, it's a 56 year old woman with messy gray hair, in a dingy old bathrobe, smelling faintly of pee. And so I sigh, and follow the street medics into the room, and get a look at this woman's face, and my god.

You know in horror movies, when the hero and heroine come across the skeleton that's kind of half decomposed? you know, with the skin so taut across the skull, bones jutting out everywhere? That was this lady's face. And I'm listening to the medic tell about her medical history--none, except for cancer in her humerus decades ago, and a history of mild, unmedicated depression, and trying to fit that in with the way her face looks. And then he mentions the bilateral pitting edema in her lower legs.

Sure enough, it looks like all the weight from her face and upper body slipped down into her lower legs. And then she starts telling us how she's been depressed, and so she went to a psychiatrist two weeks ago, and was so weak she couldn't make it out of the car, so he came down from his office to the car (how kind, you're thinking, but no, keep listening) and crouched down beside the passenger side and scribbled a few scrips--two for antidepressants, one for a benzo since, in this psychiatrist's opinion, the weakness was not a physical but a psychological issue, and, regardless of the fact that her face looked like a skull upholstered in jaundiced leather, she was obviously suffering from anxiety that prevented her from leaving the car. Uh huh.

So the nurse and I keep asking her questions, and we find out that for the last two months she's had to use diapers and a commode, and although she eats the same amount of food as she always did, she's lost over half her body weight. She's afebrile, she denies pain. Just too weak to get around on her own anymore, she says. I help slip the bathrobe off, and suddenly there's this horrific smell. The bedsore smell. Except it's coming from her chest, and the dark green flannel nightgown she has on is saturated with what appears to be blood and pus. So I peel that off, gingerly, and find that what she has on one side of her chest is an enormous bloody and oozing hole where one breast used to be, and a dried, brownish flaking mass that still kind of resembles a nipple on the other side. Her WBC came back at 34, in case you were wondering.

Yeah. 34.

That is what breast cancer looks like, people. And yes, she should have sought help sooner--she didn't because she was disgusted and embarrassed, and her husband was so respectful of her and her wishes that he didn't insist. I doubt she would have told us about that gaping wound if we hadn't found it. But that psychiatrist, a medically trained professional, saw her edemetous legs and did nothing. Nothing, except throw prescriptions at her like candy.

Isn't it funny--and I want to slap myself for this--but when I've thought about breast cancer before, it's always the survivors who've had mastectomies and stand tall and proud that I think about--you know, the ones who look like Amazon warrior women who cut off their breasts so they could shoot an arrow straight and true. And maybe that's a good thing, that I think about these survivors as strong and fierce. But among women in the US, breast cancer is the most common cancer and the second-most common cause of cancer death after lung cancer. Women in the US have a 1 in 8 lifetime chance of developing invasive breast cancer and a 1 in 35 chance of breast cancer causing their death. So for every 34 Amazon warriors, there's 1 woman in a hospital bed with a rotting breast.

I will never, ever forget the way that looked.

raccoon love

Let me share with you the absolutely exquisite sound that woke me from a deep, lovely sleep long before the buttcrack of dawn.

I startled at the noise, because it sounded like it was coming from under my bed. Initially I thought it was a dying cat- god help me- but when I opened the door to my bedroom, I saw both my big white toms, Jem and Scout, sitting there, staring at me, looking rather concerned. Apparently the noise woke them up, too.

As I listened, though, I realized it sounded less like a feline and more like a. . . like a. . .like a giant hamster in a fight with one of those aliens from the movie "Signs," you know, with the clicking and the whirring noises. So yes, a giant hamster vs an alien, under my house. At 0230. And then- oh yes, my friends, this story gets better- the pipes started rattling, and various detritus that collects in the crawl space beneath any old house started flying around down there as the hamster/alien thing rolled crazily around, nattering and clicking and yowling away. I could hear the dog in the apartment upstairs pacing, the noise was so worrisome.

If I were brave, and it were less cold outside, and a little more light, I might have stuck a hose under the house and turned it on full jet. But it was very cold, and very dark, and I was not feeling very brave at all, and did not feel prepared to deal with anything that might come screeching out at me. So I stomped up and down on the floor, and then got down on my hands and knees right next to the crawlspace trap door in my closet, and shouted in my meanest, angriest voice, "knock it off!" which had no effect whatsoever on the giant alien hamster still crashing into pipes and such, but which caused the cats great consternation.

So I got back into bed and lay there with a pillow around my ears until the giant clicky shrieky hamster thingie made its way outside, and I peeked out the door and saw what appeared to be a large, fuzzy ball that could very well have been the alien hamster I'd imagined in my head that eventually stopped making noise and turned into two raccoon butts sauntering away from me.

Raccoons mating. If you've never been blessed with the sound, consider yourself very, very lucky. I'm going to have nightmares for days.

firefighter girl turns in her bunkers for good. . .maybe

Once I got off of night shift last summer, I spent so much time lounging in the sun getting rid of my night shift pallor that I got out of the habit of writing on the computer. And frankly, I was spending way too much time in front of the screen, anyway.

So, let me get a refill on my coffee--there--and brush the biscotti crumbs off the keyboard, and I'll try to start where I left off ages ago.

MixMan is doing amazingly well with his implant. Watching him learn to hear is truly remarkable, but it's funny how quickly it becomes commonplace; now he's learned to ignore his parents when they're talking to him just like any other 8 year old boy does. And, unfortunately, he's picking up on (and using!) some tones and inflections (you know, that certain sigh of bored, put-upon youth that is accompanied by an eye roll) that he was not previously privy to from his classmates. But his teachers say that he is beginning to open up and initiate conversations with them and with other students without his interpreter present.

Miss Diva has enjoyed having a brother as opposed to someone she must act as interpreter for; the two of them love having a back yard to tromp around in, and they go on nature scavenger hunts, and they've developed an interest in all things spy. Her Diva-ness is losing some of her girly-girlness, but she still loves the color pink, and in fact has all-pink days quite frequently. She's waaaay ahead of everybody in her class on reading and socializing. And she comes up with the most stunning observations sometimes. I love tucking her in at night, when she looks at me and says, "Mama, I think tomorrow I'm going to have a sensitive day." and I know exactly what she means.

Recently, a box arrived in the mail for MixMan, and shortly after, one arrived for Miss Diva, too. Having been forewarned as to the contents, I hid the boxes in the closet for a while, because I knew that my days of limited peace and quiet would be over. The boxes contained a trumpet for MixMan and a recorder and fife for Miss Diva, courtesy of my brother. (When I told The Rock Star about this, he squeaked, "Egad! Does he hate you?" and "egad" is hard to squeak, let me tell you. But no, I informed him, my family just has a strange way of showing affection.) MixMan played that trumpet until he had a blister on his lip; he slept with it, he tucked it in and made me kiss it goodnight. Now things have calmed down a bit, my headache is gone, and we're discussing lessons.

Meanwhile, across town, a new hospital was opening, which made for some big changes at the small hospital I work at. Like how none of us are sure that we'll have a job by next year. And I'd been thinking about my profession a lot lately, anyway; how the only paramedic positions around here are in ERs and on fire departments, how the ER job was supposed to be until my injury healed and I could get on to a fire department, but how because of my injury I'll never be able to hoist hose effectively again. So, after much discussion with the honey, and a lot of soul searching, I decided to go back to school again to become a licensed massage therapist. It's a very portable profession, and I want to eventually focus on hospice care. I've seen a lot of death in the last few years, and some people go with such dignity and grace, it's an honor to be a part of that, even when I'm fighting so hard against it, pushing drugs, defibrillating, doing CPR. I want to help ease terminally ill patients into that place of grace and acceptance, and massage therapy is one way I can do so. Plus, like I said, I can do it anywhere. So I started school fall term; it should take me about a year to finish up. The honey's getting me a massage table, but I think that's because he's sick of lying on the floor for his massages.

Since my new hours weren't quite making the rent, I took a second job at a new urgent care clinic the docs from my ER opened up. And just in time, because I was informed last month that my position in the ER is being eliminated. Luckily, I have senority, so when the dust settles I'll have a job again. But for now I'm stuck in an office, learning more about hospital policies and JCAHO national patient safety goals, etc than I ever, ever wanted to learn.

I don't know what the next year will bring. I know I don't feel terribly maternal most of the time, and figure the kids are probably better off with benevolent neglect instead of active parenting from me; as long as they know I love them, I think they'll do okay. And sometimes, it's all I can do to show them that. It is so hard doing this alone. So hard. Thank goodness I have sisters and a great mom who help me with parenting advice. As long as I've got that and a what-will-become-of-me bed with lots of pillows and a cushy down duvet I can hide under, I think I'll mostly be okay.

So. That's the news from Meth Central. Happy holidays to all of you!