Pink Warm and Dry

Honesty.

In the interest of complete honesty and accountability…

(Eeek!)

I failed a test.  Not only did a fail a test, but I did it in spectacular fashion, and it was on the one subject I pride myself on.

Cardiac.

I’m cringing as I type that.

To those people who have given so freely from their pockets so that some poor chick from Ohio could go to achieve a dream… And to those people who have listened to me freak out either through email, or IM’s or on the phone…

Jesus, I let ya down.

Know this.  It wont happen again.

Life happened and I slacked off.  That fact in combination with an instructor who knows how to put a test together spelled disaster for me.  I knew it was coming.  And I’m unbelievably embarrassed by that.

The retest is on Thursday and I have been and will be studying until I sit down and start circling letters.

And you will never see another post like this again.

This week on the farm…

My apologies to the two people still reading

This week…

My car, “Dirty Old Bastard” died.  Had to get a new one.  Or at least get roped into a new 5 year loan.  My luck with vehicles, unfortunately, is horrible.  It’s not a good thing when you can’t afford to buy a clunker, but you can manage a new car.  The car note didn’t go up too much.

My boy’s soccer team won two games.  (That’s him in the black sweats with the red stripe.)  The team really needed a win, it couldn’t have come at a better time.

The dog (who is still very much alive contrary to what my friends believe) continued to chew on one of my crocs.  Why does he like the left shoe, but not the right.  (And no more hate mail about how ugly Crocs are.  They’re COMFORTABLE, Kyle.  Sometimes a girl needs COMFORTABLE SHOES!)  But look at that face!  How could I be angry at him???

And finally, I switched schools.

I am no longer a part of the class I started with two months ago.  While I was unbelievably attached to everyone at the program, for reasons I can’t really go in to I’ve had to transfer into another class at another facility.

So the bad news is I’m losing the twice a week contact with 12 of the most fantastic Basics and Intermediates ever to practice in NW Ohio.

The good news is that my new instructor is one of the best in the not just the state, but the country.

So… I’m a little heartbroken, but I’m extremely excited to be a student of this particular teacher.

**********

So while I’m off to study like a mad woman, tell me… How was your week?

School :)

Is going really well, for the most part.  The challenges that I’m running in to I’m overcoming with help from my people.  It’s occupying a huge amount of my time, I will say that.  I seem to be living in my school uniform lately.

This is what we’re currently doing in lab:

Yeep.  That’s me wielding a mean laryngoscope.  Sumdood needs a tube

New post up tonight.  Promise.  Promise promise.

Pass!

After countless hours of reading, and rereading, and rerereading one of the most stimulating chapters ever written for a Paramedic text book, I’m happy to report that I passed the test.

*Does a little happy dance*

Goodbye, Pathophysiology.  While I understand how important you are, you will not be missed.

To my fellow medic students…

Well, one in particular.  They know who they are.  They’re the one with a spouse and kids and a full time job.  They’re the one who’s stressed to the point where they want to scream, kick puppy dogs, and strangle the next person who tells them that “It’s going to be okay,” and that they”ll “get through it”, and that “the end result is all worth it”.

You’re stretched kinda thin right now.  And you know it.

And, unfortunately…. The worst is yet to come.

Wait until you start clinicals.
Wait until you start cardiac.
The endocrine system is a total BITCH!
Wait until you’re reciting information on drugs until your head spins.  While in the grocery store.
Wait until you are so burned out from school that you truly believe that learning one more bit of information is going to push out something that you truly need to know. Like your address or phone number or the names of your kids.

It’s going to happen.

You’ll be at this point several times over the next several months. I know. I’ve been there before, and I’m there now. Juggling it all is difficult, but it’s not beyond our reach. We can do it. WE CAN DO IT! (I’m doing my best Waterboy imitation now, email me if you don’t get it)

You need to keep it together. We all do.  And the horror stories are not going to help, but you’re going to hear them.  So take them in stride and move on. The important part is that you KEEP MOVING FORWARD.  Keep reading.  Keep reciting.  Keep going. And you know what, it IS worth it.  So FIGHT!

Yes, it’s going to get worse, and I’m sorry to be the one to say this to you, particularly since I was the one who begged you to go to Basic school…  But I saw that potential in you… Like someone saw in me.  And that’s where I’m coming from.  Look how far you’ve come from just a year ago!  You’re working for one of the best services in the country!  It might not be doing what you want to do, but it’s a foot in the door.  You know that.

Please… Try to not get so discouraged.  You can do this.  You really can.

As a friend of mine would say, “You GOT this.”  And the truth is, you do.  You KNOW it.

You got this. You do.

And so do I.

From Completely Confident to An..Annn…Anxious pt. II

Here’s the first post in the series… this is the conclusion.  I realize that this isn’t the most interesting post I’ve put up, but it’s one that I’m extremely proud of for some reason.

For those of you medical types who are reading and who have been through (or even teach) ACLS, I realize that it’s been dumbed down (for lack of a better way to put it) and that it was considerably harder to pass for a lot of you.  Others walked through it with their eyes closed.  For my class it had been built up to be one of the most stressful nights of the year.

We sat in the hallway, staring blankly at our notes.  The brown and tan berber carpeting (seemingly laid directly on top of concrete) offered no comfort to our sore backsides.  Any irritation we were feeling at that point would soon be replaced by the pain of the mental spanking we were sure to get from our I/C’s.  The Mega Code was minutes away.

We were quickly joined in the quiet hallway by three or four others, equally as nervous.  Liza, the only other female in the class looked pale.

“How’d you do,” I asked her.

She shook her head.  “What the hell was up with the procainamide questions?  I mean… Procainamide?  Really???  What VW class is it?”

“1a” three of us replied simultaneously.

“Shit.” She slumped down against the wall across from me.  “I knew that.”

“Did Mikey finish yet?” I had to know.  Mikey had spent the first half of the course on my heels in the classroom standings.  He was also dating Liza.

“He’s in the bathroom.” Liza sighed.  “He wasn’t feeling well.”

The door to the skills lab opened up and I/C #2 popped his head out.  “Jeff and Epi, let’s go.”

Jeff helped me get to my feet while our classmates wished us luck.  We passed the two who had just finished testing.  They didn’t look very pleased with their performances.

**********

I/C #2 sat at a desk a few feet away.  Our patient, an adult sized manikin was sitting on a stretcher.  A quick visual survey revealed a LP-12, an orange drug box, collars, IV supplies, oxygen tanks with tubing, you name it we had it.  Most of the contents of an ambulance was in that room.  Unfortunately it wasn’t organized in any way and I was instantly worried that we were going to be wasting time looking for things.

“Are we able to take a few minutes to put things together?  This room is a mess.” I didn’t know if we had what we needed.  Or if we even drugs in the drug box.  Knowing I/C #2,  it was probably empty.

Our I/C nodded.  “Go ahead.  Let me know if you need anything.” His nose was buried in that month’s edition of Fire Chief Magazine.

We had everything we needed.  Except for vasopressin and epi.  A small oversight, I’m sure.  Our I/C immediately opened a drawer to his desk and produced several boxes.  He tossed them to Jeff.

Score one, Team Epi.

When the room was finally set up with some sort of order, we were ready to go.

I was already sweating. My poor partner Jeff wasn’t much better off.

My extremely intimidating (up until this point) I/C shuffled some papers and wrote a note on one of them.  He looked me in the eye and started,  “Epi, you’re up.  Do what you can do with that arm… I don’t want you hurting yourself any more than you already are.   Are you ready?”

I nodded.

I/C:  You are toned out for a 48 year old female c/o SOB and lightheadedness. Family states that they were out shopping when Mom started to feel dizzy, they got her home immediately and now she’s having some difficulty breathing”

Easy enough, yeah?

I struggled with the latex free gloves, putting gloves on with one bad arm isn’t as easy as you would think.  Add in the fact that my hands were a little…er… sweaty (Hey, I was nervous!) and it’s impossible.  Once they are on I start.  “I have my BSI on, is my scene safe?”

I/C:  “It is.”

Epi:  “Do I have all of my resources with me? ” My I/C nods and tells me that I do.

“What kind of help do I have?” It’d be nice if he would tell me that there’s a cardiologist willing to travel with the patient in the room.  Yeah.  Like that’s going to happen.

I/C:  Paramedic Partner, four first responders.

“Ma’am, my name is Epi, I’m a paramedic, can you tell me what’s going on tonight?”  I look to the I/C for his (er, her?) response.

He responds in a not-so-forced effeminate voice, “Well, I was out shopping for a new handbag, (he pauses to breathe) and I just got this (pauses to breathe) jittery feeling. (forced exhale)”

I talk to our patient, “Okay Ma’am, we’re going to take good care of you.   How about I put some oxygen on you, I think it might help you feel a little better.”  I turn from the manikin to my I/C and say, “I’m going to put her on 15L by NRB.”

He nods and makes a check on a sheet of paper.  I hook up the O2 and put it on our patient.

“There you go,” I start.  “Have you ever had something like this happen before?  Do you have any history of or do you see a doctor for any medical problems?”  I find myself already caring about our lifeless manikin.  “Just breathe that oxygen in.”  I turn again to our I/C.  “I’m going to take her radial pulse.  Do I have one?”

Our I/C rolls his eyes.  “Yes, you have a radial pulse, the patient has a history of controlled IDDM.”

I roll my eyes right back at him.  “Can I have the rate?”

“It’s too fast to count.  Over 160.”

Back to the patient, “Ma’am, do you have any allergies?”

“No allergies” The I/C responds.

“Ma’am, your heart is beating a little too fast, which is why you probably feel the way you do.  I can correct this, but there are a few things I have to do.  I have to start an IV and put these pads on you that will take a picture of your heart.  Would that be okay?”  I look to the I/C for our patient’s response.  I/C nods in the affirmative and tells me to “do what I have to do.”

“I’m going to have my partner start an IV and hang a bag of saline…”  And then I drew my first blank of the night.

What’s next?  Why is my instructor rolling his eyes again?  Why am I flipping out?  I know this!  Why did I bother with explaining everything?  It’s an effing manikin for crying out loud.  Shit shit shit shit shit.  This room is the temperature of the sixth level of Hell.  Okay, Epi… Let’s get back on track.  Airway is clear, the patient is breathing, the patient’s pulse is sky high, but she’s stable so far.  No allergies (thank GOD), what’s next?…  Monitor?

“I’m going to have a first responder get a baseline set of vitals, BP, pulse ox, while I get her on the monitor.”

My I/C nods.

I fumble with the packaging to the electrodes.  It’s already open, but my fingers can’t quite get to them.  I hand the package to Jeff and ask him under my breath to fish them out while I take my sling off.  I can’t work with it on.  Jeff hands me the stickers, one by one, and I put them in their proper place on our patient.

“IV’s in.  18 in the left AC”  Jeff is proud of his taping job, I can tell.  It consists of four or five wraps around the arm with two inch tape.  That IV’s not going anywhere.

I work to untangle the leads and manage to finally get everything connected.  I turn on the monitor and am rewarded with a nice clean SVT in lead II.  “I see SVT on the monitor, my leads are all good, correct?”

I/C:  Yes, your leads are good.

I can see her rate is at 170-ish.  “What are her vitals?”

I/C shuffled a few papers and reads them off.  “BP is 110/78, respiratory rate is 22, pulse ox is 92.”

“Ma’am, we’re going to hook up just a few more wires here to get a better picture of what your heart is doing.  Are you doing okay still?”

I/C responds, “I’m *takes a breath* doing okay.  *takes a breath* Go ahead.”

I attach the 12 lead patches and hook the leads up in record time.  An accomplishment for the one-armed medic student.  I print the 12-lead and decide to go with adenosine.  What kind of person has a favorite cardiac drug?  A geek.  This geek.

“Ma’am, I’m going to give you a little medicine through your IV… It’s going to help slow your heart rate down…. Uhm…  You might feel a little discomfort.” I turn back to the I/C.  I’m going to give adenosine, 6mg rapid ivp with a 10cc flush.  First I’m going to check the drug for the six rights, right patient, right route, right drug, right time, right documentation, right… right… Dammit.”

I/C:  Excuse me?

I was wracking my brain for the sixth right… “Uhm, Right dosage?”

I/C:  Are you asking?

I wiped the beads of sweat from my forehead.  “No, Sir.”  I can feel my heart beating in my chest and wonder if maybe I might need a little adenosine myself.  “It’s right dosage.”

I/C:  Okay, continue.

Another check in my favor.

“I’m going to push the adenosine fast and follow it with the flush.  I’m watching for conversion from the SVT.”  I know it’s not going to be that easy.  I hold my breath and wait to see what button on the simulator my I/C is going to press.

The rate drops from 170-ish to 120-ish for a brief few seconds… It skyrockets back up to 220-ish and holds.  I curse under my breath.  “Okay, we’re going to try a second dose at 12mg.  Again, confirming my six rights.”   I push the second dose, flush it, and watch and wait.

Asystole.  We have a winner.

I hold my breath and wait for something close to NSR to march across the LP screen.  Thirty seconds later we’re still in asystole.

Fantastic.  I killed her.  With my favorite cardiac drug.  Effing wonderful.

“Okay, we’re in asystole.  Are my leads still good?” I/C nods.  And yawns.

“We’re going to…”  I couldn’t make up my mind… Pacing or CPR…  Pacing or CPR… “I’m going to start compress–”

A bleep marches across the screen… then another.  Then another.  “Okay, I’m not going to start compressions…” I reach down to check the patients radial pulse again.  “Do I have a radial pulse that matches the rate of … 43.  Or so???”

I/C nods.

“Is my patient conscious?”

I/C channels his best female patient voice yet again.  “Don’t you ever do that again, that hurt like hell!”

“I’m sorry ma’am.  How are you feeling?”

I/C:  “I’m a little bit dizzy… and my chest hurts something awful.”

I’m staring at the screen again… I can’t quite figure out what the rhythm is.  I have p waves, I have QRS’s.  They’re not matching up.  Could be 3rd degree HB.  Could be Wenckebach.  QRS to QRS almost line up, and the p waves almost line up.  Almost but not quite.  Because our patient has chest pain (I realize she just had two hits of adenosine) and everything isn’t lining up exactly I have to go with 3rd degree HB.

“I’m going to have my first responders repeat a set of vitals, please?”

I/C nods.  “You have respiratory rate at 20, BP is 92/62, pulse rate is 40.”

I decided to pace.

**********

In the end, my patient died.

She pulled through the SVT, and the 3rd degree HB, but went downhill quick with the bigeminal PVC’s, the STEMI, and the whole Asystole debacle.

I gave drugs, I paced, I shocked, I intubated,  I did CPR, I gave more drugs, I did more CPR, I gave more drugs, I did more CPR. I gave more drugs, I did more CPR, I gave more drugs.

In the end it didn’t matter.  It didn’t make any difference.  My patient was dead and I was a sweaty mess with an aching fractured recently reduced shoulder that begged for narcotics.

Who knew that doing what you were supposed to do, and doing it correctly, could be so painful.  (Okay, I’m sure a number of you just raised your hand.  You know what I meant.)

The patient died, and I still passed.  Funny how that works out.

From Completely Confident to An..Annn…Anxious

I have always been an excellent test taker.

In grade school we had to take state issued standardized tests.  I routinely scored three years ahead of the grade I was in.  In high school my class was the first required to pass a proficiency test to graduate.  I was one of four in my class of 400 to pass it the first time. In Medic School I was at the top of my class, consistently scoring the highest on tests.

It’s never come easily for me, particularly in Medic School.   I had to study my backside off to make those grades.  I would habitually stay up for hours after putting the kids to sleep, pouring over my pharm flash cards, reading and rereading (and re-rereading) chapters that I had a hard time with.

The Endocrine System, for example.  The bane of my existence.  We had two quizzes and a final test over the course of two weeks.  I think I studied a total of 60 hours on that damn chapter and never scored below a 95%.  It definitely took a toll on me.

When we got to Cardiology I found myself revitalized.  It’s a subject that’s always fascinated me as I lost my Grandfather to an MI when I was two, and my Mother (who was in phenomenal shape) had been developing some cardiac issues of her own.  Some of my classmates were a little more anxious about the cardiac final.  We were told if you scored below a 78% on the test you were not able to retake it.  If we failed it we would wash out of the program we were now a third of the way through.  The idea of failing the test was not an option to any of us.  We all dealt with it in our own ways.

I dealt with that anxiety by studying to the point of mental and physical exhaustion.   I wanted to walk confidently into that classroom, and I didn’t care how much studying I had to do to be able to do that.  I wanted to sit down and answer all 180 questions correctly.  Then I would go perform the Mega Code perfectly.  Then I would go home and have a margarita to celebrate.  Maybe two.

That was the plan.

The night before Test Day I spent two four hour chunks of time studying.  By three in the morning I was falling asleep at my desk, drooling on my power points.

Get it together, Epi…  Just go over it one more time…  You can DO IT!

I picked my head up and wiped the sleep from my eyes and whined to no one in particular,  “But I’m TIIIIIRED!!!!”

Fine.  Go to sleep.  You’ll be getting plenty of opportunities to sleep when you wash out of the class.

“Jesus, I’m talking to myself.  And answering.”  I knew it was time to hit the bed.  What I didn’t know by now I wasn’t going to retain anyway.  I was beyond exhausted.  I stood up and stretched, feeling my back crack… The result of sitting in one position for two long.

Then it happened.  I took one step.  That was all it took.  I stepped on a pile of power points that happened to be in sheet protectors.  I slipped.  I planted my left shoulder directly into the cinder block wall that my basement office was constructed of.  From there I fell to the floor with my arms in front of me.

That’s me.  I’m the graceful one.

The pain was instant and blinding.   My first thought was something I can’t repeat here.  My second thought was that I needed to go to bed, because I had a massive day ahead of me.

*skip ahead five hours*

BEEP BEEP BEEP BEEP BEEP BEEP

I rolled over in bed to turn the alarm clock off and screamed.  What I can only describe as the sensation of a red hot knife stuck in my shoulder shot a lightning bolt of pain down my left arm.  I yelled a few more four letter words while my husband tried to make sense of what was going on.  I told him what had happened earlier that morning.  He couldn’t do much more than shake his head.

“Well, you know you need to go to the ER,” He said a few minutes later, making a pot of coffee.

I was holding my left arm up against my chest, the only position it could be in that wouldn’t result in me crying out in pain.  “I know,” was all I could say.

Mr. Epi packed up my back pack with the power points and study notes that I would look over while waiting to be seen in the ER, and sent me on my way.

Yes, I drove myself to the ER, one armed.

**********

“Okay, so is it dislocated or broken?”  I pushed my glasses up, the pain from my arm was so intense that I was sweating.  I had been focused on test notes, studying to the very last possible minute.   The ER Doctor, for the record, happened to be the Medical Director for the EMS service I worked for at the time.

“Epi, look at me.”  His voice was calm, serious.  He meant business.  I looked up immediately.  “Epi, it’s broken and dislocated.  We’re going to have to give you some good drugs to reduce it.  I’ll get a nurse in here to start a line on you.”

“Uhm, no.  We can’t do that.  I have a test to take today, if I’m not in Ann Arbor in two and a half hours I’m going to miss that test.”  I set my papers aside and winced.  Every movement was excruciating.

“I’ll write you a note for school.”

“No, you don’t understand.  He won’t accept a note.  If I miss this test I fail it.  If I fail it I’m out of the class.”  I did my best not to cry, but I was terrified.  Hot tears rolled down my cheeks.   I knew that he had been a Basic, and a Paramedic before medical school.  I was pleading to that side of him.

“You really don’t want me to do this without sedation.  It’s going to hurt like hell.”

“I’ll deal with it.  Really.  The only other option for me is to drive up to Ann Arbor, take my tests, and come back here afterwards.”  I was just as serious as he was.  Hell, I’ve delivered two babies, one without an epidural, surely I could handle this.

**********

Good GOD in Heaven did that hurt.  The ER Doc reduced the dislocation, put my arm in a sling, and sent me out the door with a script for percocet.  Too bad I wouldn’t be able to take one for another seven hours.

I made the hour long drive to Ann Arbor without incident.

Getting out of my car and carrying 30 pounds of books and binders filled with notes would prove to be slightly more difficult.  My classmate and practicals partner, Jeff met me at my car.  When he saw my arm in the sling his jaw hit the frozen Michigan asphalt.

“What in the HELL did you do?” He set his coffee on the roof of my car and grabbed my backpack from me.

Who said chivalry was dead?

After I told him the whole sordid tale, his only worry was whether or not I’d be able to do the Mega Code that night.

“Thanks, Jeff.  Nice to know you care.”  Sarcasm dripped from my lips.

“You know I care.  I just don’t want to see Ben take your spot at the head of the class.  Then I’d have to go bribe him to be his partner for practicals.”  He smiled a big toothy dimpled smile.  I couldn’t help but laugh.

As soon as we entered the building I sought out my I/C.

I should probably pause here for a moment.  I might have mislead a few of you.  While I truly believe I’m great at written tests… I get a mean case of stage fright when it comes to practical tests.  It’s the oddest thing.  Give me a real patient with real problems and I perform flawlessly (well, as flawlessly as can be expected in a Medic Student during a clinical, but I digress).  I’m cool, calm and collected. Put me in front of a manikin in front of my classmates and I/C, and I freeze like a deer trapped in headlights.

Please don’t tell anyone.  Thanks.

While seeking out my I/C I was silently praying that he would let me out of the Mega Code that night.  I didn’t feel adequately prepared and certainly I couldn’t intubate one armed….  Well, I had never tried, but that was beside the point.

**********

“You’ve never tried to tube someone right handed?  Didn’t he teach you anything?”  I/C #1 was incredulous.

I shook my head.  Jeff was standing next to me, and I had the feeling he wasn’t any more excited about the Mega Code than I was.  I bit my lip and prayed silently.

Just give me one more day to prepare… please.

I/C #1 rubbed his temples and laughed out loud.  “Hell girl, you don’t think every person you have to tube is going to be on his back, do you?”

I didn’t know what to say.

I/C #1 went on, “I can teach you how to tube with your right hand in about five minutes.  You know your stuff, Epi, you’ll get through it just fine.”

Shit.

**********

I made it through the written Cardiac test just fine.  As a matter of fact I pulled through like a rockstar.

It wasn’t until I turned in the written test that I started to get those butterflies.  Jeff wasn’t nearly as confident about the written test and it showed.  His normal jovial demeanor was replaced with a borderline anxiety attack.

“I failed it I failed it… I know I failed it.  I can always go back to Arbors, they’re always looking for another CNA.  I didn’t really want to be a Medic anyway.  You know what? I think I’m going to go home.  What’s the point in sweating the mega code when I failed the written test.”  He was pacing back and forth and sounding more and more like what I was thinking to myself.

“Jeff, you passed.  You knew your stuff.  We did fine.  Let’s just focus on this, make it through it, and go out and have a beer.”  I was annoyed, very tired, and in pain.  Not the best combination.

**********

Tomorrow, the conclusion.  The Mega Code from Hell.