Tuesday, September 25, 2012


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.

Wednesday, September 12, 2012

A Million Years Later...

Best laid plans, and all that. I meant to get back to blogging, but my available time has been at a premium. I'm not complaining, mind you. It's just that the longer I go without a post, the more it starts to feel like something has to be a Big Deal in order to be the first post after that long time, and I never seem to find the time to sit down and write up the big, complex stuff.

So forget that.

An update, of sorts.

It's time for me to re-cert.
Not a big deal, right?
Well... it wouldn't be, if for once the world would simply go along as it should, instead of managing to throw roadblocks up nearly every step.
The state has decided to CHANGE EVERYTHING.
Change what levels of certification there are.
Change the curriculum.
Change protocols.
And... the nearest place to take classes decided not to have a re-cert class and test for the level I am now, since that level shortly will no longer exist, and anyone certified at it would be required to take more classes and certify at a different level within the next year.

Which is great, and stuff.
Excepting for that "I need to recertify NOW" part.

What to do?
The short version of a long, frustrating process is that I'm going up to the next level (which ALSO will shortly no longer exist, but that's another story) and somewhere in the middle of that, they're going to manage to find me a test to recertify so I don't end up with NO certification for six months.

Definitely digging the "go up another level" part.
Still not entirely clear on how this all fits in with all the level changes- and neither is anyone else.
Not surprised AT ALL that I ended up smack dab in the middle of the changing, considering all the curveballs that got thrown at me to certify at THIS level in the first place.

Why not just take a medic class?
I'd love to.
I'd have to pay for it out of pocket and I simply can't afford it.
Long term plan is to actually get paid for this, and work up to medic once I'm doing that, either by saving up, or by working at an agency that will spring for it.

Best part of taking the EMT-CC class?
My daughter is taking it with me! What a team!

We had our first lab last night, and it was great. Excellent instructor team. Good bonding experience, what with the sticking each other with needles part. And to top it off, no one passed out.

Ah, now that I've broken the ice and started writing, there is so much I want to say. Guess I'll have to save it up. The class ought to give me lots of stuff to post about.

Before I go...
There is something I need to mention.

It finally happened.
Something that I knew would happen, eventually.

This here blog is quasi-semi-sort-of-anonymous.
I don't use my real name, although it's easy enough to figure out.
I don't mention my agency, although, again, it's easy enough to figure out if you have any online skills at all- and you likely do.
I'm very careful not to post any HIPAA violations.

And yet.
There are probably some folks who would not be happy about me blogging at all.
Especially because I post some truths that they'd prefer to hide not to acknowledge.

The question has long been how long it would be before someone locally finds this blog and figures out who and where I am.

It won't be long.
How do I know?

For the first time locally, I came across someone who reads the same blogs I do. (That is a pretty funny story, in and of itself.)
And if they read THOSE blogs, it is somewhat likely they will stumble across THIS blog.
I know he's looking.
And it isn't hard to figure out, at all.

So...uh...yeah... if you found me, you're right, this is the one. :-)

Next up... more training opportunities, of course.
And some comments about this post.

Hopefully, sometime sooner than a million years.