May 30-June 5, 2010 Days 251-257
Before you decide to read this blog entry, I would suggest you get a small snack, or bring your lunch. Make sure you have a nice beverage available, maybe even a pillow in case you need a nap. I am not implying that it is boring, at least I don't think it is, but this is a long one. I hope you enjoy it because you've certainly waited long enough for it. Thanks for following me and being such a great support to me.
This week was very intense for me... the next to last week before finishing EMT school! Ordinarily I would share my week with you in chronological order, but I don't want to leave this blog post on a low note so I will tell you about the latter part of the week first. In fact, I am only going to blog about the first and last day of the week.
On Saturday, I had my ER rotation at a local hospital. I showed up about 15 minutes early. I was still riding the high from my ride-along the first part of the week and I was anticipating a busy, educational day. When I was granted permission to head back to the desk, I introduced myself to the first employee I saw and asked for the charge nurse. They didn't know where she was but told me to have a a seat and wait. There were two chairs outside of the patient rooms just across from the desk so I sat. I waited about ten minutes and finally she came into the hub. Somebody informed her why I was there and she walked over and greeted me. She never gave me her name. She told me she would assign me to Nick for the morning and in the afternoon I would probably be with someone else. The problem was, she didn't know where Nick was. She told me to have a seat and it shouldn't be long. 15 minutes later, Nick showed up at the hub. She told him I was a student and that he was assigned to take me around with him and to make sure I got what I needed.
Nick came over and introduced himself. He asked me where I was a student and I told him. He had taken the class from my same two instructors a while back and had then gone to Texas to Paramedic school. I thought that was interesting since our college has a highly respected Paramedic program. Nick took me around the ER, which was currently quiet and we put away linnens, disinfected and remade beds and then went on a bed hunt to fill empty rooms. I helped as much as I could, wiping down beds, placing new linnens, etc and even pushed a bed back to the ER when we went on our bed hunt. Once that was done, there wasn't anything to do.
There were only six patients in the ER at the moment. Three were on suicide watch. One was a very sick woman who was post stroke with a tylenol overdose, renal failure and kidney failure with altered mental status, one was a man in severe back pain, and one was an older gentleman who was having some chest pains and respiratory distress and also had a rash that looked like a bad sun burn all over his arms, and it was blistered in places.
There was a nurse supervising the older gentleman with the respiratory distress and one of the suicide watch patients, and Nick relieved her so she could have a break. That meant he was tied down to one spot for a while. He told me that things were very slow so far for the day. He said that to make sure I got my patient contacts I should just start going room to room and taking the SAMPLE history from patients. SAMPLE is a neumonic device to help us remember what information to get during patient assessments.
S=signs and symptoms and from that information we also ask
OPQRST,I (
O=Onset, when did this happen?
P= provoke, What makes this better or worse?
Q= quality, can you describe your pain -sharp, stabbing, crushing, etc. R=radiate Can you show me where it hurts the most? Does it stay right there or does it seem to travel anywhere else?
S=Severity Rate your pain on a scale of 1 to 10,
T=Timing Is sthe pain constant or does it come and go?
I=interventions What have you done to try and make it better?) After all of that for each symptom we check
A=allergies meds, food, environmental.
M=Meds What medications are you taking, do you take supplements, are you taking any "recreational" drugs?
P=pertinent medical history. Have you experienced this kind of thing before? Are you under a doctor's care for anything? etc.
L=Last oral intake. When was the last time you had anything to eat or drink?
E=events leading up to the situation. What were you doing when this came on?
I attempted to get the SAMPLE history from each patient, checking back with Nick periodically, that is when I could find him. The patients were wonderful. I would introduce myself and tell them I was a student. I would ask if they minded answering a few questions and all of them who were able were more than willing to talk to me. I tried to be encouraging for those who were scared or uncomfortable. I asked if I could do anything for each of them to help them be more comfortable. I squeezed hands. I smiled. Inside I wanted to make them all better, to give hope to the hopeless and to ease the pain of those hurting. But I knew I could only listen and try to encourage them and pray. That would have to be enough. I enjoyed the patients. Even though Nick kept disappearing for long periods once he was freed from covering for the nurse.
There were times when I could not find him for 15-30 minutes and nobody else working there seemed to know where he was either. I wasn't learning much. I was getting a little out of it, in that I was becoming a tad more comfortable around the patients. I was frustrated though because Nick kept disappearing and he was supposed to be the one I was shadowing and learning from. I started following another ER technician who was friendlier. She explained a few things to me and allowed me to ask questions. Then she hooked me up with a nurse. Norena was a nice nurse. She was friendly and let me help her with patients, but mostly it was just getting things for them to make them comfortable. Nothing to learn medically speaking.
After I had seen all of the patients there, the staff were pretty much all seated around the hub, chatting with each other about their weekend, their dates, their families and what not or surfing the internet. A few were using the computers for patient reports. Nobody talked to me and I didn't know how to engage them when all they seemed to want to do was talk about their personal lives. I finally saw the charge nurse again and explained that I kept losing Nick when he'd send me one direction and go another. She said to me, "he can be like that sometimes," and then walked away. Nice. Norena then came to me and said that the doctor wanted to do a lumbar puncture on the patient who was post stroke and asked if I would like to assist with it. She explained the procedure and how I could assist. I was excited to be able to help with something so I agreed. She went to the doctor and asked if it would be okay and he said he would be happy to have a student assist. :)
While in the patient's room the doctor noticed that her foley catheter was leaking. There was a puddle of urine on the floor. I told him I would see to it that it was taken care of and had Norena show me how to correct the problem before I wiped it up and sterilized the area. I was willing to do ANY job that needed doing and had mentioned it to each person I had been with. If I had been told to change bed pans I would have done it. I just wanted to learn.
I helped hold the patient in position for the lumbar position and tried to comfort her as best as I could. It is not a pleasant procedure and her inability to communicate with us I am sure did not make it any eaiser on her. She understood us but only nonsense came out of her. I felt sorry for her and frustrated for her. I patted her leg that I was holding in position. I wanted her to know that I cared, even if we couldn't understand what she wanted. When the doctor was performing the procedure, he explained to me what he was doing. When he was finished, I thanked him for letting me participate and he was very nice. He said he was always willing to help a student.
After the procedure I was directed to another ER tech, who was standing guard over two rooms on suicide watch. All he had to do was make sure they stayed in bed. He couldn't leave that spot. There wasn't anything he could have me help with. We chatted about who I was, what I wanted to do, how much longer I had in school. We talked about who he was, what his background was, where he went to school, how long he'd been an ER tech, etc. Then he began showing me things that were in the various carts around the ER, a line of which were next to his post. He showed me the cart with supplies for suturing, opened a few packages to show me instruments and the needles used, etc. He showed me the intubation supplies. This continued for about 15 minutes, both of us at a loss for what to do with me. Finally Nick passed by and was told to take a patient to a CT scan. One of the nurses told him, "She's a student (pointing at me), take her with you." He looked at her then me, then her again and said dripping with sarcasm, "Thanks a lot!" WHOA!!! Wait a minute. I'm RIGHT HERE!!! I didn't want to take things personally but I felt like I'd been slugged in the gut.
The nurse tried to lighten things up and play it off and then looked at me and said, "It's okay. Go with him." He glared back at her. I followed him but he walked as fast as he could, pushing the gurney and never looked back. His legs are much longer than mine and I had to almost run to keep up. We went to CT scan where the Technician was nice but Nick did not let me help with the transfer of the patient or talk to me at all. The scan took a few minutes and then I chased Nick back to the ER. He put the patient back in his room then told me he'd be right back and promptly disappeared again.
I again found myself standing around the hub with nothing to do. A new ER tech I had not seen before finally approached me and introduced herself. Kim was her name. She was nice. She told me she worked for the ambulance company that I am hoping to get on with and that she also worked here. She was doing an internship of sorts here and today was her last day in the ER. She had taken her EMT class with my instructors too and we shared some funny stories. She was very nice and told me about how the ambulance company worked, encouraging me to apply when I was able. I liked her a lot. Sadly, she had to get her final evaluation and therefore had to leave me alone again. She handed me off to a nurse who barely looked up at me from the hub. While she and her co-worker talked about boyfriends and dating she would look up at me occasionally and say things like, "How long are you here?" or "What do you still need to do while you're here?" At least she cared a little that I had criteria that had to be met on this rotation. I was now six hours into the 8 hour shift. I needed four patient contacts this day because I already had been hands on with one during my ride along earlier in the week and needed a total of five. I needed to put in 10 hours of observation time but only five would count from the fire department, even though I had thirteen with them. Well, 5 from that day and six so far from this day was enough to satisfy the requirements. I technically had my patient contacts too, though I thought it was lame. I decided that I wasn't going to stand around doing nothing, being ingnored and put down any more. I was going to miss an important wedding by working this shift today and it meant a lot more to me than hanging out for another two hours of mostly garbage treatment. I spoke to a nurse about leaving and she said if I had all I needed I should go enjoy the sunny day because it was, in her words, dead around here. She signed my paperwork and out the door I went, resisting the urge to run.
That was a most unpleasant experience and taught me one thing: I do not want to work in a hospital, I definitely want to work in the field. I went home feeling discouraged and lousy. It has taken me two weeks to get around to writing the blog post and I still feel lousy about the whole thing. I felt beaten down. I wondered what I did wrong. Perhaps I did or said something though I don't really think I did. I've reviewed it over and over and I can't think of anything. I was comforted a bit when a friend told me she participated in a disaster drill at that hospital as a victim. The staff there were rude to her and treated her and other non-hospital staff like gum on the bottom of their shoes too. I've come to the conclusion that it must be the culture of that hospital. And I want nothing to do with it. Instead I am going to focus on what I really want to do with my life. And that brings me back to the beginning of the week.
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I started it out with a very fun day!!! On Sunday I got to participate in a Ride-along with a large neighboring city's fire department. I was stationed at a downtown, waterfront station. The station has one fire engine and two fire boats. I got to ride along in the Engine! But, let me start from the beginning.
When I signed up for my EMT class, I wrote a favorite author, paramedic and blogger for advice on how to be successful as an EMT student. His name is Peter Canning, author of "Rescue 471," and "Paramedic." He also writes a blog called "Street Watch Notes of a Paramedic."
http://medicscribe.com/ Peter answered me back right away with the advice to study hard and to take every opportunity I could for ride-alongs, ER time, etc. So I took his advice to heart.
At first I tried to schedule ride-along time with my town's fire department. I figured I already knew people and might be able to get some preference because of my work on the Fire Buff Battalion, but this town's Fire Department proved to be extremely challenging to get into. I haven't succeeded yet, though the firefighters keep telling me not to give up. Even they think I ought to be able to ride with them! (I love these guys!) I kept trying to think of other ways to get in somewhere when I thought of my friends on the IACOJ website. I recalled that one firefighter who had private messaged (pm'd) with me a few times was from the large metropolitan town not too far to the North of me. I pm'd him right away. His name is Randy.
Randy took very little time in getting back to me and after a few pm's back and forth I composed a letter to the Fire Department in the large metropolitan town to the North. Very soon after, I received a letter along with a bunch of paperwork to fill out. Basically I was signing away my life. I didn't care! I sent it back in and within a few days I received a call from a Chief up North saying my ride-along request had been granted. WOO HOO!! And Sunday was the big day.
I arrived at the Station at 8 a.m. with 3 dozen chocolate chip cookies (Cap's favorite I was told ahead of time) and a dozen and a half of my favorite Orange Vanilla Chip Cookies that I got the recipe for from the IACOJ website. (And before dinner they were ALL gone!!)
Randy greeted me when I rang the doorbell and brought me back to the day room. There the guys were mostly sitting around the table, shooting the breeze and eating breakfast. Randy introduced me to the crew and told me to "make myself at home." Did I mention that I am shy? (Message to Cat...Yeah, I know Cat, you don't believe this, but it is true, and I had warned Randy ahead of time!)
The next 15 minutes were a little awkward as Randy was in and out doing normal stuff that he does around the station and the rest of the guys went about doing what they were doing when I walked in. I sat quietly, taking it all in, trying to think of some intelligent thing to say. I couldn't think of anything so I sat quietly. I was expecting a briefing of sorts, explaining the rules of my visit, the "what to do if's", that sort of thing. And I was expecting to be given an orange vest and blue helmet to wear, which I wasn't looking forward to but I think I would have worn an itsy bitsy teeny weeny yellow polkadot bikini if that was what it took to get this gig in the first place! (Sure glad THAT wasn't the case. That's a freaking scary image!) Thanks to Randy, I almost looked like one of them. The public didn't know the difference. Oh yes, he was terrific!
Finally, someone invited me to have some breakfast. (Randy had told me he would arrange breakfast and dinner and that lunch was on my own, same as the rest of the guys). I took a peek at the offerings. Oats and a large bowl of fresh mixed fruit and yogurt. It looked good, except that I am allergic to pineapple and it was in there. Randy had asked me ahead of time and so he knew I was allergic but whomever the chef of the morning was apparently forgot that he had told them that. Oh well, my pineapple allergy isn't that bad. I decided to pick through the bowl and try to dish up fruit without getting any pineapple in my bowl. It proved to be challenging and I didnt' want to draw attention to myself so I only got a small serving and threw some yogurt over the top. It was really good!
The briefing I expected never came and Randy summoned me to the apparatus bay after I ate. I walked in with him and he handed me his fire department coat. He told me to wear it whenever we were out so that I would blend in. (I had worn black pants and a black button down shirt so I wouldn't stand out too much.) He said, "We're supposed to make you wear an orange vest and a blue helmet but we're not going to make you look like a dork." I had never met Randy in person before this day but I liked him a lot already! :)
First order of the day was a cruise ship tour. We toured a Norwegian Cruise Lines Ship. This was their drill, to check out the firefighting capabilities and systems on the ship. The FD had to submit a list ahead of time of all the personnel that would be on the tour and I was not on that list so there was no guarantee I would be allowed to board. They were going to try and get me in but if they couldn't, I was going to be on my own from about 0845 to 1200 hours. Yay. I could go visit all the waterfront shops, hang out in a bar or pay to tour the aquarium. Not what I travelled North to do, but God knew all about the situation before I ever got there and I decided I would trust him to work out the details. Very shortly after Randy gave me the coat to wear, we all piled into the Engine and headed to the pier. The Captain explained to someone who I was and why I was there and there was no hassle at all in getting me aboard. God is GOOD! For the next almost three hours we got all the behind the scenes, below the decks tour and toured the passenger cabins, recreation facilities, and everything. We heard all about the ship's fire fighting capablities and staffing in place for that and how the system all works. It was a really great tour and quite fascinating. The head of firefighting on the ship was our tour guide. He was from Paraguay and he had an English accent mixed in. He actually looked and sounded Ukranian. During his tour he called a halligan tool a "hooligan tool," and I suppressed a giggle but I heard a couple of snickers from a few of the guys! =D
We saw the engine rooms, the incinerator, all the fire lockers, how the watertight doors and compartments work, the gear they use (It'sGerman and very nice gear! The firefighters I was touring with were envious of their gloves!) We also saw the passenger cabins, even the premium ones, including a small suite with private deck that went for (believe it or not) 25,000 dollars a week, on top of the cost of the cruise itself!!!
The firemen were scheming about 50 guys going in on one together and bringing sleeping bags!
There were a ton of stairs on the tour! I did pretty well when it was one or two decks we were going up at a time, but at one point we were on deck 4 and needed to go to deck 11. The first 8 guys took the elevator but the rest decided not to wait... One of them said, "screw this!" and they all started up the stairs. I wasn't supposed to leave my partner's side and he wasn't going to wuss out so up we went. After three decks I told the one guy behind me he had better go ahead of me because I was going to slow him down, but he wouldn't hear of it. He said it wasn't very nice of them not to consider me. What a sweetie! No way in HELL was I going to be a whiner or a wanny. I had actually prayed about this situation the night before. I just headed for the stairs like the rest of them. (But I was freaking out inside about how the heck I was going to accomplish that many stairs in one fell swoop.) About half way up the fifth set of stairs, my right leg actually rebelled and I almost missed a step. I caught myself and the nice firefighter that had refused to leave me asked if I was okay. I told him I was running out of steam but that I was going to make it somehow. He told me to take my time and although I slowed down, I finished that flight. Randy was just coming back down a flight to me when I reached the landing. He too iquired as to weather or not I was okay and I had to admit I didn't think I would be able to make the other two decks. He was so kind! He said, "GOOD! Let's take the elevator. I hate the stairs!" The other firefighter told me I did well and we climbed in the elevator and rode the last two levels. In the elevator I apologized to Randy for the ribbing I thought he might get for taking the elevator. He told me he was GLAD to be in the elevator. I don't think I believe him, but I liked hearing it. :) Did I mention, I loved those guys? Before the tour was over we had seen all the amenities, the pool area, the rock climbing wall, all the restaurants and bars, we saw the crew quarters... it was really amazing! I feel extemely fortunate to have been a part of it and the guys treated me very well.
When we got back to the station a little after 1200 hours we sat around b.s. ing for about 15-30 minutes and decided we needed lunch. Randy said he was going to go to Subway, (Basically next door) and asked if that sounded alright to me. I agreed it sounded good. Randy asked around to see if anyone else wanted us to pick up anything for them and the Cap took him up on it. Soon Randy and I sauntered over to place our orders. He had me order first and he was about half way through getting the Cap's sandwich made when (predictably) the first run of the day was dispatched. Randy told the Subway sandwich artist that he'd be back, but we had to run and we ran back to the station and jumped in the Engine which was was waiting for us on the apron, door opened. I threw my sandwich and coin purse in so I could use both hands to hoist myself up then scooted into my seat and out of the way while Randy jumped in behind me. His radio went flying and landed somewhere near my sandwich and coinpurse at my feet while we wrestled the seat belts as we bumped along, siren screaming. WHAT A RUSH!!! Randy and I retrieved our belongings as we raced along and then we all gloved up. Randy told me the call was for a woman down, in cardiac arrest with CPR in progress. When we arrived, I estimated her to be about 65 and word was she had been down for an undetermined amount of time. The guys worked her with everything they had, at least 10 min of cpr but she was asystole which is not a shockable rhythm. They gave her sodium bicarb and epi but nothing worked. They called medical control and got permission to stop. I was surprised a little that I didn't feel much. I mean, I thought of her family and I was a little sad for them, but other than that, I didn't feel anything. I know partly it is because I was already aware of the low rate of success in reviving someone found in cardiac arrest, and I would guess that if I had personally been performing CPR on her, it might have been different too. I had never seen cpr on a real person before and it was really educational. It was sad, but they did all they could for her. They did an amazing job. I helped them clean up the scene and we hopped in to leave and promptly got another call.
The second call was a 57year old female cancer patient with fever, and in septic shock. She was at the cancer center. As we bounced around inside the cab while the lights flashed and siren wailed, I was watching out the windows. People were waving as we drove by and giving us thumbs up signals. Some took pictures. We were the heroes on our way to save the day. Only it didn't feel like it to us. We were just doing the job, trying to make a difference. Nothing more, nothing less. It was odd to see and feel the appreciation of strangers not even related to the patient... as we headed out to come to the aid of people...these people who had no idea who we were going to try and help, or where, but who appreciated that we were there anyway.
After reaching our patient all we could do there was assess her and then, after the doctor at the cancer center gave her report to them, the medics transported her to the hospital. But her daughter was there and the medics did a great job with her too. In the elevator as we took the patient to the ambulance, one of them patted her shoulder and rubbed her back offering silent comfort and support. It was very touching and a real demonstration of the compassion that attracts me to this line of work in the first place.
When that call was over we headed back to the barn. Once inside we washed up and then Randy and I headed back to Subway to get Randy and the Cap's lunches. This time we completed the transaction and brought the sandwiches back to the station where we got to eat them without interruption.
There were quite a few awkward quiet moments at the station but throughout the day, there were times I would participate in some small conversations. As often as I thought I had something valid to contribute, I did. During lunch one of the guys' family showed up... his wife and two kids. I had a good time conversing with the firefighters and with the kids and their mom a bit too. Kids I am definitely comfortable with!
They were wondering what seagulls eat and I told them "just about anything!" I was telling them about some of the enounters with seagulls that my daycamp kids have experienced and they enjoyed that. One firefighter mentioned that although seagulls DO eat about anything, alkaseltzer probably wasn't a good idea. LOL That reminded me about squirrels and large marshmallows. I told them about how my husband as a kid used to put three marshallows on a log when he was camping and then sit back and watch the fun. A squirrel would approach cautiously and investigate. After deciding it was food, the squirrel would put one inside it's cheek and then put another inside it's other cheek. This is a pretty ridiculous site to behold because squirrel cheeks are not really meant to store something as big as large marshmallows. But it gets even funnier when the squirrel gets greedy and wants to take the third one with him. He will attempt to put the third marshmallow in his mouth but it of course will not fit. So he will set it down and try to use his little paws to rearrange the first two marshmallows and make more room. But now they're covered with squirrel spit and getting ooey gooey. The squirrell will play with his food for quite a while and end up a sticky gooey mess before giving up. I have not personally witnessed it but my husband's accounts of it have had me rolling on the floor holding my sides more than once. Of course as adults we realize this is cruel and inhumane punishment of relatively innocent little creatures and we would never dream of doing this, but the stories are fun to hear. The kids and firefighters alike were laughing by the end of the story.
After lunch, Randy and I spent some time out back of the station people watching at the pier, chatting about the fire boats and our families and so forth. He told me that when the tide came in more so the ramps to the boats were not so steep, he'd take me down to tour them. I was looking forward to that.
The next call to come in was for a ferry worker and was reported as an ankle injury. When we arrived, less than two minutes after the call came in, they let us on the ferry but as we approached the patient, who had been seated in a wheelchair, we were asked to take him into the ferry terminal to examine him so that they could prepare the ferry for its next run. Our patient told us he was the second mate on the vessel. Apparently there had been a dead motorcycle and he was getting ready to push it but his foot slipped on the wet deck and he felt a "burning, tearing" pain in his calf. When we examined his calf it was very red and swollen. when we got there. We assisted the man with getting his leg elevated while we waited for AMR to arrive for transport and Randy's partner took the man's vital signs. When AMR arrived we assisted them in transferring the patient to their wheeled stretcher and that was that. I felt sorry that we were not able to ease the man's obvious pain. In fact, I found that to be difficult, realizing he was in great pain and not being able to do anything for him. Still, he seemed grateful that we had come and he thanked us as AMR EMT's began wheeling him out.
As we were leaving the ferry terminal, Randy stopped and pointed at a sign on the wall. He had a grin on his face. The sign said something like, " Please keep a close eye on your small children to make sure they do not put their fingers in the holes on the benches." It was an official looking sign. Seemed a little odd to me.
Randy who was apparently seeing it for the first time explained. It seems on a shift a month or so ago, there was a cute little two year old girl who got her finger caught in a hole on the bench and they had to saw around her stuck hand and then use snips to remove the ring of bench still attached to her. I guess the girl was a real cutie but pretty freaked out by it all, understandably. Her mother was taking all kinds of pictures. Poor kid probably had pics of her oredeal plastered all over facebook! :( Randy and the rest of the crew found the sign amusing though.
On the way back to the station, Randy's sixth sense must of kicked in. He said to me that he wanted me to know that if they got a call on the freeway, he liked me and all but he wanted me to stay in the truck. He assured me it was not personal and he didn't want to offend me. I told him I understood completely. The last thing I wanted to do on my ride-along was to become a patient myself!
When we got back to the station this time, I started to discover that the driver of the Engine is an amazing cook! Of course, I haven't eaten anything resembling real food since I started school. My family has not kept up their end of the bargain to keep me in decent food. Consequently I have eaten a lot of corn dogs and frozen chimichangas when they were available in the freezer. I also had many dinners consisting of two pieces of string cheese and a 20 oz. bottle of orange juice... So maybe I would have been happy with deep fried slugs, but this guy ground his own spices... several different kinds of chili powder, dried mustard seed, salt, something smoky, paprika and I don't know what else. He let Randy and me smell it after he ground it and give our opinions as to what else it might need. I thought it smelled great the way it was and Randy suggested something with a little more zing. An adjustment was made and then he rubbed it under the skin and all over about 20 gigantic chicken breasts and set it aside to soak up the flavors. He then went on to fix potatoes.
We were only back at the station a short time when the next call came in and wouldn't you know it, it was a freeway call. The patient's chief complaint was chest pain. He said he had felt palpitations and had chest pain so he pulled over and called 911. I guess he was following a relative so when he pulled over she did too. Amazingly he listened to his body and didn't try to deny he had a problem. He did the safe thing and got out from behind the wheel! I had to stay in the rig to be safe which was perfectly understandable, but I was still bummed. From my view however, the patient appeared to be in his late 20's or perhaps his thirties, but a young man for sure.
I wished I could be part of the patient assessment but I knew it was best I was where I was. I made myself busy by taking in as much as I could of my surroundings. I looked at the helmets hanging from hooks and one thing I noticed was that the helmet ornaments were different on Randy's helmet and on his partners. His partner had an eagle but Randy had a beaver. I took pictures. And while I was at it, I took a picture of myself seated in the fire engine, wearing Randy's coat. Modern cell phones are cool. I love being able to take my own picture!
While I kept myself entertained, the crew assessed their patient and called for transport, but while they were getting him setlled on the gurney, steam started coming out from under the hood of the patient's relative's car. The firemen checked it out and she had busted a radiator hose! They taped it together and threw some water in for her. Then one firemen drove the patient's car and followed the woman off the freeway to a pay parking lot. We followed in the Engine. That was so nice of them! Heroes twice in one call!
I remember coming back from the freeway run and hopping down from the cab of the Engine. The fire station smelled heavenly! Ordinarily, I love the smell of fire stations anyway. Sort of a mixture of cleaning products, deisel fumes, smoke and I'm not sure what else, but that is not the smell that had my attention this time. The aroma we were greeted with was the smell of the roasted potatoes with onions, rosemary and I don't really know what else. I only know that it was an amazing aroma and I started to drool!
Finding ourselves with some down time, we noticed that the ramps to the fire boats were not so steep any more so Randy offered to show me the two fireboats at the station. Who was I to complain?
The older one was pretty cool and he took me to every nook and cranny. He took the time to explain what things were for and the advantages/disadvantages of some of the features. He commented that I should have brought a camera. I told him I had my camera phone with me and he offered to take a few pictures of me on the boat. He also told me there were not any secrets on the fire boats and that I should feel free to take whatever pictures I wanted to. I was kind of shy to take pictures for some reason, but I did take a few. Oddly, I never took pictures of any of the crew or even the Engine. :( The shy bug had bitten me hard that day and I'm kind of frustrated that I didn't master it but I guess that leaves me an excuse to go back.
The newer boat was really awesome. When it was to be made some intelligent decisions were made. Experts were consulted. I mean, each area was designed by people who work in and with or use those areas. For example the patient area was designed with heavy input from paramedics. It is set up very conveniently and well stocked so that the only thing the medics have to bring on board with them is their drug box. And the patient area is directly off an area that can be enclosed for privacy but it has special shower heads in the ceiling to facilitate decontamination procedures in case of hazardous material exposures. I was very impressed with both the layout of this boat and all the thought and planning that went into it.
After we had spent quite some time touring the boats we headed back inside the station to find that dinner was ready. The chicken had been grilled on the barbie along with corn on the cob and there was a pot of baked beans along with the roasted potatoes. A large bowl of freshly cut watermelon was set on the table for dessert. A few of the guys were giving our chef a hard time about not having any bread with dinner but I would have to say that I am of the opinion that none was needed! Nobody hesitated to dig in and it got very quiet for a while while we all devoured the gourmet meal set before us. I thought perhaps I had died and gone to heaven. It was absolutely amazing and there was more food than I could possibly imagine! All nine of us could have had two chicken breasts, (that seemed like they were turkey breasts by the size!) and there would still have been leftovers.
As I finished my dinner I thought about pinching myself to see if the day was real or not. There I was in a fire station, having the time of my life, running calls (I love riding in a fire engine running code red!), hanging out with my heroes, eating food fit for royalty and I just wished the day would never end! It was freaking awesome! After dinner the guys all started stacking their money on the table. Apparently buy in for the meals for the day was ten dollars. I felt a little awkward because Randy had told me he was arranging for breakfast and dinner and lunch was on my own, but I didn't want to assume a free ride either. I mean, these guys went out of their way for me, especially Randy and the Cap. As I started to get into my coin purse to pay my share, Randy paid his share, but double. He told his crew mate who was collecting that he was paying for mine too. That was very nice of him. I thanked him and he smiled as he told me, "you're welcome." I still felt a little funny because nobody had asked anything of me all day. When I asked how I could help after dinner I was told to sit down and relax. I appreciated that hospitality but I wanted to pull my weight, so to speak. I didn't want to come across as self-entitled.
After dinner we were watching movies "ON DEMAND". As my friend later called it, "Movie night with the fire department." I commented that it was MY kind of date! Even so I wished for at least one more run before I had to leave this adventure.
We only saw about twenty minutes of the movie, because we started it ""already in progress" and then got another run. Woo Hoo for me! (Sorry, I don't mean to "be happy" about other people's misfortune, but this WAS what I came here for! Honestly, I don't like seeing peole in pain or scared or distraught at their circumstances, but I do want to be a part of making things a little better if not, at least more bearable.)
As we hopped into the Engine, Randy looked at me and said, "you're going to help with the work up on this one." YES! A formal invite! I nodded, trying not to look too eager and to not look scared to death. I probably failed at both but I made a valiant effort anyway. Randy told me to glove up and pointed to his box of gloves. I smiled and nodded. He didn't understand why and said to me, "No, really. Glove up." As he was saying this I was trying desperately to get into my jacket pocket, fighting the shoulder restraint of my seat as I did so. I said, "I am, don't worry. I just have tiny hands. I'd drown in those gloves. I have my own in my pocket." He looked surprised when I pulled out a zip log bag with several pairs of nitrile gloves three sizes smaller than the ones he had offered me. As I put them on he told me what the call was for... A rectal bleed at a homeless shelter. (I thought, "oh goody yay".) Oops. I said it aloud. He smiled as I mentally prepared myself for a GI bleed. I knew it could be something else, but that was a real likelihood and I knew it. I have never smelled one but have been told it is one of the top three worst smells imaginable, along with brain matter and rotting human flesh.
By the time I had gotten both pairs of gloves on, we were pulling up to the scene. Upon entering we found our patient not far inside, seated on a set of stairs. He was cyanotic around the mouth and diaphoretic, (blue and sweaty) and he was definitely sick! He was clearly scared and distraught at his condition. He had blood down the legs of his pants and there was a small pool of blood on the floor. It looked like a lot but I doubt it was 8 ounces. (I know it is measured in cc's but I can't translate that yet.) Luckily, it turned out not to be a GI bleed. No odor.
The employees of the shelter came up with a sleeping mat for us to have him lie down on and we assisted the patient in moving from the stairs to the floor onto the mat. One of the guys got some bulky dressing materials and instructed the man to pull his pants down some and place the dressings in his underwear then pull the pants back up snugly. They encouraged him to do this for himself but assisted as much as was necessary.
Meanwhile, Randy started with vital signs. As he checked the patient's pulse, I timed his respirations. They were 30, shallow and irregular. (normal for an adult is 12 to twenty, with adequate and equal chest rise and fall and a regular rhythm). Automatically I started to think, "Non rebreather mask, 15 liters per minute."
When I reported it, Randy handed me the oxygen cyllander and a nasal cannula that he had removed from the jump kit. "Set up the nasal cannula and get the O2 started," he said as he set the jump kit down between us. He looked at the patient and told him, "My partner is going to get you set up with some oxygen, alright?" The man nodded and I began working. I took the tank out and checked the psi to make sure it was well above 200, then I checked to see if the O2 was "on." (I had no idea if they left the valve open when the flowmeter was off or how they put their equipment "in service.") I don't remember if it was on or if I turned it on but when I made sure it was ready to go I attached the tubing of the cannula to the port and set the flowmeter. I was about to put the nasal cannula on the patient when the Captain kneeled beside me and took it from me. He said to me, "What do you have that set at?" Confidently I answered, "15 Liters per minute." He said matter of factly, "No, not that." and waited for me to make the correction. Immediately I realized my mistake. A non rebreather mask is what I was taught to use first in this type of situation, but Randy had given me a nasal cannula. 15 liters per minute would be a hurricane in the nostrils! "Nasal cannula!" I said and smacked my forehead. I set the flow meter down. "4 Liters per minute," I said as I corrected it. The Captain put the nasal cannula on the patient. About that time the paramedics arrived and took over the patient's care.
Randy's partner came to me and noticed a smudge on my glove as I stood up. "Did you get blood on your gloves?" he asked me. I had already seen the smudge and determnined it to be dirt from the O2cyllander. "No," I said. "What is that?" he asked pointing to the smudge. "It's dirt, I already checked." He asked if I was sure and I said that I was. He then informed me quietly that our patient had hepatitis C.
I stepped back out of the way but wanted to do what I could to be of assistance. I knew the best thing I could do was assist with the patient's ongoing assessment. I knew we needed updated vitals, but I wanted to stay out of the way of the paramedics so I started with respirations. They hadn't improved much and I said so. I didn't have my stethoscope or BP cuff and others were working around the paramedics to assist as well so I stayed on respirations. After four more counts of thirty seconds each, the respirations had dropped to 24 but were still irregular. I reported to the Captain who was recording it all. The paramedics were almost through packaging the patient for transport at that time. Cap said to me, "So he is improving then," looking to me to agree. I shook my head affirmatively but repeated that his respirations were still irregular. Cap wrote the information down. Then Randy whispered to me "Did you catch that the patient has Hepatitis C?" and checked me for blood. I nodded affirmatively.
One of the employees of the shelter began yelling, "Close off the bathroom. We've got Hep C here!" He kept yelling that the patient had Hep C, affording no dignity or privacy to the patient who willingly shared that information with us. We aren't sure how the employee caught wind of it as we all did our best to keep it very quiet. I felt really bad for our patient. It bothered me how scared he was and how he kept asking us, "What do you think it causing it?" All we could do was assure him that we were going to take good care of him and get him to a hospital so the doctors could find out.
We disinfected everything we touched, handles to boxes and bags we carried in, the stethoscope, etc. Then we picked it all up and carried it back out, following our patient being wheeled out on the stretcher by the paramedics. As we began to leave, the place broke out in applause. It was a weird feeling, they were clapping because we came to do our job. On the way out, another potential resident for the night was coming in and puking all over the entryway floor. We did our best not to step in it as we left.
Once we were all back on the truck, the Captain announced that nobody set foot in the station until we were disinfected. As we drove through downtown, I noticed people pointing to us, and kids waving, and BIG kids waving (read adults here), and pictures were being taken. I pointed out that one man was trying to take our picture while we were at a red light. He was on Randy's partner's side of the truck. Randy gave his partner rabbit ears. LOL
Once we were at the station Cap instructed Randy's partner to make up a bucket of bleach water to rinse our shoes in right away. Normally when we arrive back at the station, everyone jumps out (except the driver, LOL) and the Engine is then backed into its bay. I had been instructed from the beginning to stay seated until we were parked in the bay. This time, I wasn't sure what to do. We stopped and I didn't get out. I wasn't supposed to set foot in the station. I waited until Randy came to the door. "Are you okay?" he asked. "Yeah, I just wasn't sure what to do, Cap said not to set foot in the station." He chuckled and offered me a hand to assist me out of the truck. I jumped down. He said his partner would have the bucket ready in a minute. I followed him behind the Engine and waited my turn to rinse my shoes. Then the floor was mopped from the bucket to the doorway and all the way around the Engine. The floor of the cab was wiped down with disinfectant wipes and then we all returned to the living area of the station.
Randy and I talked afterward. He told me I had done a good job. "Except for the mistake with the O2," I agreed. He smiled at me. "It was no big deal," he said. "It wouldn't have hurt anything and it is an easy mistake to make. You were excited. We could have used an NRB on him, we just didn't. But you'll never make that mistake again. Don't worry about it, you did just fine." I really appreciated that neither Randy or the Cap criticized or scolded for the mistake. In fact, they never brought it up, I did. Randy and Cap were excellent teachers. They taught me gently and patiently. For that I am very grateful and appreciative. Every call we had been on so far had only served to confirm that this is what I want to do. And I was treated like a professional. For that too, I am grateful and appreciative.
Our last call before I went home was a "fire" call. Notice the quotes. It came in as "a transient with a cooking fire and lots of smoke."
It was only a few blocks and we did not use the siren. We arrived and it was indeed a transient and a cooking fire, fully and safely contained in a small hibachi type grill. He was griling fish and potatoes. There wasn't much smoke at all. He was along side a vacant building using a few stacked pallets for a table where his things were, but the grill was safely on the ground. The firemen admired his dinner, inserting a generous dose of smiles and humanity and told them why they had come. They said that they could see there was no problem however and as far as they were concerned this was simply a man enjoying a good meal. They asked him where he got his fish and told them it smelled good. They told him to enjoy his dinner and that they were going to go. The man was all smiles. I loved how they handled it.
Once back in the rig though the Captain was very upset. He said he was sick and tired of property owners trying to get the fire department to be the heavy. He said the man wasn't doing anything wrong and should enjoy his meal in peace.
We got back to the barn at 8:45 and Randy and I chatted a bit, and he printed me out their EMT flow chart, a cheat sheet to walk through the steps of patient assessment and treatment. Then I decided since it was 2100 hours I ought to respect their time and make my leave. I thanked Randy for hosting me and for a very enjoyable day. I made the rounds to thank and say goodbye to the men who were still in the day room. Most of the men were upstairs in the sleeping quarters by now so I didn't get to say goodbye to them. Randy walked me out to my car.
He told me he hoped I had enjoyed myself and gotten something out of my day and I assured him that I had. He told me I was welcome to do this again anytime and that he hoped that I would. I told him I would LOVE to do it again, perhaps this summer after I finish my class, just to keep fresh all the things I've learned before I become employed in this line of work. He wished me a safe trip home and then I left. I cannot believe I left the station without getting a pic of the crew, the engine and without purchasing a shirt which was available in the station. I was a little high from all the thrill I guess. SIGH. Oh well, as I said before, it gives me an excuse to come back! This was without a doubt, the most awesome day I have ever had. And I know now FOR SURE this is what I want to do!
Until I blog again, stay safe!
Hotflash out.
