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Published on April 5, 2008 By dharmagrl In Life Journals

I said I wasn't coming back, and, for a while, I meant it.  Today is the first day I've logged in and commented since the start of March.

 

It would have been my dad's 80th birthday on Wednesday.  I still miss him like crazy.  I want so much to pick up the phone and tell him how I'm doing....

School is over half way done.  I graduate on May 10th, and take the National and State exams on May 22nd, 2 days after mum arrives for her annual holiday (we're paying for half her flights this year).

My tutor told me 'you're going to make a fine medic, karen.  Your midterm grade is an A.  That's rare'.

I AM a good medic.  I know what I'm doing, I have a good instinct and treating emergent situations comes naturally.

I'm doing clinical ER time this next week.....in East St Louis.  In the ghetto of East St Louis, to be exact.  The kind of place that requires it's staff to be escorted to and from their vehicles by armed staff.  I'm looking forward to it.  I'll get do EVERYthing, and that makes me happy.  I WANT to get in  and get dirty; I WANT to do my JOB.

I am taking 95% less medication today than I was on January first.  Next month, I'll be taking NO meds at all.  I'm doing great.  I didn't need them, and I don't miss them.

I'm compliling a book of dumb-ass quotes from my class.  There are a couple of people in there that really don't belong; they won't be eligible to take the final because they're failing the class, but they want to stick with it so they'll have a good starting point to re-take from.  Here are a few gems:

(we were talking about delivering babies in the field) 'why would you want to have a baby in the field?  Won't the grass get in the way??'

(during a discussion about 'artifact' - environmetal interference on an EKG, either by muscle tremor or road interference or an issue with the leads) 'so, if I have a patient with Parkinson's disease, should I tell him to lay real still?  Or shall I wait until he's done shaking?'

(during a discussion about why we don't try to revive stillborn  infants with obvious signs of decomposition such as skin slippage and discoloration) 'why not?  I mean, everybody knows that it's physically impossible for a baby to die inside it's momma.  It breathes through that cord, so as long as the cord's attached to it's belly, it's still alive'

(during a question about triage and who should be treated first - a 9 year old male with an open skull fracture, brain extrusion and who is in total cardiac and respiratory arrest, a 70 year old female with absent breath sounds on the right and who is having shortness of breath, a 28 year old male with obvious tib-fib deformity bilaterally but no altered level of conciousness who's complaining of pain, and a 30 year old female with a 2 cm laceration to her left forehead but who is awake and lucid) "well, the kid's got to be revived first.  That's the rule, kids and women first.  But, that old woman's going to die anyway, so we'll leave her.  We should take the kid first, then the woman with the cut, then have the man walk to the amboolance.'

* This is my reaction, and the way the triage SHOULD be run* "Umm....that child is dead.  He's lost part of his BRAIN out of the gaping skull fracture he's got.  He's also in cardiac arrest, and the likelehood of him being revived successfully is none.  That woman with the absent breath sounds likely has a hemothorax and needs a chest tube, so she's got to go first.  The man with the tib fib fractures needs an IV, pain meds, splints and a backboard, and he's going second.  The woman with the lac is alert and oriented x 3, has no hemotoma or LOC, and she's ambulatory so she can wait until we've taken care of the other two.'.

The response: "No!  Children first!   That boy needs to go first!  He's only 9 years old!!!!"

Apparently objective thinking doesn't play a part in this person's decision.  So, we told her what would happen if she ran the trauma the way she wanted to:

'Ok, so you take the kid and do a full recuss on him.  He's pronounced dead 3 mins after he's in the ER.  You left the woman with the absent breath sounds, and she's now got a pericardium full of blood preventing her heart from beating.  She's also bleeding out into her chest and is in hypovolemic shock.  She's got no pulse or respiratory effort, and she's pronounced dead in the ER.  The man with the broken legs, the one you said could ambulate, tore his tibial artery when he tried to stand, and he's lost blood flow to his lower legs.  The orthopedic surgeon will try his best, but his feet have been without blood flow for a significant period of time and he may lose them.  The woman with the lac ended up with some steri strips; she didn't even need sutures.  So, you killed one patient you could have saved, caused someone's legs to potentially be amputated when all you had to do was transport them, and wasted time and resources on a patient who was dead and who wasn't capable of sustaining life.  Congratualtions.'

 

Luckily, the people I'm describing here aren't going to be eligible to take the national exam (not without a miracle, that is - and even if that happens, the likelihood of them passing the national is pretty much nil).  So, you can rest easy knowing that these people WON'T be taking care of you or your loved ones in your time of need. 

I, however, will.  But, I know what I'm doing. 

You can believe that.

 


Comments
on Apr 05, 2008
Oh my God you have stupid people in your class!

'why would you want to have a baby in the field? Won't the grass get in the way??'


Wow...wow...a literal field? Yes, because pregnant mothers often hang out in pastures...

'why not? I mean, everybody knows that it's physically impossible for a baby to die inside it's momma. It breathes through that cord, so as long as the cord's attached to it's belly, it's still alive'


This surprised me the most...no...no that is wrong and stupid! These people have been studying this stuff and even I know it's wrong...

Please make sure these people never have to provide medical care for anyone...even animals.

~Zoo



on Apr 05, 2008
Grr...double post.

Still, I'd like to add that those people are so very, very stupid.



on Apr 05, 2008

Go go competent medic!

Best wishes for continued success in the training, seriously.  And also best wishes for the work in East St. Louis.

on Apr 05, 2008

I echo whip's advice of care.  I'm sure you'll be careful, but I'd hate for something to happen to you.


I'm glad to hear that you're getting off the meds and feeling better about stuff.


I've missed you, my dear.  It was good to 'see' you here.

on Apr 05, 2008

First off, great to see.  I've been remiss about...  well, you know, but I've also been very busy at work.

I can't believe some of the 'quotes'.  Thankfully, as you say, these people won't be working in the field, at least not in the foreseeable future.

As for getting off the meds, good for you.  I hope you're feeling much better for it too.

on Apr 05, 2008
Try to steer them into accounting. That's where they'd be good. Nobody knows what the heck is going on in accounting, they'll fit right in. They could cause the next Enron!
on Apr 06, 2008

ZOO: Yeah, a literal field.  The person who made these quotes (yes, it's all one person) is a lovely, lovely human being who is already employed and is good at what they do.  Why the hell they feel the need to be involved in EMS is beyond me, but they're here and they want to do it, so....there you have it. 

LW: We don't fuck around in ESL.  We have police escorts at every scene we go to, and if it's not safe, we don't stop.  It's not worth us getting shot or stabbed, period.  The ER has armed staff on duty at the triage desk and in the back and each patient gets patted down before any medical staff get near them.  However, that doesn't mean that we're not on 'high alert' when we're down there.  Complacency kills. 

Having said that, pharmeceuticals are wonderful persuaders.  A little Versed, a wee bit of Etomidate or Succinol Choline....people tend to go right along with what we're asking them to do when they're on those.

Jyth: They don't have a cerebral power necessary to work in accounting.  Then again, we ARE talking Enron...

 

Maso:  I know, and I have too. 

 

San: Que pase?  How's la viva Espagna?  My bro was in Madrid last week, I thought about you being there then....

 

 

on Apr 06, 2008
Be very careful in east st loius, Karen. They play for keeps there.


Just act like you own the place and you'll be fine. (At least that trick's always worked for me    )

I've missed you, my dear. It was good to 'see' you here.


Ditto that. But I understand!
on Apr 06, 2008

It's nice to see you here again.  I was wondering how school was going....as expected you are doing wonderfully!  Congrats.  I'm looking forward to hearing about your adventures in the future!

on Apr 06, 2008

Dana:  nice to 'see' you too, and I'll be back with some stories, I'm sure.

Roy:  I'm not swaggering anywhere.  I'm staying in the security of the ER and waiting for the patients to come to me. 

LW:  Like I told Roy, I'm staying in the ER and waiting for the patients to come to me.  This is just clinical time; we get to practice what we've learned with real people.  The hospital is about 2 blocks from the MetroLink station - you can see the entrance from the platform - but there's no fucking way I'm walking.  Period.  One of the girls in my class is from the 'hood', and even she won't walk from the metro to the ESL ER.  That tells me a hell of a lot.

I want to see trauma, and ESL is a good place for that.  However, I'm not about to jeopardize my safety for ANYone.  That's the first thing we learned in class: scene safety.  Personal safety.  If it's not safe, we don't stop.  We stage at a safe distance and we wait for PD to control the scene.  There are ambulances down there that have bullet holes in the sides of them where people have taken pot shots at us.  In those cases, we take cover and we leave.  You are absolutely correct about people short-sniping; it's a local pastime. 

I don't mind working the ER; it's a relatively secure environment and it's fairly controlled.  However, I'd either have to be paid VERY VERY well or have a death wish to work the streets.  On second thoughts, there isn't enough cashola in the world that would make it worth my while to get shot at.  It's not worth it, period.

I'm working a suburban ER on Tuesday night.  It's going to be a fascinating experience.

on Apr 06, 2008

I know, and I have too.

Things are starting to quieten down a bit so I will try later this week, maybe Thursday morning my time (your Wednesday evening).  Let me know it this is not suitable, though.

 

on Apr 06, 2008
I'm not swaggering anywhere. I'm staying in the security of the ER and waiting for the patients to come to me.


A good idea as there are BAD people in the world, believe me (and NOT just in the 'hood either. Heh, funny thing though -every time I bring that fact up on JU I seem to get dissed for saying it...   
on Apr 07, 2008
You should submit those to Scott Adams for inclusion in his famous Quotes of InDUHviduals!

Best of luck on the exams and your internship!
on May 15, 2008

Doubt you will see this Dharma, but just wanted to stop by and say "hello".  Having come back after a bit o' a break myself, I was just noticing the hole left by your absence.

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