Thursday, March 22, 2007

A good conversation

Still waiting to precept, I have been passing time trying to learn by observing others.

On scene for a shortness of breath, my paramedic partner lets out a quiet sigh as we enter the patient's room. He has been here before, many times for the same complaint. The female patient is agitated at the apparent dismay of her home healthcare workers. Yelling, she chastises them for mismanagement of her medications, poor planning, and an "inedible" meal. Turning towards us, she takes a deep breath and begins to explain how difficult her breathing is. Long, elaborate sentences flow easily without a hitch: she's been short of breath all day. No-one will listen to her. She needs to see her doctor right away.

I fight the urge to roll my eyes, an effort made easier as my medic remains perfectly stable. He is focused on the patient, performing an assessment on this that I have already decided to be nonsense. I wonder what it is he sees that I dont.

I set up the stretcher and lug the gear, handing him the bits and pieces that he needs. I assist as his decisions direct our path. He speaks calmly as he describes to the patient what he is looking for. Slowly he eliminates possibilities, narrowing his impression as we get closer to the truth. She has had periods of dyspnea over the past month, transient in nature with acute onsets usually in the early afternoon. The effort and sheer annoyance of the condition, the woman says, tends to render her a little "touchy" about matters of etiquette around the house. The meal wasnt even really that bad, she admits. My partner nods and smiles, a hand over hers as he says that its OK. We'll take you to the doctor.

She smiles, and thanks us.

He rides in the back as I drive. Not because she required ALS, but because they have established a repore. Together they talk as we bounce down the street.

After the call I reassemble the equipment, puzzled. My medic walks to the back of the ambulance and lets out another sigh, louder this time and more clearly filled with annoyance.

"What bullshit was that, eh?"

I ask him why he decided to ride in the back, then, if he knew she was bullshit. Why did he entertain such nonsense? He saw the same thing I saw when we walked in the door. No increased work of breathing. Long, full sentences. Clear lung sounds and stable vitals. Still, he said, he wanted to hear her story. Maybe there was something there, maybe there wasnt.

Taking a sip from his coffee he shrugged.

"At least we had a good conversation."

Sunday, March 18, 2007

A problem

People are upset about this blog.

Over the past week I have been on the phone a lot, explaining both myself and the words I have written here. There are concerns about HIPAA and an upset family, unhappy administrators at work and eyebrows raised at my medical control hospital. Despite my intention, and great efforts to avoid this, it seems that I’ve caused quite a mess.

I want to be clear. I have never written about a patient or a call in a manner that I thought would enable direct identification of that person. All of the written names are pseudonyms, locations are changed (if they are mentioned at all), and I have done my best to be ambiguous, if not facetious, about demographic type details. I am familiar with the HIPAA regulations and I have taken great efforts to make sure my entries here are in accordance with them. It is my strong belief that the details I have written here cannot be used to determine the identity of any of my patients, through either direct or indirect means. These are the guidelines that I have written my entries by, and reading through the archives, I have not strayed.

Still, people are upset. There was concern that I had used a patient’s real name, a rumor spread around my school and the company where I work. My medical control hospital heard about this as well.

It is not true.

My administrators are upset about photos that I posted of an ambulance, in a compromising situation that truly looks worse than it was.

My own fault.

A family is upset about an entry that they found inflammatory.

It was not meant in that way.

Still, I owe explanations and apologies. It seems that despite my intentions, I have caused a good amount of grief for some people with this blog. Over the next few weeks I will be attending meetings, and making those apologies the best I know how. I am responsible for this blog and whatever comes out of it, and I truly am very sorry.

I use this writing for myself. I find it extremely therapeutic to compile experiences with patients and compress them into blog entries, find lessons and crystallize them into paragraphs. This is how I have learned, how I continue to make myself better. I hope that these intentions are clear through the words I have written.

Still, to cause harm with this blog would compromise all of its benefit. I will not do this if it is at the expense of others.

Please bear with me. I hope I can sort all of this out soon.

Sunday, March 11, 2007

JEMS Conference

The JEMS conference was an awesome experience. For three days I felt privileged to be surrounded by such a vast number of EMS educators and providers, to learn from them and hear their stories. I walked from class to class with my friends, an ID badge hanging from my neck identifying me as a Paramedic. I wore it proudly, turning it face-forward whenever I noticed it had turned around. I felt honored to be part of such a crowd.

Two friends and I attended classes on a huge array of subjects, ranging from difficult airway management to heart sounds, from COPD to seizures. We sat and listened as providers from around the country told their war stories and the lessons they learned, with each experience backed by science through presented research. Myths were busted as revelations were made, the truth revealed through academic rigor. It was interesting to see EMS from such a prospective. To be taken seriously. Doctors on the panels were focused towards our cause, standing ahead of the class but beside us as colleagues. It was clear to everyone there: this is how EMS is supposed to be.

I am excited to bring this feeling home with me, renewed in strength. The patient always comes first. Our actions have to be regulated through the rigor of science. We have the capability and responsibility to make ourselves better. Each of these, not lessons learned but mantras that weaved through the convention center. The message was common knowledge, both the reason and purpose of attendance. I am thrilled to be part of this.

Through the dark we drove home on Saturday night. All of us were tired from the experience, the late nights and early mornings having taken their toll. Still our conversation remained heavy with the purpose of EMS. We discussed the things we had learned, the reasons why we do this and the responsibilities we have been charged with. Exhausted, but recharged.

A quote from Biologist and Nobel laureate Jacques Monod:

In science, self-satisfaction is death. Personal self-satisfaction is the death of the scientist. Collective self-satisfaction is the death of research. It is restlessness, anxiety, dissatisfaction, agonoy of the mind that nourish science.

May we all remain dissatisfied.


In other news:

I am very sorry to have missed the meeting with the other bloggers on Friday night. I mixed up the times, staying later to watch the JEMS games instead of heading across the street. I was looking forward to meeting everybody, but by the time I got out everyone had already left. Sorry guys, next year I will be there.

I am still not sure when or with whom I will be precepting. Things seem to be still somewhat up in the air, and I hesitate to guess what will happen. I'll post about it when I find out.

Sunday, March 4, 2007

Precepting II

On the phone with one of our administrators the other day, he informed me that there was a "problem." The voice was ominous sounding, followed by a long period of silence. I had worried this might happen. Due to a number of circumstances within the company, my assigned preceptor has changed. No longer will I be precepting with Mr. Canning.

I hesitate to say that I am disappointed. My newly assigned preceptor is also a long-time paramedic, and a knowledgeable man for sure. I look forward to learning as much as possible with him, and I am sure that our experiences will be both interesting and fruitful. I will be precepting in the city now, instead of mostly in a nearby suburban town as I would have with Canning. This is good. I think.

Still though, I admit that I was a bit excited to precept with Canning. A published preceptor, a man well respected throughout our system and beyond: interested in EMS beyond the immediate and eager to teach. Even the blogging would be an experience, with our two sites mirroring each other in student/teacher fashion. That would have been really cool. I am happy to be given the opportunity to precept with my company, but it is a shame that I missed this chance.

Those of you who know me and are familiar with our system are probably smirking at my careful wording here. I am doing my best to take care and not complain. I dont want to come off to my readers, or especially my administrators, as ungrateful for this opportunity. There are many people who did not pass through the system as quickly as I did, lots of preceptees who have had to wait a long time. I am happy to be starting so soon. I am glad I got a good preceptor. I am aware that this engagement is only for a few months, a mere moment compared to a future of paramedicine. On a wide enough scope, this is a hiccup that shouldn't matter at all.

I know all that, but even still, It would have been very cool.


The schedule has been mostly set. I will not start this week (as I am going to the JEMS EMS conference in Baltimore), but the week after on Wednesday the 14th. I look forward to it.