EMT With A Syringe

Contagious

    I have been an employed nurse officially for 5 days now.  I have been officially contagious for a bout 3.  Orientation has been typical, HR/policy/procedure/learning to be an RN instead of a student... etc.  My drive to work is atrocious, and I've been near-falling asleep at the wheel for the last few days. I THOUGHT it was because of work.  Howeverrrr...

    On day 3 of work I was summoned to Employee Health.  I was told they didn't have a record of my immunization boosters and I needed both a Hep B and Varicella ( Chicken Pox ) booster.  Ok. Done.

    So I start feeling a little nauseous and really tired, low-grade fever.  Decide I'm just run down.

   But of course, here's my real story of the week: I HAVE CHICKEN POX!  And those were th early symptoms.  Yes, chicken pox.  Nasty, itchy, fluid oozing CHICKEN. POX. I am 22.  I feel slightly retarded

    The real problem here? I just started a job in an EMERGENCY ROOM of a HOSPITAL, and I can't go into work!!  Maybe for 2 or 3 WEEKS!!  I am beyond screwed.

    What a way to start off being an adult.

The night before life goes on.

I start work at my nursing job tomorrow MORNING (not happy about that- i'm a nightshift chick), in giant Big City Trauma Center ER, and although it is just classroom orientation for the most part, I am nervous as shit.  As such, I am distracting myself by talking to a fellow EMT/student nurse about how we both dislike nursing and would rather be EMTs/medics, but can't because there's just no money in it (even though I should be sleeping instead). He works 3 or 4 jobs and is busting his ass to make ends meet trying to do what he likes.  Sad.  Alright I gotta sleep so I can talk to my nurse manager tomorrow without passing out.  Oooo coffee is not my friend tonight.

Wish me trauma. Kidding.  More like, wish me short HR presentations. Sigh.  Cynical already.

-Syringe

EMS: Earn Money Sleeping

A tour can play out so many different ways, but rare as it may be, Earn Money Sleeping is clearly the greatest version of the job ever. That is, until Captain makes you stay up until 230 AM finishing charts, Boyfriend Medic texts you at 4, and then 5 AM because he had to fly people and is awake and you should be too, Dispatcher calls twice to inquire about your crew status at 6 and 630 AM (even though you put it up until SIX P.M.), Early Rising Partner decides 8AM is a super time to organize pots and pans, and Drunken Roommate jumps on you at 10 AM wanting your keys.

I'll take those back-to-back traumas, now.

-Syringe

Traffic Patterns

    I leaned my head out the window as I am known to do... taking in the wind, the sunset, the smell of summer and BBQ.  Feeling warm, comfortable and totally intent on enjoying the evening; sirens and awaiting trauma victim be damned. Not insensitive, just not out of the ordinary.  Pretty music sang back-up to the crackling of the scanner and the main street in the township was that awesome, late-afternoon-glowy scene, still busy, winding through the end of rush hour.  To others, we're disruptive to this setting: changing traffic patters, piercing the air with shrill sounds and reminding them that all is not well somewhere.  Kids on street corners wave and mothers sling arms protectively around them to keep them on the sidewalk.  College students scatter backwards as we come up fast and push the red-light.  Brakes and tailights show we are an intrusive blip, coming from nowhere, storming through their lives, their afternoons, like a ten-second hurricane and gone just as quickly leaving a mess behind for them to sort out.  But to us, there's a rhythm to it all.  You go right, we'll go left, switch siren frequency, cross the white line, heavy same-flow traffic means crossing the yellow line, airhorn for the pedestrian-heavy red-light intersection, watch the mirrors for reference points (too close to that truck), wave to the kids, smile, pay attention, enjoy the ride.  Every "hot" ride we take by nature risks the lives of everyone onboard, everyone on the road, and everyone waiting for us at the end of our trip.  We are supposed to weigh the risks and benefits of the initial dispatch - is this person's condition life threatening?  Enough so to put many other lives at risk?  If so, the lights and sirens are allowed.  If not, we are by law required to obey all traffic laws when responding to that patient.  But is this how things actually happen?  Well... no.

    The problem is, we can't always know for sure if the dispatch is accurate (many times it truly is not).   Sometimes the patient worsens between the time of the 911 call and our arrival.  "Dizziness" deteriorates into "unconscious."  Sometimes the caller is distressed and unable to give an accurate report.  "Finger cut" in actuality is "Amputated hand."  That in and of itself is enough to pardon the lights and sirens stretch.  Like so many other times on the job, we are required to make this decision with a lack of crucial information.  We don't really know what we are getting into.  And once you turn on the lights, you can't turn them off in the middle of the roadway.  Talk about confusion.  If you're going to do it, you gotta commit to it, and everything that comes with it.  If we don't get there fast, someone could die.  But if we use unnecessary risk, someone else could die.  So why risk it?  Well, we know there is someone waiting who needs us, who could hypothetically be in life-threatening danger, and everything else... everything else is possibility.  Everything else is, theoretically, in control.  But we all know that isn't true.  Things you think are in your control sometimes aren't.  You can't control the other driver's choice to swerve to the left instead of the right.  You can't keep someone from coming to a full stop right in front of you.  All the airhorn in the world won't stop that 5 year old from running out into traffic.  The light is GOING to turn red.   It always does.  You can't stop it from turning red.  But you can choose what you are going to do now.  Do you blow through the intersection without stopping, and just pray everyone hears/sees you coming?  Do you come to a full stop and wait for it to turn green?  How many minutes will you save?  How many will you waste, that might have saved a life?  I guess the answer might be proceed with caution.  Try your best to find a happy medium.  Slow down at the red light, blow the airhorn, look both ways and proceed if it looks safe.  There's always a risk.  Either way there's a risk.  Either way you might let someone down.  You might let yourself down.  Either way someone might get hurt.  Too much risk and you'll create destruction all around you.  Too much hesitation and you'll miss the opportunity you were given. What do you do?  What can you do?

The only thing you can control is yourself.  The only thing you can control is how you react to what everyone else is inevitably going to do.

    My frame of mind shifts as the ambulance comes to a stop.  We made it, we've made the right choices so far (presumably).  Now? Game time: no more enjoying the night.  I do a mental checklist of the things I want to take up with me (jump bag, collar, backboard, CIDs) and throw them on the stretcher, but try to keep my mind semi-blank.  If you approach a patient focused on what you think you should be seeing, you might miss what's actually there.  The apartment complex we're at is on top of a hill, and I can see the street at the bottom where we turned in moments before.  The traffic pattern is still sorting itself out.  There's a close call as a car tries to pull back into a lane from where they pulled over to let us through.  Just then, the medic's chase car throws it all into chaos again as he flies through, lights and sirens ablaze.  I sigh and lead my crew into the building, shoving the stretcher roughly into the elevator.  There's a cop already in there.  He presses the floor number.  The medic slides in at the last second.  I'm sure I scowled.

    "So what's the matter with you, Chief?"  He smiles and pokes me in the ribs.  "Lighten up... what the hell are we going to anyway?"

    Truthfully, sometimes I like not knowing what I'm getting into. Sometimes in order to take the risk, it's better to go in blind.  It may not be safe or healthy, or the right choice but... if I always knew, I might never go.  I might be too slow.  I don't want to make the choice.  I don't want that responsibility.   

    "Fuck if I know."  I watch the sunset disappear as the elevator doors slide closed.  "I didn't read the dispatch printout."

    I leaned my head out the window as I am known to do... taking in the wind, the sunset, the smell of summer and BBQ.  Feeling warm, comfortable and totally intent on enjoying the evening; sirens and awaiting trauma victim be damned. Not insensitive, just not out of the ordinary.  Pretty music sang back-up to the crackling of the scanner and the main street in the township was that awesome, late-afternoon-glowy scene, still busy, winding through the end of rush hour.  To others, we're disruptive to this setting: changing traffic patters, piercing the air with shrill sounds and reminding them that all is not well somewhere.  Kids on street corners wave and mothers sling arms protectively around them to keep them on the sidewalk.  College students scatter backwards as we come up fast and push the red-light.  Brakes and tailights show we are an intrusive blip, coming from nowhere, storming through their lives, their afternoons, like a ten-second hurricane and gone just as quickly leaving a mess behind for them to sort out.  But to us, there's a rhythm to it all.  You go right, we'll go left, switch siren frequency, cross the white line, heavy same-flow traffic means crossing the yellow line, airhorn for the pedestrian-heavy red-light intersection, watch the mirrors for reference points (too close to that truck), wave to the kids, smile, pay attention, enjoy the ride.  Every "hot" ride we take by nature risks the lives of everyone onboard, everyone on the road, and everyone waiting for us at the end of our trip.  We are supposed to weigh the risks and benefits of the initial dispatch - is this person's condition life threatening?  Enough so to put many other lives at risk?  If so, the lights and sirens are allowed.  If not, we are by law required to obey all traffic laws when responding to that patient.  But is this how things actually happen?  Well... no.

    The problem is, we can't always know for sure if the dispatch is accurate (many times it truly is not).   Sometimes the patient worsens between the time of the 911 call and our arrival.  "Dizziness" deteriorates into "unconscious."  Sometimes the caller is distressed and unable to give an accurate report.  "Finger cut" in actuality is "Amputated hand."  That in and of itself is enough to pardon the lights and sirens stretch.  Like so many other times on the job, we are required to make this decision with a lack of crucial information.  We don't really know what we are getting into.  And once you turn on the lights, you can't turn them off in the middle of the roadway.  Talk about confusion.  If you're going to do it, you gotta commit to it, and everything that comes with it.  If we don't get there fast, someone could die.  But if we use unnecessary risk, someone else could die.  So why risk it?  Well, we know there is someone waiting who needs us, who could hypothetically be in life-threatening danger, and everything else... everything else is possibility.  Everything else is, theoretically, in control.  But we all know that isn't true.  Things you think are in your control sometimes aren't.  You can't control the other driver's choice to swerve to the left instead of the right.  You can't keep someone from coming to a full stop right in front of you.  All the airhorn in the world won't stop that 5 year old from running out into traffic.  The light is GOING to turn red.   It always does.  You can't stop it from turning red.  But you can choose what you are going to do now.  Do you blow through the intersection without stopping, and just pray everyone hears/sees you coming?  Do you come to a full stop and wait for it to turn green?  How many minutes will you save?  How many will you waste, that might have saved a life?  I guess the answer might be proceed with caution.  Try your best to find a happy medium.  Slow down at the red light, blow the airhorn, look both ways and proceed if it looks safe.  There's always a risk.  Either way there's a risk.  Either way you might let someone down.  You might let yourself down.  Either way someone might get hurt.  Too much risk and you'll create destruction all around you.  Too much hesitation and you'll miss the opportunity you were given. What do you do?  What can you do?

The only thing you can control is yourself.  The only thing you can control is how you react to what everyone else is inevitably going to do.

    My frame of mind shifts as the ambulance comes to a stop.  We made it, we've made the right choices so far (presumably).  Now? Game time: no more enjoying the night.  I do a mental checklist of the things I want to take up with me (jump bag, collar, backboard, CIDs) and throw them on the stretcher, but try to keep my mind semi-blank.  If you approach a patient focused on what you think you should be seeing, you might miss what's actually there.  The apartment complex we're at is on top of a hill, and I can see the street at the bottom where we turned in moments before.  The traffic pattern is still sorting itself out.  There's a close call as a car tries to pull back into a lane from where they pulled over to let us through.  Just then, the medic's chase car throws it all into chaos again as he flies through, lights and sirens ablaze.  I sigh and lead my crew into the building, shoving the stretcher roughly into the elevator.  There's a cop already in there.  He presses the floor number.  The medic slides in at the last second.  I'm sure I scowled.

    "So what's the matter with you, Chief?"  He smiles and pokes me in the ribs.  "Lighten up... what the hell are we going to anyway?"

    Truthfully, sometimes I like not knowing what I'm getting into. Sometimes in order to take the risk, it's better to go in blind.  It may not be safe or healthy, or the right choice but... if I always knew, I might never go.  I might be too slow.  I don't want to make the choice.  I don't want that responsibility.   

    "Fuck if I know."  I watch the sunset disappear as the elevator doors slide closed.  "I didn't read the dispatch printout."

"I Have A Bad Feeling"

    Tapped for an unresponsive person at the local Heaven's Waiting Room Nursing Home.  Just up the street, took us less than a minute to get there.  Pull in, Medic J enroute from elsewhere in the township.  I like this medic a lot, but like most smart people, he dislikes when people are stupid and/or things don't go smoothly.  But what he most loves, is to laugh at my expense.  He and my partner T have that in common.  But it's cool.  I mean, what else are EMTs for but to entertain the medics?

    Anyway, we pull up and  T pauses and goes, "I have a bad feeling.  Better bring the AED."  I had the same bad feeling, I just know better than to say it aloud, geez.

   

Inside we go.  Greeted by a, "ARE YOU HERE FOR ROOM 666?? I'LL SHOW YOU!!" That, coupled with a nurse who almost took our stretcher out as she sprinted by us to "COPY THE PAPERWORK!!", bad feeling not alleviated.  Picked up the pace, turned the corner into the room and smelled it before I saw it.

    "She's awake now," the tech says (because why leave a nurse with an unstable pt. when there's paperwork to copy!)  Awake she was, and completely covered in shit, and now so is my boot, because no one warned me not to step *there*.  I resist the urge to plug my nose.

T walks in behind me and smirks.  "So THAT'S what that bad feeling was! I'll be outside," he says. "Enjoyyyy!"

Ms. C. Diff frowns at me and states that the only way she's going to the hospital is if I wipe her and get her some real underwear. Sure, it's not my job but I think we all know how waiting for the nurses will turn out here.  Might as well drop status with the county for the day.  So, I dive in.

I'm up to my elbows when Medic J sticks his head in just in time to get in his first laugh of the day at my expense.  "Remember, Syringe, the patient is our customer!!"  Oh, yes.  They call me Customer Service for a reason.  I can hear him laughing in the hallway.

Another life saved I guess?  Another life made a little more comfortable, at least. Oh well.

Except now I'm going to smell like poop for the rest of the day.

Oh and that bad feeling?

Still hanging overhead like that dark cloud over Eeyore.

Here Endeth the Lesson.

    The three of us took her to the airport this morning.  It could have been any other car ride, on any given Sunday; just a trip to the outlets, breakfast after a long night or a mission to pick out furniture for one of our new apartments.  We sang our favorite songs, loud and off-key, with the windows down and they seemed to mean more.  The three of us walked her in, got a stranger to take a last picture, stood in the security line and cried when it was time for her to go.  Then the three of us walked away, got back in the car and drove home.

    Someone asks if we "are OK?!?" as we leave.  I guess three girls dressed haphazardly in a mismatched combination of pajamas and duty gear shuffling through the terminal arm-in-arm and bawling at 6 AM raised some sort of flag.  "We're OK. We just had to say goodbye to our best friend," says L.  We are unusually quiet, aside from the crying.

    All I can think of is an episode of Buffy.  Willow is having a hard time forgiving herself and Giles asks her if she wants to be punished.  She replies, "I wanna be Willow."  He says, "You are.  In the end, we all are who we are - no matter how much we may appear to have changed."  The scene fades into an incredibly grown up Xander, getting out of a new car dressed in a suit and on his way to work.  It seems surreal how much he has clearly grown up, from the goofy, awkward, naive high school kid he was when we met him.

    I can't get the image out of my mind.  I can't help but think of how much we have all changed, and wonder how the hell we got here, to today, to saying goodbye.  How did we move from 4 years ago at our first ambulance meeting, before "EMS" stood for "Earn Money Sleeping", before college EMS was "for kids"?  When did that happen? When did casual acquaintances and Thursday night shift partners become family?  And how do you tell the first family you've ever had that it's OK to leave and move across the country, if that's where there heart is?  How can the girl I remember being so nervous and scared to ride on the ambulance for the first time be confidently moving clear across the country to start all over, live on her own, and work more than competently as an ICU nurse?  How can my first preceptor, a new cleared at the time herself, now be the President of an ambulance company, married almost a year and thinking of starting her own family?  How can one of *my* first probies be the Captain of the company where we met, and less than a year from being an RN herself?

    And as for me, how did I go from whacker-queen to competent EMT, registered nurse, and -arguably, most importantly- somebody's love, somebody's world and probably future wife?  When I got out of the car at the airport today, where was that scared little girl who thought it was a good idea to traction splint an open tib-fib fracture (don't worry, it was a drill.)?  Where was the girl who needed her the friend that's leaving today to pick her up off the floor on a daily basis, to make her good choices for her, to sit by her hospital bed on multiple occasions?  Who is this chick standing in her place?  How did the three of us leave her and walk tall back to the car today, in one piece?  How did we walk at all??  How did we drive home, part ways and go to work, like it was any other day?  Like we hadn't just lost a piece of ourselves?

    EMS has given me many things.  The first job I've enjoyed getting up and going to.  A great resume.  Awesome clinical experience.  Proof positive direction for my career.  Fun nights, both on duty and off.  But most importantly, it turned my friends into my family.  Some of my best and most important conversations, experiences and memories with those four happened on the clock, on calls or just driving around in trucks.  The rest happened because those times happened first.

    EMS also showed me what I was capable of, myself.  That I could be something worth being proud of.  That I can do things I never dreamed of, do them well, and even occasionally help others in the process.  That I could stand on my own, even lead others, when before it didn't seem like I could stand at all.  That I will continue to move on, to grow, to do what I have to do, no matter what happens around me.  That I have to.

    Today my friend moved on.  I know what I have lost, and it's a lot.  But I know I will be OK.  When I got to work today, her ID from her bunker gear was clipped to my gear rack.  I don't know how it got there, and I don't care.  I think I'll leave it, to remind me.  We will stay in touch.  We will talk and visit.  I think the worst part is realizing not that I can't do it without her, but that I can.  I know we will see each other again.  And in the meantime, it's time for me to go to work.  Like I said before... in the end, we all are who we are - no matter how much we may appear to have changed.  And yet...

    We have been taught and we have learned to do what we have to do, no matter the cost, no matter how much it hurts.  If there could be a snapshot of who we are today, it wouldn't be the picture of the four of us in the lobby at the airport.  It would be the three of us walking away.

EMT with a Syringe.

This post has been interrupted a lot tonight.  It's been one of those nights... people in the township keep finding the "9" and "1" buttons on the phone and putting them in that magical order.

I tend to be a black cloud when I work, attracting calls for all four corners; life-threats, bullshit and everything in between.  But recently in the last few weeks, I've gone shift for shift with next to nothing.  I'm not complaining, I just find the timing for the re-surfacing of the storm to be interesting.

I found out yesterday that the NCLEX gods conferred and deemed me worthy of placing the two letters "R" and "N" following my signature.  It was surprising, but no less exciting. However, it appears I will definitely be unable to avoid trading in my four wheels for the four walls of a hospital unit.  Or, more accurately, the 4 pods, intermediate unit, observation area, trauma bay and triage/waiting room of the Level 2 trauma center I've sold my soul to for $22 an hour and health insurance (which no one appreciates how much it sucks not to have until you don't).

It's not like I haven't thought about being on the other side of all this.  I imagine everyone does, even if they they never actually end up there.  Whether it's appreciating being relieved of 82 year old Spitting Sam and his unfortunate "Code Brown" situation or being disappointed you can't follow your 25 year old MVA trauma code resuscitation save to CT and beyond, it's pretty standard to wonder what it's like to be stuck with the patients you leave behind.

I wonder about the nurses too.  I have several friends who are, and I always enjoy interacting and working with them when I see them.  I enjoy it because they respect me, listen to my report and value my opinions and assessment.  What I don't enjoy is when nurses speak condescendingly to me before I even have a word out, talk over me to the patient instead of listening to my report, or call me an "Ambulance Driver."  I'm not allowed to drive.  I crash things.  I wonder about those nurses - the terminally crabby and bitter ones.  I mean, everyone has their days (I sure do) but come on, if you hate everyone who walks through the door already, what are you doing here?  But then I think, that could be me.  I hope that if it ever is, I know to find something else to do before I hurt someone physically or emotionally.  Before I miss something important because I'm too busy dismissing everything as "been there, seen that, everyone's wasting my time."

When I first started running as an EMT, I was so silly.  I didn't know the up end of a backboard or the leads from the BP cuff.  I was a disaster on calls and the absolute definition of "Whacker."  I had goals though.  Oh yes, and my main goal?  My main goal was to be that cool EMT who walks into the ER and knows everybody.  Who can walk around the ER like they own the place and make jokes with the Registration ladies, high five the nurses, suavely answer the doc's questions and trade stories with the cop on the way out.  It's silly and funny but you know what?  I guess I am.  I mean, that is how I am (more or less) when I drop off in the ER.  It's cute to look back on how I was and where I am, but that... that is not what I'm most proud of, not how I define who I am and what I've accomplished.  (Thank god, right?).

Who am I?  What have I accomplished, what have I learned?  Well... This is what I know.  Any idiot can learn when, where, and how to collar & board, give oral glucose, or hold pressure on a spurting wound.  Being an EMT is mostly common sense; it actually is pretty hard to screw up as long as you act in the best interest of the patient.  We can give hardly any medications, we don't start IVs, we don't secure advanced airways.  Being a nurse is a whole different ballgame.  There's a lot more too it.  But my knowledge hasn't changed.  I haven't added to my skills repertoire.  Yet, yesterday I was just an EMT and today I am a Registered Nurse.  I haven't changed.  The difference between my being an EMT and my being a nurse, right now, is literally being allowed to hold the syringe (hence the blog title).   That's it.  And that's scary.

But, I digress slightly (impending full circle circa 2 paragraphs).  The point was, the things I am most proud of and the things I believe define me have nothing to do with protocols and mechanics.  I just can't do the job "cold".  I can detach and "do what I have to do," but in the end, I'm the EMT that's going to hold your hand when you're scared.  I'm the EMT who will answer your questions honestly and accurately and will find you the answer when I don't know.  I am the EMT who will make sure you have a warmed blanket before my unit clears the ER.  I am the EMT who will wash the sticky blood and dirt off your face and hands when you're strapped to a backboard and we have extra time on the way to the trauma center.  I am the EMT who will lie on the rainy and wet highway next to your upside down car, holding your head in alignment through the window and talking about whatever keeps you calm and happy while the firefighters cut you out.  I am the EMT who remembers to take your medications with you to the hospital.  I'm the EMT who gives up my Saturday night out to hold your hair back while you drunkenly vomit and curse at me.  I am the EMT who makes sure your family in the waiting room knows where to find you, who stays with your wife after the ED code team takes over, and who makes sure your kids aren't in the room when we defibrillate you.

It makes no difference to me if you appreciate it or not, that is how I am going to do my job regardless because those things are what make me happy and the job worthwhile.  These are the things I have learned.  These are the things that make me good at what I do.

Today my station had a fatal MVC.  Guy went off his bike, hit two curbs and a hill.  He basically made his helmet a brain bucket... broke every bone in his body, went into traumatic arrest and was pronounced locally... didn't even make it to the trauma center.  My station is fairly busy (about 2500 ambulance calls a year), but things like this don't come along every day so I made sure to ask my buddy who rode it in if he was alright with what he saw, etc (read: do we need to go drink?).  He said absolutely, when it came to those calls he's "pretty cold."

I agreed.  At least while on the call, I find it easy to shut down and "do what I have to do", on autopilot if necessary.  I have learned how to not be a mess.  I have learned how to do what I do, and do it well, in any setting (rain, snow, angry dogs, 4AM, angry bystanders, even when treating someone I know).  I know I can translate that part of my job, that much that I've learned to the Four Walls setting.  It's the rest I'm not sure about.  It took me a long time to not be a mess and then to be more than just adequate, to how I am today.  I don't want to regress, so to speak.  I don't want any patients to receive anything less than stellar, compassionate, accurate care from me while I'm busy figuring it all out again.  I know it's inevitable and I have to try not to be so hard on myself, but these things are the things that mean the most to me, what I pride myself and my standards of care most on.  These are the things I make sure to pass on to those I teach.  The "little things" really are everything.  I don't know how to take them with me AND be an excellent care-giver in this new job, when I just don't know enough.  When I have other things I have to focus on and learn.  I don't know how to be the one who stays with you and holds your hand or watches over your wife and kids when I have 8 meds to look up and give, a foley to place, a shoulder dislocation to assist with re-setting, a patient to go to CT and 3 IVs to start.  I just don't know how, and I'm terrified.

All I know is what I know, you know?  And I don't feel like it's enough.  I literally feel like I'm going to be standing in the middle of a crowd of patients, doctors, experienced nurses and everybody else all looking at me and expecting me to act like and have the knowledge of a great nurse and I just feel like an EMT with a syringe.