Wednesday, April 8, 2015

Coming Out

Remember dragnet?
"The stories you are about to see are true. The names have been changed to protect the innocent."

About that…

Recently, I made the decision to include my :::gasp!::: real name on my blogs (of which I write several, on different topics).
I did so because on one of them, it's fairly important that people know who is writing it, and when someone I know recently commented on a post somewhere, it became clear that she had no idea I had written it.
I knew it would make the change to all of the blogs associated with the same account, and rather than go through contortions to move any, I decided to just use my name.

So all two of you who read this blog- and the one of you who might not have already known who I am- now you know.

I'm pretty comfortable with my decision, largely because I don't post stupid stuff online that would cause me, or anyone else, problems.

But just in case it worries anyone, I thought I'd make a brief (ha!) post about it.

HIPAA.
Yes.
That.

When I write stories for my blog (or anywhere), I'm not about to violate anyone's privacy. I wouldn't do so, even if there wasn't a law prohibiting it.

My stories are "loosely based" on real stories, in the same way many movies, TV shows, and novels are, with one important difference.

The question here is, how do I retain the "heart" of a story, while making it absolutely unidentifiable? Most "based on" situations don't have that requirement, but I do.

Fortunately for me, I learned a lot about this years ago, from a friend who is a television writer. She used to share with me all the revisions of a particular script, so I could see all the change it went through. Maybe they can't get a particular actor that week, so can't use that character. Maybe they can't get a location to match what was written, so need to change it. Maybe they can't afford a certain special effect. Maybe the director or actors have ideas they want incorporated into the story. And so on.

It was very interesting to me to see that through all the many changes, for many different reasons, the MEANING of the story stayed. The emotional content remained. 

That is what I try to do.
I write stories because of how they affect me. The story is about what I learned, or what I felt, or what I think is important, rather than about the patient or their specific medical situation.

So I make a lot of changes.
I change ages.
Change locations.
Change seasons.
Sometimes, I change genders, but not always- because if I always did, that would be the same as never changing!
I may add, or take away, family members.
I may add, or take away, pets.
I may add in specific details that weren't actually there.
I may even change the medical condition, or the signs and symptoms, sometimes almost entirely. Often, they aren't the point, at all.
Sometimes I combine several stories into one, as if they all happened to one person.
I never post about anything close in time to when it happened.

I live in a small town.
Tiny.
Even leaving out names and locations, it would be far too easy for some of my patients to be identified, so I don't write about those, at all. It means there are good stories I can never tell, but that's the way it is.
It is not possible to read any of my stories and identify any specific person or situation.
Sometimes, I go back and read through earlier posts, and even I can't recall what call or patient was the catalyst for the story.

Just sayin', in case anyone plans to go all HIPAA on my ass, or something.  :-)

Tuesday, March 3, 2015

Snowstorm

She died of a snowstorm
each breath
blowing drifts across the road
her broken heart
even slower 
than the ambulance could travel
too late
to shock her back

Sunday, March 1, 2015

Wishful Thinking

I've learned a lot from being involved in Emergency Services.

One of the things I've learned is that most people OUTSIDE emergency services have absolutely no idea what we do, how, or why.
Many of them don't WANT to know. Too scary.

They just want to be able to call 911, and have someone come solve their problem for them.

That sounds good to me.
Or it would, if it really worked that way.

There are two separate problems, which often overlap.
One is a lack of understanding, and one is a lack of resources.

When people have no understanding of their medical problems, and/or no understanding of what is or is not really an emergency, and/or no understanding of what an EMT, Paramedic, or the ER can do for them, it's not such a great fit.
In the other case, even if they do understand, if they can't afford medical care, and/or live by themselves without anyone to help them, that's not such a great fit, either.


Here is my wish list:

1. Everyone would know enough about their own bodies, how they work, what can go wrong, and how to deal with it, that they could take care of most issues themselves, and be able to evaluate when that is NOT the case, and call for help in a timely manner.

2. Everyone would be able to afford medical care, both routine and emergencies. No one would ever delay getting help, or checking up on something, because of not being able to pay for it.

3. There would be more options for providing care. At night, there would be somewhere else to go besides the ER. Families would have access to more levels of care besides "do it yourself" and "put them in a home."


I can't make these things happen.

I CAN try to have some beneficial influence where possible.

I teach a class I call "functional first aid."
It provides no certification.
It has no set curriculum.
Instead, we look at the specific needs of the people there, and help them understand those needs and learn more effective ways to manage them.
There may be people with chronic medical conditions.
There may be someone who works with a population that has a higher risk of certain kinds of illnesses or injuries.

I've helped people put together a First Aid Kit for a month long summer fieldwork trip, where they would not be within easy reach of medical care.
We put a priority on early recognition of true emergencies, and on self-reliance for as much as possible.

I also teach people HOW to call 911, not just when to do so.
Most people don't know how that all works, and can be hesitant to call when they don't know what to expect.

I talk to people about what paramedics do, and why, in some cases, calling an ambulance is MUCH better than trying to drive themselves, or a family member, to the hospital. It's not so they can effectively "cut the line" and not have to wait in the waiting room; it's because for some conditions, treatment can be started in the ambulance. Many people, especially older people, don't know this, and do, in fact, see an ambulance as only transportation.

I'd like to be able to do more to help connect families with elderly family members, who need more care than they are getting, but aren't quite in need of full time care. We have a number of families in town, where either the elderly or ill person is refusing a higher level of care, or the other family members don't quite realize that they aren't able to provide what is needed any longer. Or maybe both.

I don't think I'll ever run short of things for my "wish list."

Saturday, February 28, 2015

One of My Favorites

Had one of my favorite things happen at a call recently.
It's a simple thing. A small town thing.

We got a call to an address where I had been before, but the patient description was not even remotely familiar, even though the location was.
We don't have a lot of rental property out here, but we do have some- and this was one, so I thought maybe the previous patient had moved or something, and that was why this wasn't ringing a bell.

But when I walked in, something happened that clarified everything.

The patient recognized me. 
Remembered that I had been there before, six months ago.
When the patient's FRIEND was staying there while recovering.

THAT was why nothing sounded familiar.
Same address; different patient.

At the call months ago, I assumed I'd never know how things turned out, because that patient doesn't actually live in my response area, so it was unlikely we'd meet again. It was a somewhat uncommon medical situation, so I had wondered, more than once, how things had gone.

The friend was happy to give me an update, and let me know the former patient was doing very well, indeed.

So nice to hear!

I was somewhat surprised to be remembered.

Friday, February 27, 2015

One Small Post

It has been forever since I've posted.
No excuse for that, other than life being life, and things being things.

As usual, after a long break in posting, it's a bit of a challenge to decide what topic is "good enough" to be THE post that starts up the blog again.
Also, as usual, my decision ends up being that it doesn't matter. This isn't about the big, important topics, it's about the daily, small things. The insights. The experiences. The learning process.

Since my last post, I've gotten to do something that is near and dear to my heart.
I've become a lab instructor, with a great crew of other lab instructors, and help teach EMT classes at the local community college.
Not only that, but one of the primary instructors has a different take on how best to teach the class, since the state changed the curriculum. We're running a class that is heavily lab-based, with much less powerpoint and much more hands-on. We're currently in our second run of this concept, and I have to say, I think we're heading in the right direction. Still some stuff to work out in order to make it the best it can be, but we've seen many advantages to this model, and on top of that, we're having a great time, as are the students.

The first semester I was doing this totally kicked my butt, in a GREAT way. To be able to present didactic material in the lab setting, while keeping the hands-on part engaging, not spending too much time talking OR skipping any of the critical information, requires the instructors to be on top of our games, and has been SUCH a great learning opportunity for all of us, not just the students.

Instead of the typical lab structure of setting up stations that the students then rotate through, we have "teams" of students, each assigned to one instructor for the whole lab, and then change which instructor they work with from lab to lab. This means much of the instruction is done in a small group setting, which has done wonders for encouraging students to ask questions, and to keep up with the reading, since they really are expected to participate and contribute to discussions (and they DO). This ALSO gives the instructors a lot of one-on-one time with every student in the class, and our post-class review highlights any student who is having trouble keeping up.

For me, this way of teaching is a "natural" fit, since it is so connected to the teaching I've been doing in the rest of my life for the past 15 years.

I think this is enough for coming back to this blog. Lots of other stuff to say, of course.
Updates on our "medical mystery." (Solved? Maybe.)
Lessons learned from calls.
Maybe an update on not being so alone out here anymore… or am I?
Or maybe… I'll end up not posting again for a couple of years. It could happen.

At any rate, if anyone out there cares, this is just a short post to show that I haven't quit, haven't disappeared, haven't become one of the many, many people who burn out.
I am, however, intensely jealous of everyone in Baltimore right now for EMSToday. I couldn't afford to go, in time or money. :::sigh:::

Monday, March 11, 2013

Grieving

Some calls stand out.

It might be because of the patient's condition, or it might be that things went particularly well- or not well. It might be the weather, or who was there, or where it was, or almost any other detail. There's no question, some stay with us longer than others.

If the reason that the thought lingers is that it was an emotionally traumatic event, there are a variety of ways that people deal with that. There's even a process in place, to bring help to anyone who is having a hard time.

I've been doing this for a few years now, and have seen more than a few things that most people never see. I've had calls go extremely well, up there near the "miracle" category. And I've had some that didn't go well, necessitating much thought and re-assessment and some researching and pre-planning for the next time.

I've had calls that might make most people stressed out not cause me to be so, and I've had some that weren't particularly "bad" stay on my mind for a long time.

I get attached.

This shouldn't come as a surprise to anyone who knows me. I get emotionally attached to inanimate objects, like my car, or my computer, or the house I lived in as a child, so attachments to actual people isn't much of a stretch. Even if I don't know them.

Through all of this, I've learned what helps me process things, what helps me cope, what helps me stay human, without staying sad.

I recently had a call where the patient didn't make it.
It wasn't a surprise, given the situation at the time.
I would really like to have been able to do something more helpful, but it was not to be.

I read the obituaries every day.
Partly to see if anyone I know died, partly to notice the ages of the deceased, but also, to see if any of "my" patients are in there. Sometimes, we get called to a patient and we don't find out directly what happened, but they never go home again.

It is in those obituaries that I sometimes begin my healing process. I read about their lives, their families. Sometimes the things they have done, or the dreams they had. I see how they were- and are- loved.

I "get to know them," just a little. Enough to say goodbye, and to mourn them as a person. Enough to be sad for their passing, and to remember them.

And then, I can move on.

Goodbye, my short-term friend. May your smiles be remembered, and lighten the hearts of your family and friends.

Thursday, February 7, 2013

In the Middle Of It

So we're taking this class, and having a great time. Learning a lot. Working with some great people. And now, cardiology. What we've been waiting for.

Sounds great.

Except for one little detail...
We are also right in the middle of our very own Mystery-Diagnosis-worthy medical situation.

As in, I wouldn't be surprised if we actually DO end up on that show.

So far, we're on Dr.visit #7, and medication #9.
And no one really has a clue what is wrong.
Lots of theories.
Conflicting theories.
Most of which don't match the signs and symptoms.

Some tests are being ordered, and I'm bouncing back and forth between "Oooh, cool!" and "oh, crap!"
Hopefully they will shed some light on the situation, and we'll get things figured out and fixed and life will go on.

In the meantime, this is wreaking havoc with any ability to do clinical or ride time, and the future of staying in the class is somewhat doubtful.

As much as I find the entire subject fascinating, I've been telling people that what I'd really like is for no one in my family to ever have anything medically "interesting" happen to them.

When we get to the other side of this, I'll write it up as an exercise, and see what people think. Until then, good thoughts would be appreciated.