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.