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.