This thing I refer to as My Life

I'll start this with one important detail I left out of the public blog: I got to drive the ambulance! :-) It basically drives like a moving van.

ER started a week last Monday and there have been some interesting moments. After our full day of orientation lectures with the bonus of getting to practice placing IV's on each other, I started with a Pediatrics ER shift. Well, that's disingenuous already: I did not have an IV started in me because of my long history of fainting when I have blood drawn. That's right! I can accidentally cut myself and watch myself bleed, I can get shots, but if someone takes blood out on purpose there is a good chance I'll go out. I don't pass out if I'm lying down, but sitting is bad. With that said, I can draw blood on others without difficulty--so far.

Ped's ER was pretty straight forward, a broken bone here (I did learn what a buckle fracture looks like), rash there, etc. Thursday's shift was in the regular ER which started casually enough, but got exciting when there was a patient who experienced about a 20 foot fall down a steep hill. He was being worked up in a resuscitation room and, although he was pretty stable, we had no venous access. Normally this is not a significant problem, however, this particular patient had an extensive history of IV drug abuse and has destroyed about every easily accessible vein. I tried a couple of times on one arm while the best IV nurse worked the other arm. No luck. After several attempts, the attending decided to place a line in the femoral vein. I offered to assist, which I used to do in cardiology, but I really wasn't being utilized so I decided to try placing an IV just to see if I could get access. I must have tried a half dozen or so times and the attending had to switch to the other leg before he finally got IV access.

Friday night I worked a 4:30pm till 4:30am ambulance shift. That was actually a surprising amount of fun in part because it was the lightest night they had in months. It started off hanging out in the park and poke. During the day it is where people park to ride-share into work. At night it is the place that teens hang out to park and, well, poke. I asked if the teenagers were intimidated by having an ambulance in the lot when they're doing their thing and the paramedics said, "they seem to have gotten used to us." We were called to a house where a person had a raging case of leg cellulitis, but he refused to be taken to the hospital. We were sent to one of the smaller ambulance stations because it was not being covered that night and, after making a "run for the border" for "fourth meal" (that's right! I road in an ambulance to get dinner at Taco Bell!) we hung out until 1:20am. The ambulance I was in was the mobile intensive care unit (MICU) which means the paramedics are specially trained to administer certain drugs, intubate and transport patients from one hospital to another when they are on IV drips. So, they do not get called to the more routine calls unless they are the only ones nearby. This may be an oversimplification. Just after we started watching The Seed of Chucky, we got our first (and only) serious call: this was a good thing because the movie was not going anywhere good. We were called to a home where a person had fallen while walking with her walker and could not get back up. She was experiencing neck pain so we put her in a collar and loaded her up in the ambulance. Since we had spoken about learning to do IV's and blood draws (which is why I mentioned all of that earlier), I was told to place an IV while we were driving! (I seem to recall the statement, "don't worry about it now, we'll let William Tell place [the IV] on the road!") I saw a vein I wanted to try, but the paramedic helping me out in the back suggested trying at her anticubital space. Just as I was getting ready to pierce the skin, we hit a bump. I tried, but did not get the flash (I did not hit a vein). So I decided to go to my first place, which was farther down on her arm and, well after the next bump, I got it! When we got to the hospital, I requested the singing of the "William Tell overture." We hung out for another hour or so and then our shift was over.

Other observations: riding in the back of an ambulance that is going down the highway at 90 MPH is a little disconcerning. The seat in the back of the ambulance closest to the widow of the cab has been sat in far too many times and is not nearly as comfortable as the other seats. The narcotics are locked up. The puke buckets are not locked up.

Saturday was an off day, of sorts. I spent much of it sleeping. Today I had another shift from 8a till 2p. It went pretty well until the very end: one of the nurses told me there was a resuscitation getting started and she told me to go take a look. I popped in while they were establishing the airway. After getting the ultrasound, I started helping out with chest compressions. This was the youngest patient on which I had performed such a task. The patient was experiencing an asthma exacerbation that was not being relieved by the rescue inhaler. About 20 minutes away from the hospital, the patient lost consciousness and was not breathing at the time of arrival--may have also been in cardiac arrest, but I am not sure of that. We worked for 40 minutes performing CPR, administering drugs, shocking, placing chest tubes, but the patient's heart refused to start beating. There was a rhythm, but no contractions by pulse or cardiac ultrasound.

I have new found respect for asthma. I knew it used to be a killer, but I did not think it still was. It is.

Now that M3 year is over, my mother made a very reasonable request: "Post your schedule for next year." So, here it is (at least the current version):

ER at St. Joe's Hospital
Radiology at UM
Pathology at UM
Anesthesiology at UM
Adv. Anesthesiology at UM (This will possibly change so an away rotation.)
Radiology at UTMB
Forensic Psychiatry at UM (it's actually off-site)
Translational Research Management at UM (I created this class.)
Vacation/interviewing
CCU (Cardiac ICU) at UM (Sub internship & ICU month)
Urology at VA (Sub internship)
Vacation/packing/moving
Graduation (May 11th for those of you that want to see me walk for a 5th time)

I'm trying to gear up for a Radiology residency but I'm still considering Anesthesiology and, surprisingly enough, maybe even Family medicine! Who would have thought? But, Radiology is the most difficult to get in to, so I figured I would start with that and if I change my mind it would be easier to shift into something else.