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Saturday, June 29, 2013

Oh my achin' back....

It was September of 2010 when I went to SWAT school. I had waited 10 years to feel like I was ready and to have the opportunity to go. I couldn't have been more excited. On the first day we did the obstacle course. I will never forget hanging off the side of that 10 foot wall right before I dropped down. I was thinking "oh myGod I'm really here, shut up and get back to work, ready? ok drop" and when the lightening bolts of pain shot up my spine when I landed flat on my feet I thought "no worries I'll be fine". 2 days later I couldn't do a jumping jack. The team doc thought it was a disc. He wanted to know if I was still good to go or if I needed to stop. "stop?! STOP?! do you know what I've been through to get here??" I pushed on. Until the half way mark, when I woke up on the cold concrete floor of an building at an outdoor firing range, after we had been up clearing buildings most of the night, and the thought of putting on my vest made me tear up. I had to go. I hung my head in shame all the way home. The doc was right I had herniated two discs in my lower back. After some rest and PT I was good to go back to work....Fast forward 2 years to a long night on the medic. It was late, already I was behind on my paperwork and we get a call for breathing difficulty. We get there and she isn't having breathing difficulty. The cellulitis in her leg hurts and she wants stronger pain meds. Sigh. Here is the problem. She is a robust woman of nearly 500 lbs or more and somehow she can't get her jazzy chair through the doorway she is in. (I'm still not sure how it got in there!)so we get the stairchair. It took a while but we maneuvered her from the house and onto the stretcher and we were off. On the way back my lower back began to hurt. After 4 days I couldn't sit up or turn over in bed. I couldn't squat, I had constant sciatic and leg pain and then I began walking like I had a stroke. Dragging my left foot along because it wouldn't cooperate with the rest of my body. We went through all the traditional non surgical options and finally 5 months after this began I had a laminectomy done. Which lasted about a week before my pain came back. I did everything the doctors wanted. Nothing worked. I was in the office looking at my last post op MRI and I noticed that one of my discs was poking out. I asked my surgeon about it, and he told he it wasn't herniated bad enough to cause me issues. He wrote me off as a failed laminectomy syndrome patient. But my gut was telling me that wasn't true. I found a neurosurgeon and took everything for a second opinion. Well that disc that " wasn't that bad" is smashing the nerve root and it has been since before my first surgery. My original doctor only fixed half my problem then acted like I was the crazy one for still having pain. For 8 months I tried to get him to do something and all he did was deny deny deny. I have surgery scheduled for a week away. Hopefully this brings me the relief I crave. I have at-least another 4 months of recovery and rehab time ahead of me. Yesterday I learned they filled the last 2 positions on the SWAT team. There goes my dream. I am sad about it and angry that my goals were kicked away by a person who didn't need emergency care and a doctor who refused to admit he may have made a mistake.

Tuesday, November 15, 2011

pain

Mine and theirs. Somedays I feel like I wear the pain of all those I have encountered. Weighing me down like a heavy coat in the rain. Suck it up buttercup. Yes I know. Find an outlet. Yes I have. Who cares? I still do. Over ten years of anger, pain and fear. And somedays no matter how far I run, no matter how much I write,no matter how much I laugh, I wear their pain along with mine Heavy like the rain.

Wednesday, June 15, 2011

PTSD Survey

I know it has been a ridiculously long time since I have blogged about anything. But I have been buried to my eyeballs in college. I am currently writing a paper on PTSD symptoms in first responders. I have created a survey to collect some data. It is completely anonymous. I would love it if any of you out in blog land would take 10 minutes and fill it out, maybe pass the word to your first responder friends? If you wish to add any information you can email me at my gmail account. Anything you send me will be kept confidential and no names will every be used in my paper.

THANK YOU ALL!

http://www.surveymonkey.com/s/Q62F3Y8

Tuesday, October 27, 2009

Crass Pollination

Hey I can't seem to access Nurse K's blog! anybody know whats up and how I get an invite? I miss reading her stuff

Tuesday, September 1, 2009

The case for critical care

I know it's been a while guys. I just wrote this for a friend who wants to go to criical care to give him some ideas. It is by no means complete, I thought you all could expand on it for me.


Critical care is not merely vent settings, balloon pumps and lab values. It is a deeper understanding of what we already do. Medicine is an ever changing field with great advances being made all the time. How often do you pick up patients with new unfamiliar medications or medical devices you have never seen? How do we know what to do with them when they are in extremis? How do we know our normal course of action will be sufficient or if it will do more harm than good? The answer is that we further our education to become more well rounded providers that have a better understanding of how the body works, how certain disease processes effect us and how medications work. Every city in this region runs mutual aid into the surrounding areas. Do we know all of the special needs patients in these other cities? When the weather is bad and the helo isn't flying there are times when we run critical ground transports to other facilities. How many street medics know how to manage multiple drips when there is no nurse to go with you on the run? How do they handle chest tubes and central venous access? How many medics can manage a propofol drip? Do they know how it works and what to watch for? EMS is diverse, we walk not only into patients homes but into doctors offices, military clinics, shipboard clinics, and a multitude of other places. They call and we go, it doesn't matter where they are. We as providers should be able to handle anything that we walk into with more than a very basic understanding. We may accept a patient who has had treatment started by a doctor and we should know what that treatment does and what else we can do for this patient. To have medics that are critical care certified is not only an asset to your department on the street it is an asset to your training division. These medics can put together classes to help the other field providers improve their knowledge base thereby improving the quality of prehospital care and patient outcome. Patient care and patient outcome are really what we are all here for, and critical care does nothing but improve on an already strong system.

Tuesday, July 21, 2009

SANE cases

People. We deal with people everyday. But how often do we deal with the victim of sexual assault? When we do, do we allow our perception of the world to color our views of them? These patients are a breed all their own and require a certain amount of special handling. These assaults can occur on both sides of the gender fence, though they are more reported when the victim is a woman. They can happen to anyone; Black, white, rich, poor, drug addict, prostitute, lawyer, doctor, old or young it is a crime that crosses all social barriers. Rape is a crime of violence and usually less about the sex and more about domination. So how do we deal with these patients who are in a moment of crisis, knowing that how they are handled can effect them for a very long time? I have had no formal training on this but life and quite a few psych classes have taught me a few lessons. Hopefully this can help others to deal with these psychologically complicated patients. If any of you have any thing to add I would greatly welcome any suggestions.

First I always approach my patient slowly and maintain a "safe" personal space distance. I don't want to violate their space any more than they have already had it violated.

I speak with a low even tone. I maintain an open stance and squat to their level so they can see me. I try never to stand over them or to have what appears to be an aggressive posture.

Before I do anything with them, I ask permission. I tell them up front what I would like to do and explain what is going to happen while I am doing it. I will not cross that personal space barrier until they give me permission. This is an attempt to give them back some control over what is happening to them.

I ask minimal questions, just do the basic assesment, treat any obvious inuries and I don't ask specifics regarding the assault unless they relate to the injuries I treat. ie were you struck with a fist or an object? kicked ect. I stay away from rape specific questions. I think that is more the place of the detective and the SANE nurse.

I let them talk. If they choose to talk to me I just let them say whatever they need to say. I assure them that they are safe with me and will continue to be so when they arrive at the ER.

The last thing I do is explain some of the process they will go through in the ER. This gives them an idea of what is next and also people feel more in control if they are informed.

In our area we have what are called SANE nurses. They are forensic nurses, SANE stands for Sexual Assault Nurse Examiner. They examine and collect evidence and help point victims in the right direction for further care. They are invaluable in my mind and I think all ER's should have atleast one.

I hope some of the things I have learned will help you guys deal with your patients. I am hoping to get some training with our department and a local SANE nurse. If it happens I will pass the info we get on. Remember when we are dealing with these patients that no matter what their life circumstance no one deserves to abused this way and they deserve the utmost of care and gentle handling.

Tuesday, July 14, 2009

Loss


Our department lost a man today. A firefighter,paramedic, brother and friend. He was my preceptor when I came to the city. He terrified me at first but we got into a comfortable rhymth and when I was done we moved out of our preceptor/preceptee relationship and onto the comfortable banter of coworkers. He was a teacher and friend. He could be a butthead but it didn't last long. He had a dry wit and a sarcastic sense of humor. He could make me laugh until I cried. The loss of him is a huge loss from our lives. He will be sorely missed.

Rest well Brother you'll be in our hearts.