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.

Sunday, January 27, 2013

Where Has the Time Gone?

Haven't found the time to write here for a while. Again.

Life is busy.
That's not a complaint, but it does make it challenging to keep up with everything.

I'm taking a class that takes a lot of time, for the class itself, studying between classes, and now, substantial ride and clinical time.

These are good things. I'm learning a tremendous amount. Excellent instructors. Plus, I've been doing this long enough now, and doing enough additional learning, that many things are starting to come together well.  That's interesting, a little exciting, and very useful on scene.

We've had interesting calls.
We've had more small town, small agency, politics.

I'll work on sharing more of the good stuff here. Learning opportunities. Stuff I've been thinking about. At least SOMETHING, rather than nothing.

Appreciating all of the support from those of you out in the blogosphere, even while I've been mostly absent.

Tuesday, October 23, 2012

The Tough Women Club

It was nearly Christmas. We were just sitting down to watch the Grinch, and tradition in our family is that if you want to see the major Christmas specials- Rudolph, the Grinch, and Frosty- you have to catch them when they are shown. No taping allowed.

Not five minutes into the show, the pager went off.

I knew where the house had to be, being familiar with our response area. It was back behind trees, at the end of a long driveway, with no obvious numbers. WE knew where it was, but the ambulance likely would not.

Sure enough, they missed the house. Twice, at least. We could see and hear them go by, but since I'm not allowed to carry a radio, we had no way to contact them to give them directions.

Meanwhile, we were inside, with the patient, listening to her story.

She told us about her cardiac history. About her stroke history. About being diabetic. About her asthma. She talked about tiring more easily than she used to. And oh, by the way, she casually mentioned she also has cancer.  All of this relayed with no apparent distress, like discussing the weather, or a television show.  She was, as she described herself, "a stubborn old lady." Certainly tough enough to kick whatever this was that made her feel "a little off." We had a good laugh together, the three of us, the "tough women" club, before anyone else arrived on scene.

She reminded me of another patient we had seen, another tough old lady, who made me smile more than once over the years. I wondered if they knew each other, if, perhaps, they had been close friends, they seemed so alike. I could easily imagine the two of them as youngsters, turning heads and causing trouble. This little town seems to grow some tough women, women who live long and well. Women who are good workers, and even better friends. The kind of person you can count on, no matter what.

I just now saw her obituary. She died a few days ago. I'm absolutely certain she was tough to the very end, and probably had friends and family chuckling over some joke, or tall tale. If I had to guess, I'd bet she was comforting family and friends, rather than the other way around.

Godspeed, Alma. Keep everyone wherever you are in line, until the rest of the club gets there, okay?

Tuesday, September 25, 2012

Connection/Separation

There is a patient we have seen many times over the past few years.
I like her.

She has a rare chronic medical problem, one I had never heard of before meeting her, and am now almost an expert on. When she calls, I know what to expect, where her pain will be, and what I can do to help alleviate it. I love knowing those thing, knowing that I am able to offer her at least some relief before the ambulance even gets there.

It is an intimate thing.

When a person is in a lot of pain, they are rarely at their most sociable best. Anytime someone is very ill, they tend not to be fresh as a daisy and ready to entertain, to say the least.
That we are allowed into that world is an awesome privilege.
She and I have met enough times that she trusts me, at least enough to allow me to be there, to touch her, to comfort her. She knows I care, and I know that she is grateful.

Living in a small town, it is inevitable that we would have friends in common, and we do. We don't "run in the same circle," but we do see each other from time to time at events, or in passing.

It is always good to see her when she is feeling well, when she is out being happy, being a whole, comfortable person in the world. To look at her then, you'd never imagine that she has any medical problem at all. She is vivacious, smiling, confident.

But not once, in any of the times we have run into each other outside her home, has she said hello, or acknowledged me in any way. And not once have I gone up and spoken to her, either.
It is an unwritten agreement, of sorts.
Although there are times when we are as close as people can be, sharing sweat, tears and pain, the rest of the time, I do not belong in her life. I am forgotten. Unacknowledged.

It is not that I expect her to run up to me and thank me every time she sees me.
That would be horribly awkward, at best, and isn't at all necessary.

I just find it interesting that there can BE such separation of connection.

I like how I am able to be there when she is having difficulty, and not have that spill over into a semi-social relationship, just because we live near each other. That we are not "friends" does not lessen the intensity or value of the relationship we have. It may well enhance it by removing all social awkwardness, or any obligation to each other outside the narrow window of emergency situations.

Saturday, September 15, 2012

What the Heck is Going On Here?

I'm having a few thoughts this morning, so I'll share them.

Class is going very well. We have a good group of people, both students and instructors, and I'm enjoying this very much, and looking forward to hanging out with these folks for the best part of a year.

I've found a very useful resource for the class. An obvious one.
The text we're using has an associated website, with lots of study-stuff. Some is more useful; other stuff somewhat less.
I've been taking advantage of the "flashcards" they have set up for each chapter.
After going through them a couple of times, I realized that they are set up to match exactly with the vocabulary list.

Memorization is not, in general, the best tool for learning. It provides no context, and that means much of it will be remembered short term, but not long term. I'm going for long term.

So if the flashcards were FACTS, I think they would be less useful.
But they aren't facts.
They are LANGUAGE.

Perhaps you have noticed that your language, the vocabulary you frequently use, has changed somewhat since becoming involved in EMS. We talk about stuff that no normal (read: "not an EMT") person talks about.

Being comfortable with the language helps to avert those "I know what it is, what it does, and why it is important, but I just can't remember what it's called" moments. More than that, it brings the medical field into daily thoughts, rather than something in a class, on a test, or during a call.

One of the things that knowing the language has helped me do is be an advocate for friends and family who are having some sort of medical experience. This is not a small thing.

Have you ever noticed that the average person has no understanding whatsoever of hospitals or medical conditions? I thought so. They often don't know what is happening, or why. Mostly, they ALSO don't really care to know all the details past "this is going to make me (or a loved one) better so we can get out of here."

I don't know about you, but I have found friends and family to be fabulous sources of medical education. I have also found that it's better if I don't mention this to them directly. The person having the A-fib typically does not find the monitor NEARLY as interesting as I do. The person just out of brain surgery has no actual interest in knowing about the effects of intracranial pressure.

If it's a situation where I have fairly direct access to the medical staff, it works well to have them explain to me what the situation is and what they plan to do about it, and I can make sure it is understood by the patient. I tend to know what questions to ask, and can explain procedures and options. I have found hospital staff very open to this, and willing to provide more accurate, less "dumbed down" information, once they realize I understand what they say.

If I don't have access to the medical personnel, it gets even more interesting. I get to play the "what the heck is going on here?" game. There is great challenge to be found in taking what the average layperson says about a medical situation, and figuring out what is really going on. Especially in the early stages of diagnosis, when no one really knows yet, in the investigative stage. Tests, descriptions, differential diagnoses- these are all rich with the potential of a layperson getting things very confused.

I once had a distant family member describe someone's condition as "she has a wiggly thing in her head." Hmmm. Where to go with that?

I find that I'm pretty insatiably curious about all the various ways a body can fail to function correctly. There is no end that I've ever found. It's no wonder doctors specialize- there are simply too many variations out there for anyone to be well versed in all of them.

I get to specialize in "whatever odd conditions find their way into my awareness" through my friends, family and patients. I look them up. Any time I hear about some medical condition I haven't dealt with before, I create my own "crash course" in whatever that is. Google is the most amazing thing. I can no longer fathom trying to learn about things without it.

I learned a lot of cardiac stuff when my father had an arrhythmia. I've had patients with spinal abnormalities, very rare kinds of cancer, rare diseases named after some combination of people with fascinating combinations of signs and symptoms. Right now, I have an acquaintance recently diagnosed with an unusual type of non-malignant brain tumor.

All of these are not only opportunities to learn about the condition, but to learn about how people respond when they discover they have a serious disease. The whole mental/emotional process is as important as the physical process, and often overlooked. I find this aspect as compelling as the physical part. It's probably where I can actually provide the most help to someone, rather than any of the technical skills I can perform. It's unfortunate that there is so little focus or training provided for this.

Then again, if we were experts on everything, an EMT class would take approximately a zillion years to complete. In essence, it does. Anyone who thinks their learning is complete when they pass the final test, is missing the point entirely. Anyone who thinks a class can "cover" everything we need to know hasn't spent much time in the field.

It's a fascinating world out there.

Friday, September 14, 2012

No Experience Necessary?

As promised, some comments on this post, about a study showing that having a year's experience as an EMT-B before taking a medic class makes no appreciable difference.


I think a LOT depends on the situation, and there is a huge variety of experiences.

I understand what people are saying, about how there is so much more clinical and field experience required IN the medic class, that what little someone may have had in a year before then doesn't make a whole lot of difference. That is probably true for someone in a small agency, with a low call volume, who doesn't go to many of the calls that there are, who have little in-house training available and who doesn't pursue a continuing education on their own. I know people in that situation, and they really don't have enough experience for it to matter much at all.

But not everyone is in that situation.

Some are in active agencies, with great mentors.
Some spend that year not only going to calls, but availing themselves of every learning opportunity they can find.

For those people, that year of experience will make a huge difference. Not in whether they PASS a medic class or not, but in the experience they have during the class, what they get out of it, and their overall maturity and comfort level working up to a leadership role.

The problem is it is difficult to tell which of those people someone is, before observing them for a while.

I do think some things should change.

If it were up to me- and it isn't!- I wouldn't have a flat requirement of having been certified for a specific length of time. I also wouldn't depend on recommendations from that person's agency, because I know firsthand that that may not mean ANYTHING at all about the candidate.

I'd use an interview, a pre-test, and an essay.
Talk to the person, get a feel for who they are.
See how they do on a basic-level written exam.
I'd ask them to write about why they want to be a paramedic, and why they should be accepted in the program. They can list whatever experiences or education they have. They can talk about their work ethic, their commitment, their willingness to work hard.

You can fake a lot of things- but not heart.
That's what I'd be looking for.