The Chronicles of IC

So, today was Day 1 – Day 1 of 750-something Days. But who’s counting? ;) We arrived for orientation bright and early this morning. The day consisted mostly of introductions among the faculty/staff and students, some paperwork, reviewing the student handbook, ID badges, White Coat photos taken, lunch with 2^nd year PA students, a student panel discussing the next few years (especially from their significant other/spouse’s point of view), and presentations about international clinical opportunities. My new family of 25 classmates began to get to know each other today…I can only imagine how close we will be after the summer semester of intense classes, tremendous stress, and incredible learning together.

I’m super impressed with the organization of the program, the quality of the students they chose, the friendliness of the staff, and the opportunities available here. However, they did lie to me already – whether directly or indirectly. They told me to hit the ground running, not to get behind in studies, seek help if I even feel like I’m struggling to keep up, and to study everything every day. Yet, I have no homework tonight. What up with that? Not that I'm complaining. Hehe. Maybe the homework and craziness begins next week after orientation is over. I'll just embrace and enjoy it for now.

Since I’ve moved to Iowa City, I’ve had a week to myself to get settled, organized, and prepared for the upcoming semesters. During that time, I’ve also made some discoveries (or rediscoveries) which I’ve kept a record of in order to share.

Second floor peeps.  I’m used to living on the top floor, although I finally humored my dad and moved into a first floor place. Now, I have neighbors above me, which equals early morning wakings. 6:30 AM. Except on weekends; then they let me sleep until 8:15 AM. Now, don’t get me wrong, they seem to be an awesome, respectful couple. (And recently I heard them watching The Hobbit, so they can’t be that bad ;)) It’s not their fault the floors are squeaky. However, I still hear them even if they are considerate. I’ve always lived on the top floor of my dorm/apartments in the past, so have never had to deal with it. And working the later evening shift at the ER has my internal clock temporarily programmed to sleeping late. Oh well. Knew I’d have to give up my sleeping in and adopt a day-time schedule eventually. Might as well start now.

Dead zones suck. There’s nothing quite worse than a dead zone when it comes to cellular devices. Nothing, that is, except a dead zone in your newly-assumed place of living for the next two years. Frustration. I may be spending a lot of time outside the door or down the hill toward the street. However, I think my neighbors will be able to relate and may join me in their quest for signal as well.

I am my father’s daughter. By the first evening, I had the place moved into and mostly unpacked. After that initial day, there was mostly organizing left. Throughout the rest of the week, I picked up last-minutes needs/, stocked up on groceries for the foreseeable future, and had all repairs to the apartment reported and fixed.

My parents rock! They took time out of their lives, money out of their bank, and energy to come down to Springfield, help load me up, drive the Uhaul, unload the truck and unpack the apartment, stock me with household supplies, help inspect my new place, and drive back again all in 2.5 days. They helped pay, they prayed over my life and future here, and offered me love and support through this transitioning time. 

Weird feeling. Everyone is leaving for “summer break”; firing up the grills; spending time at the pools. And here I am getting ready to hunker down and embark on a 25-month educational journey. No “summer break” for me.

Clean feet. I don’t care what anyone else thinks, going to bed with clean feet makes a hard day better. I can be physically exhausted, emotionally drained, and too tired to even think, but if my feet are clean, the world doesn’t look so difficult. If you don’t believe me, give it a try. Often we joked (no, but really) about patients who came in to the ER suicidal or homicidal having many of those negative feelings cured by taking a shower and getting clean. It’s amazing what feeling clean can do to improve one’s attitude about life!

Going it “alone” stretches me out of my comfort zone…out of my comfort zone into a somewhat intimidating environment of knowing few people, having no history with anyone, and being unfamiliar with location, schedule, and preferences. I lived in Springfield 7 years, and when I left, the city was mine. I had my memories, favorite walking trails, local eateries, a home church, a job where I knew what was expected and how to excel, close friendships, and streets memorized. Now, I have an apartment, a map, and a few f/b friends in the area…

…and the family of God. Being a Christian makes going it alone so much easier; you have not only God’s presence with you, but in most places you can nestle your way into the local family of God. Already I have been incredibly blessed to meet two couples through the Chi Alpha program here who met up with me at church last month when I came to visit, and since I arrived this time around have showed up to help move my stuff in, took time to eat dinner with my family, offered help of any kind, and enlightened me to an insider’s view of the city’s personality. On Sunday night, I also visited a local church’s grad group and played trivia with some peeps. The team I was on won, and our reward was DQ gift cards. After the events were completed, a few of us went out for ice cream at a walk-up DQ and spent time just hanging out. It was so wonderful to be with such fun, like-minded people. I know I’m right where God wants me to be, and it’s wonderful that He’s providing me support.

So, that’s the update on me and IC (Iowa City) for now. Until next time…

"THE THING ABOUT QUOTES ON THE INTERNET IS YOU CAN NOT CONFIRM THEIR VALIDITY" - ABRAHAM LINCOLN

Often, you never realize how reliant you are on something until it’s gone. That’s the case with internet for me. Not being a smart phone owner, I just have the average access-internet-through-your-computer reliance on this technology. However, ever since our former apartment was struck by lightning, had the power knocked out, and created issues with our wireless routing capability, internet use been limited and spotty. Now, in my new place without any internet, I’ve been reduced to only using the net at work and pawning access at local bagel shops and the library. *insert first world problem quip here* haha. It seems like such a small thing in light of other important issues, but this posting is not meant to be taken terribly seriously.

Thankfully, this is not my situation :)

Without the internet, I’ve been reminded of life in the past. You know, back before we used the net to check phone numbers and maps and actually used a telephone book and atlas. Or when we rented movies to watch instead of streaming them from online. Or when we would actually call someone up and chat or meet in person to discuss our lives instead of stalking Facebook and emailing. Oh, yes. Times when we would read a book instead of killing countless hours on YouTube or skimming the latest greatest whatever.

It takes me back to my more recent reminder of no power – the memorable Springfield ice storm in 2007. Days after the spring semester started, the town was slammed with ice that broke tree limbs, downed power lines, and left the city without electricity for days or, in some cases, weeks. My roommate and I hunkered down at her relatives’ place, learned to crochet, cooked on a gas stove, read books outloud as a family, played board games, watched movies until the laptop battery died, and went to bed when the sun did. Good times.

Ice storm - Springfield - January 2007

Ice storm - Springfield - January 2007

Actually, it's been good to take a slight break. It forces me to re-focus on what is important. Just the other day I was reading in a magazine about families needing to designate a "no-tech" zone where members are required to leave all their electronics in a basket before entering. The article went on to list resorts that offer tech-free getaways for people who just can't unplug on their own - a place where families can focus on activities such as cooking, hiking, and playing games together. What a sad commentary on modern society.

Perfect illustration. You know you've seen this scenario in person.
Thank you google images.

Considering all these things, though, I’m still looking forward to having internet back in easy reach and at the access of my fingertips. I may be a little older than the generation that demands certain technological “necessities” (you know, the ones that can’t even put their phone down in the hospital when the doctor is assessing them because they might need to update their f/b status), but progress has its place J Here's to moderation in modern times!

“To improve is to change; to be perfect is to change often.” ― Winston Churchill

Doesn’t it seem like huge life changes always come in waves? Or is that just me? Recently, I have been preparing for huge changes in my life. Closing the chapter on one part of my life and starting it in another.

After my vacation to North Carolina, even during it, I hit the ground running with contacting future roommates, looking at potential subleases in Iowa City (IC), and wrapping up changes of service for utilities, laundry, gym membership, banking, current apartment lease, and giving notice for my last day at work. Then it was on to booking a hotel for a trip up to IC, packing some stuff for my parents to take back to their house, looking into Uhaul rentals, and finishing up my financial aid requirements. Oh, and I participated in the Color Run 5K here in Springfield. So. Much. Fun.

Fun times with old and new friends at the Color Run.
The Happiest 5K on the planet.

Between 10,000-15,000 people participated. Here's our group's final result :)

In the midst of everything, I celebrated a milestone birthday: 25 years. After work, I stopped by my local piercing salon to switch out earrings. Once back in the car, after dodging the downpour of rain, I found out my car battery was dead. After some coordinating, one of my co-workers was able to leave work and come rescue me. What an experience! *insert sarcasm here* [Happy birthday to me.] From that point on, though, the day significantly improved. I was able to spend some time with one roomie and her fiancé over dinner and with the other and her boyfriend over dessert at Village Inn for free pie night. The real celebrating occurred when my parents came down the next day to spend time with me: lunch, mani/pedi with Mom, ice cream, and a movie!

Several other life changes occurred over the course of the next week. My mom and I traveled up to IC, met with a ton of potential roommates, toured a few apartment complexes, and found the perfect place for me. 

My future home-sweet-home.

After the trip, another life change: I applied for my first credit card. (To pay for student loans of course! Might as well get some rewards for all the money I’m spending.)

Our first move is coming up in just over a week. Then two weeks after that move, I’ll be leaving my life in Springfield and heading up to IC to start my PA schooling. It’s a bittersweet time and I’m already feeling nostalgic about leaving my co-workers, college town, home church, and friends here. I know this plan is the one God has chosen for me, though, and that knowledge makes going “alone” so much easier. Here's to the journey, not just the destination.

[north] Carolina

I’ve always loved flying. The take off, steep climbing to the tippy tops of fluffy clouds, looking down over a patchwork of earth tones, the city lights upon approach for landing at night.

These past few weeks I was able to take a couple of flights on my vacation to and from North Carolina. I had never been to either of the Carolinas before so I was pretty excited. That, and the fact that I was spending all my vacation time with my sister and brother-in-law J

I determined that I wasn’t going to pay the extra $50-some bucks to check baggage, so with a little help from some YouTube videos and some significant work, I stuffed everything into my carry-on suitcase and backpack. One last stop for a pack of gum and I was ready to go. How fun to fly to the land where aviation first began!

Over the next 10 days, I had a spectacular time. Some days were more eventful than others, but I enjoyed them all. A few highlights included touring the capitol, the executive mansion, spending time at the North Carolina Museums of History and Science, spending time on Duke’s campus and viewing Duke Chapel, touring Duke’s Homestead, visiting the North Carolina Art Museum, and weekend trips to Old Salem and the Outer Banks (Wright Brothers’ National Historic Site, Fort Raleigh, Jockey Ridge sand dunes). I was able to be there over Palm Sunday, Good Friday, and Easter as well. It was wonderful celebrating such an important week of Christianity with my family.

Thanks to K & N, I was also introduced to old humorous episodes of Iron Chef, was educated in some classic video games, was able to explore the greenways and IBM’s campus, and played my fair share of Yahtzee, Nine Card, Uno, and Rummy.

Since my rigorous master’s program is fast approaching, it was great to just get away for a bit, relax, have my family pour love into my life, and be refreshed, valued, and supported. There will be many changes in my near future and, at times, it seems a little more than I can take, but one day at a time I’m trusting in God’s good plan for my future. It’s gonna be ok.

I'll close out this post with some pics from the trip. Enjoy!

The "Roman" George Washington, wearing a toga.
Raleigh, NC. Capitol building.

Tourist pic, North Carolina Museum of History

World traveler ;) North Carolina Museum of  Science

Duke Chapel

Winston-Salem, Old Salem. Getting ready to cross the bridge from the present to the past.

The "garden" and some houses in the background. Part of Old Salem.

Eating at the "tavern"

The apothecary. So glad medicine has made so many advances since then.
I would have hated to be a patient in the 1700s.

Working on our second 1,000 piece jigsaw puzzle of the trip.
This one was a photomosaic of Van Gogh's Starry Night
 - so difficult. But, as you can tell, we're having fun.
And, yes, we did finish before I left.

Lunch on the Outer Banks. Found this well-rated gem online.
Would never have stopped here by the looks of it, but it was quite authentic.
Yay for seafood on the coast!

Someone was nice enough to take one of us all together.
Crab cakes, flounder,and shrimp split three ways made a delicious lunch.

Wright Brothers' National Historic Site Memorial. So cool.
We climbed a massive "historic hill" to get to this point.

Recreation of original 12 second first-flight photo.
Something in this pic is not like the original. Hmm?

Yeah, we were there on the original flight too.
The history books must have left that part out ;)

Jockey Ridge sand dunes. The largest active sand dune ecosystem in the SE USA.

Easter attire. 

Looking snazzy. So happy to spend my time with these stellar peeps.

 

Being silly!

 

Ready to devour K's yummy yellow/chocolate  Easter cake.

 [and that's all. the end. until next time.]

[i]nterventional [r]adiology

The alarm went off (not yet quite) bright and early this morning at 6:45 A.M., not even five hours after I had set it when crawling into bed the night before. What kind of crazy insanity would inspire me to get up after so little sleep? Shadowing a physician in interventional radiology (IR). The lack of sleep was no biggie, though. He only had one case on for today, right? I could go and come back with plenty of time to take a nap later on in the day. Well, not exactly. No one mentioned the “one case” was estimated to take 3-5 hours to complete. And then he had an additional case he was going to try to perform after that one.

I walked into angio five minutes before needing to be there, dressed in “business casual” and ready for a quick morning. After meeting with the area manager, she took me to change into scrubs. Not having been told to dress for standing all day (although I had asked), I didn’t have on tennis shoes. Oh, well. She introduced me to Dr. Cooney, and he briefly went over the case he was about to work – a scheduled basilar stent placement and aneurysm coiling. Don’t know what those are? That’s ok. I’m about to give you a brief overview so you can understand what I experienced today. (And by brief I mean a simplistic overview, even though this post appears forever long. Stick with it if you’re curious, though. You won’t be disappointed. Plus, there are pictures to keep your attention. J)

First, let me give you a snapshot of what interventional radiology shadowing involved:

·         Types of procedures typically performed: stents, vertebral biopsies, dialysis catheters, and more.

·         Had to don scrubs, hair net, mask, plastic glasses, shoe covers, and lead apron while in the procedure room.

In the IR attire - scrubs, mask, hair net, glasses, lead apron and shoe covers.
And scrub jacket because it was freezing.

·         By the way, lead aprons weigh a ton; you need to work out just to wear those things! The radiology student in the room advised me I’d be sore tomorrow. I guess I’ll find out soon. However, the lead was so heavy it helped with the next bullet point. Keep reading…

·         Freezing cold, nearly literally. Apparently, the cold temperatures help with keeping germs at bay – think operating room cold. Also, their equipment functions better at cooler temperatures.

·         Sterile field. The doc and his radiology co-worker were suited up in sterile attire (gowns, gloves) working with a sterile field. They even had the monitors covered with sterile plastic so they could navigate the screens.  

[Google image showing IR room, sterile field, and monitors similar to the set-up I saw today]¹

·         Persons involved: there are usually 4-5 people on the scene. The doc, the radiology technologist, the “hander” (who grabs any equipment necessary so they don’t have to re-sterilize everything), anesthesia, and the patient.

So, what did I see today? Well, I mentioned the whole stent and coiling deal previously. First, let’s talk about aneurysms so you can follow the procedures.

·         Definition: “An aneurysm is a balloon-like bulge or weakening of an artery wall. As an aneurysm enlarges it becomes thinner and weaker. It also puts pressure on surrounding structures, causing headache or vision problems, and may eventually rupture. A ruptured aneurysm releases blood into the spaces around the brain, called a subarachnoid hemorrhage (SAH) – a life-threatening type of stroke."²

·         Causes: people can be born with them (congenital); some are hereditary; development influenced and  aggravated by methamphetamine and IV drug usage and/or elevated blood pressure;  some proponents suggest smoking contributes to development as well (questionable).

·         If under 4 mm, physicians typically do nothing unless aneurysm is ruptured. Aneurysms of these dimensions are considered small.

·         If over 10 mm (1cm), then aneurysm is considered “giant” in radiology terminology and radiologist must take action - usually placing a stent, although there are other options.

[insert diagram for visual learners like me]²

 This figure illustrates several types of aneurysms:

Anatomy of an aneurysm (top). Different types of aneurysms (bottom).

[back to text]

Now that you have an idea of what aneurysms are and what they look like, let’s move on to the procedure Dr. Cooney performed today.

·         The patient was a 50-ish year old female. Time of aneurysm onset was 1 year ago. Stent placed at that time. During a follow-up appointment, aneurysm displayed significant growth, causing further bulging of blood vessel.

·         Procedure objective: place 2^nd stent in left artery and add additional coils to ballooning original aneurysm. Part one’s success was questionable. Part two was a guaranteed occurrence.

·         Patient was prepared:  IV placed for anesthesia, groin shaved and scrubbed.

·         The catheter(s), guide wires(s), and stent first entered the femoral artery in left groin, flowed through the left vertebral artery, and then were guided (taking a backward loop approach) into the right vertebral artery at the basilar junction.

[insert helpful information here] ²

·         Blood supply of the brain: Blood is carried to the brain by two paired arteries, the internal carotid arteries and the vertebral arteries.

 [back to the story]

·         One of the guide wires had a radio opaque tip, so it was more noticeable on the monitor. Contrast was also used periodically to visualize blood flow through the arteries of the brain.

·         The technologist would occasionally take x-ray shots of the contrast (fluoroscopy) images so that they could overlay that screen shot over what was presently taking place (shown via regular x-ray imaging).

·         It took over 2.5 hours to complete part one. After trying multiple times to guide the wire where it needed to be, the doc finally got it. He, himself, admitted it was a “miracle” exclaiming “Thank God” when he finally succeeded. Just goes to show that success is not dependent on skill alone but on God’s grace and intervention.

·         There were eight monitors stacked in sets of two connected in a big rectangle to each other. It was moveable, and it was what everyone relied on to view the images. Throughout this procedure, they only used 4-6 of the 8 monitors at a time.

·         After stent placement, they performed a CT to make sure there was no hemorrhaging caused by the guide wire poking around trying to follow the flow in the vessels. On a CT involving a hemorrhage, the blood shows up as white. There was no hemorrhage in this patient’s case.

·         With the brain hemorrhage free, the doc proceeded with part two: filling the original aneurysm with more coil to protect it from further ballooning.

·         This process involved threading catheter wires into the aneurysm, gradually decreasing in diameter size. As the wires were threaded, they coiled into themselves, filling the space from the top of the aneurysm down toward the first stent.

[insert webpage information and diagram for clarity] ^{2, 3}

·         Endovascular coiling: In contrast to surgery, another form of treatment is endovascular coiling.In a coiling procedure, a catheter is inserted into an artery in the groin and then passed through the blood vessels to the aneurysm. The doctor guides the catheter through the bloodstream while watching a fluoroscopy (a type of x-ray) monitor. Through the catheter, the aneurysm is packed with material, either platinum coils or balloons, that prevents blood flow into the aneurysm (Fig. 6).

The aneurysm is packed with platinum coils by way of a small catheter.
The arrow indicates bloodflow through the artery, but not the aneurysm.

Aneurysm Coil Embolization

[back to procedure one]

·         Catheter tidbits:

o   Metal wires have “memory” and will retain shape: circular, square, etc.

o   Begin with catheter size just smaller than the size of the aneurysm. For example, if aneurysm is 10mm, then use a 9 mm catheter to begin. Gradually decrease catheter size. Dr. Cooney compared the process to the opposite of Russian stacking dolls, starting with largest to smallest size.

·         In total, they used 14+ catheters to fill the aneurysm.

·         Patient was taken to PACU (recovery room part of surgery) after procedure, and would then be transferred to a bed in the hospital to be monitored.

Other Angio Tidbits

·         There are three layers of blood vessels: tunica intima (inner), tunica media (middle), tunica adventitia (exterior).

·         Stents bend like bananas – possible to thread a second stent through first to create a “y”-shaped double stent placement formation.  If stunts placed side by side, stent placement called a double barrel formation.

The procedure was scheduled to begin at 8:00 A.M. We started at 9:25 A.M. and ended around 1:30 P.M. After the first procedure, we took a quick break and grabbed lunch. When we returned from the doctor’s lounge, the second patient was being readied. He was an elderly male. His procedure: a biopsy and cementing of fractures of the T11 vertebra (lower back). Fortunately, in comparison to the first procedure, this one only lasted about 35 minutes.

·         The patient was placed stomach-down, sedated, and anesthetized locally. Sterile technique was used in this procedure as well.

[insert another Google image illustration]⁴

Patient positioning for vertebroplasty. Padding flattens the spinal curvature while maximizing patient comfort.

 [back to text]

·         I didn’t catch the terminology as well on this procedure since it was so short. In addition, it was at the end of Dr. Cooney’s work day and everyone was tired by this point.

·         The doc identified the vertebra of interest, hammered a hollow metal tube into the body of the vertebra, and used a biopsy needle to aspirate a sample, which was placed in a dry specimen cup.

[insert additional Google image illustrations]^{4, 5}

PMSB : Ostycut needle, penetration performed with surgical hammer

Disassembled components of a standard needle/trocar unit used in vertebroplasty. 14-gauge biopsy needle set

The x-rays of the procedure looked like this:

(B) Posteroanterior and (C) lateral fluoroscopic images during vertebroplasty.

[back to procedure]

·         Then he repeated this procedure on the other side of the vertebra body, so that in the end, there were two metal tubes symmetrically sticking out of the man’s back. A 2^nd sample was obtained and placed in a fluid-filled specimen cup. 

·         Cement was squeezed into the hollow tubes using the aspiration needle and a syringe.

·         Then the tubes were removed and the procedure was officially finished. 

[another view thanks to Google images]⁶

Puncture surgical hammer.

Puncture.

Vertebral body biopsy.

This was my second shift shadowing in radiology. The first time was in musculoskeletal (MSK), and interventional radiology was different in many ways. For one, there was quite a bit of hands-on work as well as interaction with patients. In contrast to just looking at images and dictating findings, IR had a tactile component or placing or removing something in the body using radiology images to aid the procedure. I'm headed back to angiography tomorrow to view neuro radiology. But that's all for now...

1. http://www.bendbulletin.com/article/20110817/NEWS0107/108170408/

2. http://www.mayfieldclinic.com/PE-AneurUn.htm

3. https://neurosciences.beaumont.edu/aneurysm-coil-embolization
4. http://www.sciencedirect.com/science/article/pii/S0033838908000663

5. http://www.openradiology.org/zosirws/survey/biopsies/bonepen

6. http://www.openradiology.org/zosirws/survey/vertebroplasty/technique/puncture

E[mergency] M[edical] S[ervices]

So, I did my EMS ambulance ride time today. Although I knew it would be unpredictable, I figured it would be somewhat similar to my Life Line ride time with the helicopter – a lot of waiting around and a few calls…hopefully without the motion sickness. I was assigned to ride from 10am-8pm with two female paramedics. At the beginning of the day, I mentioned I knew nothing, so everything would be new. Even if we didn’t have an "interesting" day, I would still know more about how things worked than I did before. First off, learn the lingo. Every area in medicine (and in every profession, I’d venture) has their own way of talking and definitions of unfamiliar words.

With that being said, I'll give you the DL on the lingo I heard used most commonly today.

First, codes. Now when I hear codes, I think code blue as in CPR, start chest compressions stat. Or code orange, seal off area because of dangerous chemical spills. Or even code silver, shooter in hospital. But in EMS lingo, a code is the way one leaves a scene to head to the hospital. Code one is not as emergent. Code three is lights, siren, and speed because the patient should have been at the hospital, like, yesterday. There is no code two. Don’t ask me – they didn’t think it made sense either.

Next, priorities. There’s a graduated level of priorities based on the information dispatch was given in a 911 call. If there is possibility that the patient has no airway maintained, can’t breathe, or the heart has stopped beating (or dispatch is unable to ascertain the nature of the patient’s condition via the call), then the truck responds priority one.  Again, this indicates lights and siren since it’s the highest priority. The priorities become less severe the closer you count to five. There are five levels of priority total. The paramedics explained that codes and priorities seem opposite at first. You may respond to an urgent priority one patient, but leave the scene code three (most urgent). However, a non-urgent call takes, say, a priority four status and, therefore, they would leave the scene code one. Got it? Good. Moving on.

Third, districts. Springfield has two privately owned EMS operations – Cox and Mercy – and each responds to calls made in certain districts. For instance, Cox covers anything Battlefield and south plus everything between Division and Kearney. Mercy covers calls made from Battlefield to Division and everything North of Kearney to the surrounding areas. They split the calls on Battlefield depending on if the location is on the north or south side of the street. I asked specifically since I live on Battlefield. Even though they respond to patients in these areas, they can take patients to any hospital within reasonable distance, so patients in those districts aren’t forced to use the hospital of the EMS providers who respond.

Fourth, posts. When an ambulance isn’t on call, the paramedics report to dispatch and indicate they are free to take an assignment. Dispatch then gives them a call or a location at which to post – a.k.a. hang out until needed. To my knowledge, there are three (if not more) posts in Springfield for Mercy medics. Post one is the ER ambulance bay at the hospital, post two is a clinic near Kearney and Glenstone, and post three is headquarters located on St. Louis Street. Posts two and three are nicer accommodations, with leather couches and television. When there isn’t a truck stationed at post three (HQ), then they pull a “free” truck from another post to cover the entire city from that location. Then when another truck becomes available again, the truck that was pulled is usually sent back to the post from which they just came. At least that was the case today. It seemed like there was no rhyme or reason at first to why we were constantly going back and forth between posts two and three, so I asked, and that was the explanation they gave to me.

After getting some of the lingo down, I was able to follow the conversion and assignment reports more easily. I hate being lost in the lingo, so I definitely didn’t hesitate to ask questions right away. Besides the terminology, there were several other things I learned which really enlightened me to the way EMS functions.

Organization. The first thing I observed as I walked into the ambulance bay at headquarters was one of the paramedics with which I was riding (let’s call her A.) cleaning out the truck. The other paramedic (let’s call her B.) commented that A. was a neat freak, so the truck would be spotless on their shift. (Which was fine with me since I’m a tad of a neat freak myself and can appreciate a fellow kindred spirit.) B. pointed out how the truck was arranged. Everything they needed they could keep on their stretcher – monitor/defibrillator, airway bag, and med bag. The truck was stocked with meds, IV supplies, oxygen, gloves, and all the materials of the medical trade that may come in handy. Like alcohol wipes and emesis buckets. There’s a pilot chair in the back as well as a bench seat/makeshift 2^nd patient bed and a side seat. There is also a driver and passenger seat up front.

In the back of the ambulance at the beginning of the shift.

Shifts. I happened to catch a ride-along on a 10-hour shift. However, most shifts are typically 12 hours.  (County EMS shifts are 24- or 48-hour shifts.) Four shifts run all the time starting at 6, 6:30, 7, and 7:30 (morning and evenings). Then there are 9AM-9PM and 10AM-8PM shifts. There are two partners to a truck: either a paramedic/EMT or paramedic/paramedic. Usually, the teams are consistent…so they are not constantly switching partners. As B. pointed out, this makes it great if you work well with your partner or miserable if you can’t stand each other. I loved how she mentioned that her EMS co-workers were like her family – some closer than family. But there is also some discord at times when working styles, personality, or personal preferences clash – like which radio station to listen to or how to treat family members of patients on scene.

Cost. I’ve always been told – even before I started working in the ER – that it’s expensive to call for an ambulance ride. So, I specifically asked how much it would cost if I was self-pay. Apparently, people weren’t lying when they said it would be expensive. First, there’s a base BLS (basic life saving) charge – $600-something per a certain amount of time. Then if the paramedic interacts with you at all, there’s an ACLS (advanced cardiac life support) charge of $900-something per certain amount of time. If you need intubated or any airway assistance, the cost goes up significantly because an ACLS II charge is added. And on top of all that, there’s a dollar per mile charge. For Mercy, it’s $16/mile – at least initially. I’m not sure if it goes up if the distance increases or not. The BLS and ACLS charges also go up exponentially if the distance is large – like from here to Kansas City instead of across town. All that to say, ambulance rides are expensive. So, unless you are truly dying or need the assistance of sedation, find another ride to the hospital and back home.

Challenges and Advice. Being an EMS responder is tough work. There’s a huge range of emotional extremes. Among handling horrific traumas, feeling threatened by psychotic patients, and taking non-urgent transfers back home, it’s easy to face emotional whiplash or burnout. After responding to calls involving kids or working a death, most people will need to take a step back, breathe, and regroup in order to move on to the next call. The responders never know if the next call could be the best call of their professional life or the worst one that changes how they function for the rest of their career. The shifts are unpredictable – crazy busy, boring monotony, exhilarating, frustrating procedures of changing post to post or transporting patients who abuse the system. Patients can be super sweet or incredibly ungrateful. In addition to the emotional difficulties, the nature of the work is physically exhausting. Throughout their day, paramedics and EMTS are constantly lifting patients – and not always bed to stretcher. They often receive calls for morbidly obese patients (400-600lb range) who have fallen and EMS is sent to help them get up or come to the hospital for their injuries to be treated because no one else can lift them. Not to mention the exhaustion working 12-hour shifts can create.

These are some of the challenges of the job. The advice B. offered is to come into the position with some street smarts. Many times you have to be able to read your patient before you put them with yourself in an enclosed area. If law enforcement felt threatened enough to use handcuffs, by golly, the patient needs to stay handcuffed or be transported in the back of a police car. If a patient is strung out on K2/bath salts and the police can’t handle them, pre-medicate the patient before loading them in the back of your truck. If you feel threatened as a paramedic, don’t hesitate to brace yourself, yell “brake!”, and let the patient go sliding out the back. Better they be hurt than you dead. Her other advice: take a break when you’re too overwhelmed or emotionally paralyzed to function safely. Sometimes you need to take a step back before you can continue. That’s ok. Sometimes it’s hardest to recognize your own limitations – but even paramedics and EMTs are people. They’re not super-human or deity. Sometimes there’s not a thing they can do to save someone’s life and they know it.

So, that’s what I learned.

Here’s what I Experienced: two hospital-to-nursing-home transfers, a nursing home to Cox South ER transfer, and one home-based call from residence to Mercy ER, as well as quite a bit of down time at the posts, watching the US Figure Skating Championships on T.V., and a trip to Subway. Our routes included Springfield and two other cities in the surrounding area. By 7:30PM, they were “EOS” (end of shift), we headed back to fuel up and log miles, and then returned to headquarters – ending where I had started that morning.

Conclusion. The daily life of EMS responders is completely unpredictable. They have been puked on, physically and verbally abused, thanked for saving someone’s life,  and responsible for delivering babies on the side of the highway and extricating patients from car crashes; all of these situations with minimal support, supplies, and often in an enclosed space. And yet, they keep coming back to work. What I learned today: just as is true for other medical positions, EMS responders deserve our gratitude and respect. Perhaps, more so than others do. 

Meal Planning

So, this post is a slight diversion from what I normally blog, but I thought it would be worth it. As I was browsing my email, I came across an update from a blog I subscribe to. The topic: meal planning.

Now, I've always had a basic mastering of meal planning...after all, I did grow up homeschooled. We practically counted every home-care activity as home economics. But as I've moved on through college and now adult life after college, it gets harder and harder. Maybe it's because of my I'm-just-cooking-for-one-so-why-bother mentality. Or perhaps it's due to my 12-hour random work shifts making it harder to eat balanced meals.

Anyway, my friend's blog post included her #1 tip when it comes to meal planning for her family of 6 -- letting someone else do it! She's even offering a free 3-month trial for one lucky reader. The service is called eMeals, and browsing through the site, it looks pretty spectacular. Even if one doesn't win the giveaway, all are eligible for the 15% off coupon using the code provided in her blog post. Check out this link if you're interested in reading her post and this one if you're interested in exploring the service.