Two Weeks

As I sit here and catch up on all the posts I've missed, attempt to fill everyone who may be reading this in as to how life has been since "The Call" as I've come to label it now, I realize its been two weeks tonight. The comments and phone calls of people checking up on me have dwindled down, again I'm left saying thank you, the support of my co-workers, classmates, and EMS professionals from other companies has been tremendous and makes me proud of what EMS as a profession is becoming. I sit here still battling this plague that they call the "Flu", still feeling like crap, but I have become victim of my night schedule, even though I haven't worked in days, I still sleep during the day and am often up all night, I think this is adding to my stress. I unfortunately don't seem to be feeling better quick enough, I now am facing the fact that although I mentally feel better my lungs do not agree. I'm getting short winded a lot today, and find myself violently coughing, and now coughing up well I won't even tell you what kind of mucous. I'm not sure I'll make it back to work tomorrow, sounds like another call to the doctor tomorrow.

I have talked with my friends and my girlfriend, and we've all come to an agreement that my stress level and my emotions have been on the rocks ever since I went to nights, I've worked days for 2 years now and I don't think my body and mind is adjusting very well to nights, I'm beginning to think this may have contributed to my inability to deal with "the call" very well. I find that I was happy to be sick, happy to avoid going to work and facing stress again, I find it hard to face stress right now, perhaps because I have so much, I know its part of the job, but I need to lessen the stress in my life, I've begun debating if I'll be successful precepting on nights, I've contemplated asking my supervisors to switch me to a preceptor on days. Nothing against my current preceptor, I have the utmost respect for him and think he is an outstanding Paramedic, I just think that working nights is adding undue stress to my life right now, and perhaps I'd succeed more rapidly precepting on days, sure it'll be slower and take longer but I'll be healthier and a little less stressed. I also have started to doubt if this is truly what I want to do with my life, sure I know I don't want to work commercial EMS forever, but do I want to be a Paramedic, to have the stress of having someones life in my hands, perhaps on a regular basis?? I faced this same decision 2 years ago, when I decided I didn't want to pursue becoming a Police Office anymore because of the politics, did I make the right decision? Or have I again faced an obstacle that put me in a hard place, and rather then overcome it I chose a different path? One thing is clear, I am miserable in Connecticut, I hate this weather, facing yet another snow storm, another cold night, miserable people who have all chosen to live here complaining and driving like complete morons, I'm sick of the pace of life, I want it to all slow down, I want to enjoy life everyday, I want warm weather, warm people. I guess its time I really need to set my foot down and chase my real dreams. My dreams of moving down south, being happy and successful. In order to chase these dreams though I need to decide where my life is going to lead my career wise, and first and foremost I owe it to myself to finish precepting, I can't just throw this away right now, not yet, not this soon. I need to figure out how I can get through this, many before me have, maybe they haven't face the same obstacles I have this past year, the death of my aunt who raised me, the death of one our medic instructors, my life falling out from under me, and then such a shitty call so soon into precepting. The one thing I do know, is that if I make it through this, I truly will honor the ones I've lost, and hold myself on a higher pedestal. I need to get through this......

Race Day!

Sunday was an exciting day, I was awoken by my girlfriend around 2pm, and I was eager to get out of bed, because yes folks ITS RACE DAY! I had never been a true NASCAR "fan" until the past few years, I dated a girl who's family was very into NASCAR, so into it that they watch every Sunday, and usually attend 2 races a year. Now I was never into it that much prior, I'd watch highlights to see a crash, or if I was home bored would flip it on to watch a lil bit of it. I was fortunate enough to attend my first NASCAR race with her family, all be it a boring race it was a race none the less. The experience of the entire weekend really opened my eyes up to the sport and yes I said SPORT. Camping out for the weekend, just having a good time, and then the thrill of the cars rushing past you, the sounds, the smells overwhelmed me and turned me into a fan. I've since only been to one other race, but I plan to attend and even work EMS at a few races this season. So with that tangent done, today is Race Day, the first of the season and perhaps one of the biggest races of the year the 50th running of the Daytona 500. We grab some wings from a local restaurant and sit down on the couch and fire up the race on HD, turns out the girlfriend is also a race fan, we enjoy a nice relaxing day watching the race and call it an early night. I wake up Monday morning, and just my luck I'm sick, I feel like I got hit by a mack truck, my body aches, my joints are stiff, my nose is congested and I just feel generally like crap. What follows is days of misery, each day worse then the previous. I call the doctors office, knowing what they'll say but just so I can get the note for work, sure enough the doctor talks to me and tells me I have the flu, tells me to rest up and take the next two nights off from work. So now 4 weeks into precepting, I've only actually precepted 5 nights, I am not off to a good start.

Back To Work

Saturday I wake up and I'm ready for it, ready to put back on my Paramedic Rocker and go back to work, I decide that I'll get in and just tell my Preceptor how I feel, that tonight I just need to have fun, a stress free night of just doing the job together, no grilling questions about protocols or anything just fun. I walk into work earlier then normal for my shift, my supervisor is delighted to see me back, gives me a pat on the back and again tells me he thinks I'm going to be a great Paramedic and again offers his support, and tells me he's glad to see me back. My preceptor walks in and asks how I'm doing, and I tell him the truth, I tell him not the greatest, I tell him how nervous I am and he agrees, tonight will be a fun night. I get in the back of the truck and start to check out my gear, it gets my nerves going, I never get through checking the gear with out getting thrown into a call, tonight is different, tonight my preceptor gets in the back of the truck and helps me go through the gear, I settle down, I get comfortable again, I'm going to make it through this. I go to grab more equipment for our truck, and I noticed my preceptor is rather eager and hurried to have me put it away in the truck, I open the side door and see a pie sitting on my ALS bag, I break out into laughter, victim of a good prank. See during CISD we were asked how we had all decided to deal with our stress, I commented that "I throw Pie" and went on to explain after an altercation with my g/f that I had tossed a pie out my front door and down the sidewalk in frustration, to only wake up the next morning and find it back on my front porch with a note that said "I think you dropped this" apparently my neighbor witnessed this incident and found the entire event funny, as did my coworkers when hearing about the story, thus tonight everyone will eat pie at my expense. We head out onto the road, its a slow night we run a few calls 1 ALS, 2 BLS drunks that were rather humorous in nature, my preceptor and his partner run the calls, I just help them out and get comfortable being back in the truck doing 911 calls. At 2am that morning we were given an ALS transfer, now these are particularly harder to come by at night, and needing at least 1 for my precepting period it came time for me to step up and take this one.

He's 22 years old, just trying to have a good time when he made a bad choice, this gentlemen decided to jump on a couch that was on fire, sounded like a fun cool guy thing to do. Unfortunately it earned him a trip to Bridgeport Burn Center w/ 2nd and 3rd Degree burns to 25% of his body. Its a routine trip, I calculate a drip rate based on the Parkland Formula for Burns quickly in my head based on the Pts weight and his total percent of burns, and it matches the MD's orders, I also receive verbal orders for Pain Control for my Patient during transport, basically this kid has been given 23mg of Morphine thus far, 100mg of Fentanyl, and I now have additional orders for only 4mg every 30 minutes as needed, my standing orders by Protocol are better then that order, but I'm not the doc here so I abide and write down her orders. We get our Patient as comfortable as we can manage, this kid has burns to his arms and his back, its going to be a long trip for him. We set off for Bridgeport and immediately have to give him an initial dose of Morphine, we get him as comfortable as we can, and we talked the whole ride down, we keep his pain at a minimum with the first dose and get him to Bridgeport. We bring him upstairs and transfer him to their staff, we clean up our stretcher, and as we get ready to leave something catches my eye. A guy is sitting up in one of the rooms, 60% of his body is covered with sterile dressing including his face, he's looking out at us as we pass by, I look into his eyes and see the pain and agony in his eyes, I get the goose bumps as I walk by, I think to myself that what I am going through in my life is petty compared the pain and tragedy felt by others.

Getting Back To Precepting

Friday night was suppose to be my first night back precepting at work. I'm so nervous again I can't sleep. I can't figure out why I'm so nervous, I know what to expect, I've been there, I've done it for 4 nights now and quite frankly it can't get any worse then it did already. The hours inch closer and closer, and now its the time I should be getting myself in the shower to get ready, but I can't, I can't physically move, I'm panicky and find myself on the verge of having an anxiety attack. I think to myself that I'm losing it, I need to get a hold of myself, this isn't who I am. I call one of my supervisors personal cells, he's been very supportive with everything thats been going on, and a person who I know is a phone call away, he gets my the number to our EAP, tells me to call the ASAP and get back to him and let him know what happens. Well after getting the initial run around with EAP they set me up with a counselor in the area, shes contacts me by phone and we have a 15 minute conversation, she reassures me that what I'm going through is normal following a stressful incident, its my bodies way of telling me I might not be ready to face stress again, she suggests taking the night off and just relaxing, focusing myself and mentally preparing myself to go back to work. She says shes out of the office and she'll get back to me tomorrow with an appointment to come in and talk to her. I call out that night, part of my responsibilities of a preceptee is I'm suppose to call and let me preceptor know I won't be in, but I'm too embarrassed too, I just call my supervisor and tell him and leave it at that for now. Later that night I get a text message from my preceptor asking how I'm doing, and again offers his support telling me to call him anytime, anytime I need it he's willing to go grab a drink, I appreciate his support I really do, but this is something I need to do on my own...

Emotions Run Wild

Thursday as most of you know was Valentines Day, a traditional all be it "Hallmark" holiday in my opinion in which you'd spend with a significant other. I was suppose to work this night however I had previously taken the night off to spend with my girlfriend. We were suppose to go to a local bar to see a band she liked with a bunch of her friends. I had plans to be up relatively early and try to get a lot accomplished today. Normally I can pick my paycheck up and if I'm in a pinch I can get to the bank before they close at 5pm, see at 4pm they switch over to the next days date and will usually cash your check a day early for you because it won't post until the next day anyways. I can't make it to my branch by 5pm so I go to another local branch and hope they'll be understanding and help me out with cashing my check, I mean it is after all Valentines Day right? WRONG! The guy behind the counter had no consideration to my plight what so ever and said that if the folks cashing my checks at the other branch ever got caught by their corporate office they'd be fired.. This gentlemen by no means was what so ever pleasant with me, I think he was having quit the bad day himself, none the less it put me quit the rotten mood. Here I am now on Valentines Day with plans to go out with pocket change, sure I have money I'm not broke by all means, but no where enough to make it as special of a night as I wanted to make it for my girlfriend. I talk to her on the phone and low and behold shes not exactly in the greatest mood either, to make things short a lot of miscommunication unfolds and I am stuck sitting at home. She went out with the girls and had a good time, and after a little drama was sorted out and a few friends taken care of she came over late that night and we were able to reconcile things, however its just more and more instances since last week that I find myself more and more irritable over nonsense stupid things that I shouldn't let bother me, that normally probably wouldn't bother me but now do.

BLS Shift

I signed up Wednesday to work at BLS shift 2pm-2am, it will be my first shift back to work. I get dressed semi excited to get back to work, back in the truck, back to doing what I used to love, back to doing calls. I open my front door to find a miserable world waiting, its cold and wet, theres 4 inches of snow on the ground and monsoon rains dumping more and more water then the ground can handle, its going to be a crummy day to work EMS. I head off to work trying to keep my usual routine, I stop for a cup of coffee and drive into the city. I walk into the office and start my routine, I get my paperwork, my keys, my radio, keys, AED and head to the truck, check my truck out, and we head out onto the streets, we run nothing but transfers all night long, and for once I'm actually content doing transfer after transfer. It felt good to be back on the truck, in the back with patients, routine relatively healthy patients just going to a SNF for rehabilitation or home from Dialysis, I deal with no death today and I feel that perhaps I can move past this all and get back on with my life.

Rough Week

I find myself more irritable now, I know some of you who know me may laugh and say now? But yes, I'm edgier, I don't find the same humor I use to in certain situations anymore, life seems more serious now then it has to me the past few years, especially since I got involved in EMS. The week following this call has been rough, looking forward to getting back to work yet at the same time fearing it. Why am I fearing work? I ask myself this over and over again, its the same thing I've been doing for 2 years now for this company, but all of a sudden its different, I feel like the stress level is through the rough now, compile that with the added stress I already have in my life and I feel like I'm ready to implode. Monday I found myself facing some hefty news in my personal health, stuff I already knew, my back is all torqued up and needs a lot of chiropractic work, work that will go over what will my insurance will pay, but is vitally important if I want to stay in the career field, I need to have my wisdom teeth out, and soon as I run the risk of infection in one them giving me problems. To my amazement Dental Insurance covers all of 50% of the cost and only up to 1,000 for the year, this won't even come close to covering some of the work I need, my head spins as I go over the numbers, wondering how I will afford all of this medical work I need and my day to day bills and debts, the stress and tension mounts.

CISD

Once again I've fallen behind in this whole "blogging" thing and I find myself left apologizing, my life has sort of become "scattered" sort to say the past 2 weeks or so, so please bear with me. Following my first Pedi Code the amount of support I have gotten from my co-workers and fellow EMS professionals, specifically seasoned medics who have been in my shoes has been incredible. I am glad to see that we are becoming an organization much like Fire and Police Departments that look out for each other across company lines. I decided to take the following two nights off from work and attempt to clear my head, spend time with friends and just reflect on why I got into this job and answer some questions on my own. I decided I'd go out Friday night and have a few drinks, bad idea, come midnight I realized I was the "downer" of the party, the guy who just sat there, staring into his beer. Everyone pretty much knew what had happened, or heard briefly about it, they knew why I was acting they way I was, but no one could understand. I felt separated, and then I started thinking that here I was out drinking trying to have a good time while a poor grieving mother was at home trying to plan the funeral for her child, and I started to feel awful. Not only was I feeling awful that i was out, but why after this many years was I suddenly feeling connected, when so many times I could just walk away from a tragedy and find a means of escape, a laugh about something funny I noticed on scene or something else, yet this call has thrown me in a world of hurt, why is that kid calls get to us?

That Sunday the company arranged a Critical Incident Stress Debriefing (CISD) session for me and my co-workers that worked the call. It was the first time I had seen both of them since that night at work. I won't get into total details of the CISD session so I can maintain some sense of confidence for my co-workers and partners but I will say I wasn't overly impressed. We talked about the events of the call and how they made us feel, how we reacted. We discussed how true professionals we were, and my co-workers lifted my spirits multiple times, saying how impressed they were with the way I handled myself on this call, A brand new Paramedic day 4 of precepting with a dead child thrown in my arms, my ability to overcome the fear and tackle the challenge to them showed my true abilities, I however still have doubts in this. Sure it felt great to hear them say this, it was nice to sit there with them again to be reconnected but it was same message over and over again, it was "Your going to not feel right, and its okay". We weren't really given guidance on how to deal with our lives and move on, which is what i was really hoping for because honestly at that point I wasn't sure what was going to happen. We ended our CISD session and the 3 of us decided to go grab some lunch and of course a drink at TGIFridays down the street. It was great to just sit down with my preceptor and his partner outside of work, in normal clothes in a casual setting and just talk and have a good time. Of course we talked about how we've been doing, how we've been dealing with the call on our own. We talked about going back to work, what we each were looking forward to and not looking forward to. At the end of lunch my preceptor told me to let him know when I'm ready, meaning if I'm not ready to start precepting right away to let him know, and we'll just run calls together the first night back which honestly made me relieved a little stress lifted off my shoulders for my first night back.

The Aftermath

I sat in the EMS Room, attempting to collect my thoughts, numb at the world, lost in what had just happened so quickly, I second guess my math and my drug calculations and check them over and over again to only come up with the same numbers. I face the onslaught of questions from everyone who passes "What happened?" "Are you okay" "Did you get the tube" the typical questions that everyone in EMS asks, but today they're different, they sting. I can't concentrate anymore and I retreat with my preceptor to a quiet family room to attempt to finish my PCR. This lasts for a few minutes until they're bring grieving mom back to a room, and all I hear are the heart breaking screams of a mother who just lost her son. I'm heartbroken but angry at the same time, theres suspicions of abuse here, how can I be sympathetic towards her if this could have been a case of neglect and abuse, I walk way again looking for a quiet spot but find none. I finish up my paperwork and look up to see the Assistant Director of Trauma standing at the doorway, he talks of the fine job we did, asks if we're all okay, and tells us to come talk to him at the end our shift. "You guys did a great job, fantastic IO" he says, but how fantastic was it? The child still died, did we do that great of a job? This isn't the outcome we wanted. We go through the onslaught of questions from Hartford PD, we're asked to give a statement and then told we don't need to, I won't get into that frustration, since thats been resolved.

We attempt to go back on the road 4 1/2 hours later, return to a state or normal operations, we try to laugh and pig out and forget about what happened, but deep down all 3 of us are facing our own enemies. Every time I open the back doors I'm instantly sent back to seeing this child in my arms, I sit in the back of the truck staring down at the stretcher, and I see him lying there. I try to fight back the tears and go on with my shift, we do 2 more routine ALS calls, luckily nothing taxing and our shift starts to wind down. We meet with the Assistant Director of Trauma that morning, in fact we wake him up, but he doesn't mind, he offers us Coffee and sits us down in his office. We talk about the call and our feelings, the need to be open with people, and the need to get help to move on with our lives. He talks about how fine of a job we did, and we talk amongst each other how smooth the call went, it couldn't have gone better, amazing scene time, amazing intervention times, total time the Pt was in our care was only 14 minutes. He calls us professionals and tells us to take pride in what we do and how we faced this call, he says he has no doubt in his mind we are amazing providers and if he fell victim to illness would want to look up and see us looking down on him, doing our best. We leave the hospital and head into the office, we meet with one of our supervisors who does a quick Critical Incident Stress Defusing session with us, step one in the Critical Incident Stress Management process, he offers us the night off and I take it.. .

I go home, and immediately crack open a beer, sure its 7am but to me its late, I sit down on the couch and talk to my girlfiend who came over to sit with me that morning before she went to work, I talk about the call the best I can, I then crawl into bed, and out of pure exhaustion I fall asleep for hours...

The most dreaded call

On my way to work tonight, it hits me somewhere on the highway. I start thinking about all the stress I'm going through Precepting, the downfalls I've had so far, and I start wondering am I made out for this job?? Do I really want to be a Paramedic, do I really want that responsibility in my hands, how will I react when I have a critical patient in my hands where everyone is looking at me to call the shots. I start to panic and call my girlfriend, she attempts to calm me and reassures me that I'll be just fine, I hope shes right I say to myself as I pull into the parking lot. I punch in and head to my truck to begin checking out my ALS gear. I hear the radio come to life, dispatch is sending a BLS truck to a call in the city, its for a Pediatric Seizure possibly not breathing, I roll my eyes and say under my breath "yeah right, another febrile seizure" but I know what to expect next, I hear my preceptor key up the radio form the other side of the ambulance bay "216 we're sliding on that". The dispatcher responds and tells us that we'll be primary on the call, and she'll cancel the BLS truck, we're a crew of 3 we should be able to handle a pediatric seizure.

As we race across the city, still 4 minutes out from the call we get the update from Hartford Fire Dept, Pediatric Cardiac Arrest, my heart sinks into my stomach as I feel the ambulance accelerate even faster, driven harder, I look forward to see all 3 of us have the same fear in our eyes, its the most dreaded call in EMS, the Pedi Code. We come to a stop on the street outside the house, my preceptor yells out "They're coming to us" I go to open the back door thinking I can get out and give them a hand, instead as soon as the door opens I am faced with a Hartford Fire Fighter literally throwing this child into my arms. I sit on the bench seat looking down for what felt like minutes, staring into the open eyes of a small 2 year old child's eyes, my worst fears are meet, this child is gone. As I go to place the child down on the stretcher I see his tongue looks swollen, he has frothy bloody sputum, the kind you see from an elderly Pt taking their last breaths as they cling to life battling Heart Failure, but why is this coming from the mouth and nose of a 2 year old? I immediately recognize this will be a difficult intubation and make that known to my preceptor as I place the child down on the stretcher with his head and airway closest to him. I wrap my hands around him and start doing compressions until our partner places him on the monitor with the pads and takes over, I look at the monitor and see only a flat line, this poor guy has nothing, Asystole. I grab the IO Kit and get it set up, after reassuring myself of the proper placement I sink the needle into his leg and in 2 seconds I'm in, I'm amazed at how easy and quick it was, I have fluid running within seconds. I'm handed the Epi, I assure its the right concentration I do the math in my head quickly and push the Epi. I watch my preceptor struggle with the airway, I watch copious amounts of this bloody frothy sputum poor out and I help suction it away. There is no chance of getting an airway, his jaw is clenched, he's Trismus. We start transporting to the local children's hospital, before we move a few feet we notice bruising around his eyes, we question if this child has been abused, and now believe maybe this is a traumatic injury, C-Spine precautions are taken and we change our destination to the local Trauma Center. We arrive to have the doors opened by the charge nurse, attempting to give us a hand, a Paramedic I know from another service jumps in to help us, we bring the child into the Pediatric Trauma Room and let the team take over, attempting to give him a chance. I stand in the side of the room and watch the effort they put into giving life back to this little boy, they bring mom in and I was the Assistant Director of Trauma hold her in his arms and let her know they're doing everything, I have to leave the room. Minutes later everyone faces the fact, there is nothing more anyone can do for this child, he is pronounced dead.

Week 2

After learning my downfalls during my first day and a 1/2 I realize I need to do more studying, I need to brush up on a few things, and I need to work on my confidence level. My preceptor asks me questions and I find myself answering his questions with another question because I lack the confidence in my answer. This I find to be object number 1, I will be more confident. If I truly don't know the answer I will fess up, if I know the answer I will say it confidently and If I am wrong I will face it and change it! I walked into work early Wed with the goal of being more confident, we go through night and do a few routine ALS calls, nothing extraordinary, however I feel more comfortable, I am able to let loose with my preceptor and partner to an extent to where we can have fun, but while still taking on the task of serious learning. The night turns out a few ALS calls, the most nerve wracking was the response to a Pediatric Seizure, everyone hates Pediatric calls, luckily tonight I walk into the house to find a small child awake in moms arms, acting appropriately, routine ALS to CCMC, a laid back report to the RN, He's had a febrile seizure, simple enough right, at least thats what we all though tonight. We jump a call at the end of the night before the end of our shift in Wethersfield, a good Altered Mental Status call where it wasn't until our arrival at the hospital in which we noticed our Pt was incontinent that the pieces finally fell together, definitely a good call that made me chase down so many differential diagnoses. Time to go home for some rest, I left work feeling more comfortable and confident.

The Dreaded GI Bug!

Day two was off to a horrible start, the entire ride to work I was fighting off the urge to vomit, tonight was going to be a long night! I punched in and proceeded to check out my ALS Gear, once again in the middle being sent online right away and down to cover the southern most town in our coverage area. We attempt to jump an elderly male who fell and now has an Altered Mental Status, the BLS crew is calling for a medic. We are denied and told dispatch needs us for coverage and that the supervisor will intercept in the fly car with the BLS truck. Moments later we're sent into Hartford to back up a BLS crew on an unresponsive. We arrive on scene a few minutes after the BLS crew, as I exit the ambulance I see one of the EMTs come outside "Daisy what do you need?" I yell out, she responds "Everything, shes out good". I walk in to find a white female being pulled out of a chair and laid to the ground, I notice shes cyanotic with no respiratory drive of her own, "Bag her" I tell my preceptor as I toss a BVM his way, he nods and advises me that her pupils are pinpoint. A glance around the room reveals paraphernalia in the area matching my diagnoses "Heroin Overdose". I ask the EMT-I on my crew to attempt a line while I draw up some Narcan to reverse the deadly overdose my Pt is experiencing. No good my EMT-I says as she can't get a line, I quickly place a Nasal Atomizer on the end of my syringe, with our new protocols we can now give Narcan via an atomizer that dispenses the Narcan into the Pt's nasal cavities, however I noticed something is wrong, I have way to much fluid drawn up to administer, I start to get flustered as I try to figure it out. It's right about this time that it hits me, I need to vomit, and my bodies not going to take no for an answer. My preceptor quickly points out to me that my concentration is wrong, and rethink it, focusing more on attempting to hold back my bodies desire to vomit, he quickly tells me to grab the Bristojet of Narcan, to use that concentration. I quickly swap to the bristojet and administer 2mg, 1mg to each nare. She slowly wakes up, we carry her out to the ambulance, and transport her to the local facility. The 2mg barely touches her, it arouses her enough to help maintain her airway, however she still needs to be manually ventilated the entire trip in. On arrival to the hospital I find myself giving my first report in Red Pod as a Paramedic, I soon leave the room, bound for the bathroom. I have fallen victim to the GI bug that seems to be going around my company like wild fire, I do 3 more calls 2 of which were ALS fighting back my bodies desire to vomit, I finally throw in the towel just before Midnight, and head home to crawl into bed.

The First Day

First and foremost I apologize I have fallen behind with this Blog, and I'm sitting down now attempting to play catch up. It has been two weeks now that I have been assigned to my precepting shift, the end of the week overnights. I had to make a few significant lifestyle changes in an effort to adapt to this schedule, and I'm still making changes in an attempt to "adapt". The days leading up to January 31st, I spent all of my spare time, attempting to know my protocols cold, to master all of my drugs to the best of my ability, preparing myself for the onslaught of questions and challenges ahead. I attempted to get as much sleep as I could the hours before my shift, but I found it extremely difficult, my nerves just wouldn't cooperate and I also wasn't feeling the greatest health wise, i felt as if I was on the verge of coming down with something, or perhaps this too was just nerves and would pass. I woke up and put my uniform on, putting as much detail as possible into looking professional, shined my boots up, shaved, and actually did my hair, no hat the first day of precepting I told myself. As I drove to work I couldn't help but be nervous and frightened about what lied ahead, what the city would bring me my first weekend on the overnights as a precepting paramedic. I punched in and went down to our "fishbowl" conference room to meet with my preceptor and Education Dept Supervisor who would also be my supervisor on this shift. I was handed my preceptee manual and quickly told what was expected of me and of course the usual "good luck welcome to precepting" handshake and I was off to check out my gear for the first time. As I sat in the back of the ambulance nervously checking out my ALS gear for the first time, attempting to be both punctual and accurate, I was quickly interrupted half way through. My preceptor had heard a call go out for a unresponsive on the side of the road and he wanted it, signing on the air "220 we'll take that call".

Arriving on scene I found HFD and bystanders w/ an appx 40-50 year old male lying face down on the side walk, with a bottle of vodka next to him, his presentation screamed ETOH, however I must think my way through this as a Paramedic, now this is called Altered Mental Status. As I got closer, my Pt was snoring, either he's in a deep sleep, or he's so inebriated he's compromised his airway! He fails to respond to my voice or my attempt to arouse him via a painful squeeze of the earlobe, on to the stretcher he goes. Sitting him up in the stretcher manages to open his airway and rid the snoring, he's slightly awake now however still very much so oblivious to the world. I start my ALS work up, putting the Pt on the monitor obtaining my vital signs, everything fits in place, and then I find his BGL to be 68, manageable enough, a quick IV and a lil Dextrose can fix this. This proved to be harder then I thought as my nerves quickly played a role, I attempt my first IV and he pulls his arm away, as hard as I struggle to hold onto his arm, it blows. My second attempt again with a struggle blows. My preceptor manages to go right above my failed attempt in the Pt's arm and lands me a solid line, in goes the Dextrose, up he comes swinging!! We transport him to our closest facility and sure enough, another busy day has filled the usual area for our local ETOH's and Pysch's, they ship us to the hallway! I give report to the RN who looks at me amazed that I actually put that much effort into giving an ETOH Dextrose "Your precepting aren't ya" she jokingly says and she takes the rest of my information. I later come back to drop of my PCR and find her fighting with my now fully awake but highly confused and agitated Pt who's attempting to the eat the gauze I bandaged my failed IV's with. The night went on, w/ another highly amusing ETOH who had the majority of the staff at our local ED triage area grabbing their stomachs laughing with his antics, followed by a few routine ALS calls nothing exciting for night one, but we are after all just getting started.