Friday, March 1, 2013

Paramedichron # 11


Rocuronium  (with apologies to the Ramones)

Well I don't care what brought you here
Roc- Roc- Rocuronium
Your discomfort's what I fear
Roc- Roc- Rocuronium
Gettin tubed is such a bitch
I think I just saw you twitch
Roc- Roc- Roc- Roc- Rocuronium

Etomidate knocks you out, you know
Roc- Roc- Rocuronium
Do my stuff, then keep you low
Roc- Roc- Rocuronium
I hate it when my patient wakes
I'm not sure how much it takes
Roc- Roc- Roc- Roc- Rocuronium
Roc- Roc- Roc- Roc- Rocuronium

Numb! Numb! Rocuronium
Numb! Numb! Rocuronium
Numb! Numb! Rocuronium
Numb! Numb! Oh, doctor. Numb! Numb! Oh, doctor 
Numb! Numb! 
Numb! Numb! 

Roc- Roc- Roc- Roc- Rocuronium
Roc- Roc- Roc- Roc- Rocuronium
Roc- Roc- Roc- Roc- Rocuronium

Well I don't care what brought you here
Roc- Roc- Rocuronium
Your discomfort's what I fear
Roc- Roc- Rocuronium
Gettin tubed is such a bitch
I think I just saw you twitch
Roc- Roc- Roc- Roc- Rocuronium
Roc- Roc- Roc- Roc- Rocuronium

Numb! Numb! Rocuronium
Numb! Numb! Rocuronium
Numb! Numb! Rocuronium
Numb! Numb! Oh, doctor Numb! Numb! Oh, doctor 
Numb! Numb! 
Numb! Numb! 

Roc- Roc- Roc- Roc- Rocuronium
Roc- Roc- Roc- Roc- Rocuronium
Roc- Roc- Roc- Roc- Rocuronium
Roc- Roc- Roc- Roc- Rocuronium

Sunday, December 25, 2011

Paramedichron #10

"Apologies"

I imagined more frequent updates to the Paramedichron, but time and motivation have both been lacking for the last couple of months.  Which is too bad, because there has transpired much that warrants explanation and elaboration.

Thanksgiving came and went in a flash.  We were spared the day from riding the rigs, which, in hindsight, was no great gift.  Riding the rigs, and making Paramedical decisions, are the cornerstones from which this program has been, like an enormous house of plywood cards, structured.  The academics are primarily a vehicle by which disorganization and chaos can be levelled upon us eighteen.  The tests sneak up upon us, and cover material that are typically only hinted at through vague insinuation and long lists of diverse topics on the whiteboard. There is a small amount of winking and nodding on the specifics of certain test questions that might not have been fully explored in our classes, and, for the most part, everyone does OK on the tests. 

The uniform for Paramedic Training is white, poly-blend "Smock" that is slightly similar to a lab coat or the longer mantles worn by residents and other doctors in training.  Every so often, I am assigned to spend a shift - perhaps an entire long night - in the ER, and in the course of those fourteen hours, I am constantly, maybe desperately, called "Doctor" by patients who want to get the hell out of the ER, have their restraints loosened, or otherwise have answers to question that I cannot possibly provide. 

The Smock is a source of certain pride, in that being at Harborview, to receive this world-renowned Paramedic Training, is an honor and privilege.  The Smock opens doors, lends a credibility to well-intentioned efforts on our collective parts, and identifies us as participants in a medical tradition of ignorance, faith, and patience.  This Smock of white, coupled with a cardkey badge that opens almost any door, ushers the motivated paramedic student into educational and medical opportunities that are the envy of other, lesser paramedic schools. 

There are three previously-trained paramedics in our class - people with established careers in paramedicine - who recognized the quality of the education to be received at Seattle Medic One and Harborview, tested for the opportunity to go through this training (sometimes repeatedly), and are (re)learning beside the rest of us, sharing their wisdom when possible. These three intrepid men inspire me, and their commitment to being a better paramedic humbles me.  Our bleached and pressed Smocks are our admission of submission to the (sometimes inscrutable) process that generates Copass paramedics.

The Smock, however, is also the shackle by which we eighteen are chained to our Faustian education. The Smock is exposed to pathogens, bodily fluids, odoriferous bacteria that thrive on the drench of fearful, cold perspiration, and must be regularly washed and ironed smooth.  They are a robust garment, possessed of five capacious pockets, typically stuffed with the cheat sheets, IV catheters, gloves, masks, pens, nametags, and any other reference materials that will fit, all of which serve to allay the insecurity that accompanies the dispatch to the address of someone in need. 

Every ten days or so, I get a couple of days off the rig, with no classroom obligation, and I make a beeline for the Rancho Ballardo, six or seven miles distant from the apartment (known as the Valle de Cula - ONE block from Harborview) where I spend most of my time. That the most-recent two days should coincide with Christmas is another example of the inexplicable luck that I have enjoyed my entire life. I was able to spend Christmas Eve with Lisa's family and Grandmother (it may very well be her last Christmas). 



The Valle de Cula has an over-priced washer and dryer in the basement, but, so far, I have been able to lug my laundry home to Ballard every week or two.  Remembering the copious amount of crap stuffed into the sundry pockets of the Smock, picture the ritual of removing the contents of those pockets and preparing for the next Smock-donning.  I usually build a small pile from the items removed from the my Smockets, to be reassembled in and on a freshly-laundered Smock.  Envision also the hurry and frenzy of gathering a load of laundry prior to the paramedic student equivalent of shore leave, and you might appreciate how an errant ballpoint pen might slip through the cracks.  This oversight was only discovered after washing and DRYING a load of whites, including the twenty socks worn over the last week and half, and TWO smocks.   

Fuck.

Paramedic Training provides three smocks for the acolyte, but I was lucky enough (again!) to inherit one more appropriately-sized Smock from an EFD brother who attended last year.  That leaves me two Smocks if I can't eradicate the ballpoint ink from the polyester-blend fabric from which the cursed garments are constructed.  At this point, I have soused the ink spots on the cleaner Smock with a 91% solution of rubbing alcohol (which is very handy at dissolving ink)  and washed once.  It came out cleaner, but with a few trouble spots.  I doused it again, and it is back in the wash.  Time will tell.

Let's add a small layer of complexity to this situation. Perhaps I am scheduled to be at the University of Washington Hospital Labor and Delivery tomorrow.  Perhaps at 0600 hours. I have a spare Smock, but it is in the Valle de Cula, and I am hunkered down, resting my brain for the next 24-hour shift.  Remember Johnny Mac, the driver?  He's on duty tonight, but he has left the Valle de Cula unlocked so that Lisa might swing by and grab a clean smock for me.  Does this sound like a complicated Black Forest Cuckoo Clock, with many moving parts?  Time will tell, but I wager some measure of currency on my persistent good luck. 

It all works out.

I have an unoccupied house for rent in Shoreline.  Good luck will carry me.  I know it.  It all works out.

Saturday, October 29, 2011

Paramedichron #9

Making Me Crazy, This iPad

Sung to the tune of Killing Me Softly With His Song, by Roberta Flack
Reacquaint yo'seff with Roberta's sound here:
http://www.youtube.com/watch?v=DtW29oTp5cE&feature=related


Jabbing the screen with my finger,
Keeping my life deep inside,
Making me crazy, this iPad,
Making me crazy...
This iPad
Holding my whole life a hostage
Making me crazy...
This iPad


I saw the advertisements;
I know the Apple Store.
But when it was handed to me
I expected more.
And there it was, this new toy:
The answer to our prayers


Stabbing the screen with my finger
Hoping my life's still inside
Making me crazy, this iPad
Making me crazy...
This iPad
Holding my whole life at gun point
Making me crazy...
This iPad


I felt a rush of panic,
was scared - a little bit.
I felt set up to fail
with Apple's piece of shit.
I prayed the Lord to take me
or smite this damned tablet!


Poking the screen with my finger
I stored my life deep inside
Making me crazy, this iPad
Making me crazy...
This iPad
I've got my whole life on that thing
Driving me crazy...
This iPad!


I think that if you knew me
You'd see it isn't fair.
The absent keyboard threw me,
and there's no harddrive there!
And all my tests are on it -
And all my fucking books...


Hitting the screen with my forehead
I'm doomed - my life's locked inside
Making me crazy, this iPad
Making me crazy...
This iPad
I placed my trust in that damned thing
Driving me crazy...
This iPad!


Oh, oh oh , la la la etc etc etc.


Tapping the screen with my finger
What's going on deep inside?
Making me crazy, the iPad
Making me crazy...
This iPad
We should have all got an Android
Driving me crazy...
This iPad!


I was touching the screen
Yeah, it was smashing my life
Making me crazy - this iPad
I'm going crazy...
This iPad!
Holding my whole life at gun point
Driving me crazy
This iPad!

Sunday, October 16, 2011

Paramedichron #8



P.M.T. Washout

PMT is the TLA (three letter acronym) for Paramedic Training at HMC)
(Sung to the tune of "Beauty School Dropout" from the musical Grease)
If you forgot the tune

Your story hard to hear,
We still can smell your fear.
Don't know how to feel since they took away your smock!
Your future's so unclear now,
What's left of your career now?
Can't even make a payment on your truck!

MAs and Nurses: (La lalala lalala lalala...)

P.M.T. Washout,
No intubation count for you.
P.M.T. Washout,
Killed the manikin with your tube!
Well at least you could have taken time, to disinfect your hands,
After having your department spend more than a hundred grand!

Brother start packing (brother start packing)
Why are you sitting on you ass?
You took a whacking (you took a whacking)
You know you're not the first half-fast!

If you drove on out to Central, you could spend your own money.
Hand in your name tag and your iPad, E M T

P.M.T. Washout (P.M.T. Washout)
Hanging around the classroom door.
P.M.T. Washout (P.M.T. Washout)
You don't have the code any more!

Well they handed you an eighteen gauge,
Didn't know when to stop trying,
And your patients couldn't answer you - when they were busy dying!

Just say "Whatever" (Whatever)
You are probably better off
Never say "Never" (say Never)
That scratchy Nomex, you can doff.

Now your feet are sore, there's the door, and engines four or three...
Hand in your name tag and your iPad, E M T

Buddy, don't blow it,
You've got nobody else to blame.
Buddy, you know it,
Even Dan Savage 'd say the same!

But I kid you not, you had your shot, how bout a cup of Joe?
Gonna be snoozin', in some station, where it's slow!

P.M.T. Washout (P.M.T. Washout)
Still an E M T
P.M.T. Washout (P.M.T. Washout)   (fading...)
Still an E M T
P.M.T. Washout (P.M.T. Washout)
Still an E M T
P.M.T. Washout (P.M.T. Washout)
Still an E M T



Wednesday, October 5, 2011

Paramedichron #7

Bleary eyed and a little nervous, we arrived early and milled around outside the Paramedic Training classroom. We were uniformly dolled up in our freshly-pressed blues and the trademark white labcoat officially known as a smock. Even though we had spent the last two months studying Anatomy and Physiology together, meeting nine Tuesdays in this very classroom, donning the schmock changes everything. This endeavor has suddenly become very real, and the next ten months are invisible in a fog of ignorance, like an unknown wilderness.

Our morning was filled with portentous introductions and tradition dimly recognized. We eighteen have tromped in polished duty boots into a hallowed institution, with a history and culture we may not fully understand. There are labyrinthine rules for situations unimagined and undesired. We were told, in no uncertain terms, to not fuck up so as to damage the Medic One organization, nor to have "relations" with the nursing staff, but I repeat myself. Our immunization records were examined and a TB titer test bubbled under our epidermis with a hair-thin needle by a cheerful Harborview nurse.

After a brief lunch, we were inducted into the realm of high-performance CPR and required to perform two minutes of flawless compressions. For some, this took a single effort, but there is always room for improvement and the profficient were told they could improve. Soon we were all dripping sweat inside our schmocks, and the stink of fear and damp synthetic fabrics funked the room. It didn't take too long to get everyone through their requisite flawless demonstration, and we were rewarded with (we were told) a rare attaboy.

The remainder of our inaugural day consisted of a primer on the iPad tablet, which forms a cornerstone to our curriculum. Some setup, some basic hands-on, and the clever little widget is ours to command. It has its limitations, and compared to my Linux netbook, it is a pretty toy, lacking in horsepower and memory. At twice the price. But in deference to Steve Jobs, (who passed away today), I tip my hat to the genius of the robust hardware, the simple interface, and the ruthless marketing that has made an over-priced hardware monopoly into a hipster fashion trend. In concession to the device, I am composing this Short Report on the cursed gadget with insignificant difficulty and complaint.

The apartment (a modest flat we call the Valle de Cula) is only a block away, and it is a luxury to have a bed, bath, and kitchen so close to where we will spend the better part of the next ten months. Two classmates share the space with the Driver and me: A young man from Port Ludlow, and another from Port Townsend. We walk together after class, each quietly processing the events and information from our confusing and overwhelming day.

A couple beers, a call to the wife, and it's about time to hit the rack. Friday night I will be on the medic unit (doing I don't know what) until 0730 Saturday morning and all day Sunday. I have nothing to read, and the more rest I can bank, the easier the long shifts will be.

I have worked for this for years, and it is amazing to finally be here.

Friday, September 2, 2011

Paramedichron #6

I don't know what civilisation consists of, but I know it when I see it.  - Sir Kenneth Clark

In the fifteenth century, in Florence, Italy, a prosperous family took to investing heavily in the arts.  The House of Medici not only acquired masterpieces with their vast wealth, they also patronized artists whose names you now know as the Ninja Turtles: Raphael, Donatello, Michelangelo, Leonardo.  Galileo Galilei was also on the payroll as a tutor to the Medici kids, until the Inquisition made it unfashionable to contradict Catholic orthodoxy.  Even so, the Medici family loyally protected him for years after.
Among the beautiful architecture funded by the Medici family is the Uffizi, a palace originally meant to house the offices of Florence (Uffizi = Offices).  It now enshrines the Uffizi Gallery, one of the oldest and most famous art museums of the Western World.
How I found myself in Florence is a tale of luck and warped priorities, best left for another time.  Suffice it to say, that, after several amazing weeks, divided between Provence and Tuscany, in my last 36 hours, I could not marshal the energy to ride a train 175 miles roundtrip to see the marvels of Roma. I had arrived in Florence (concerned primarily with my departure from the local airport), checked into the Hotel Arno Bellariv, drained the mini-bar, perused a local attractions leaflet and was seized with the possibility of visiting some big-damn-deal museum in the last hours of a Saturday night. The next day I would fly away.
Imagine a warm and muggy August night, in the ancient and hallowed hometown of the Renaissance.   Imagine also that the sky is pregnant with the promise of precipitation, and the flagstones are still damp in places from earlier showers.  You best enter the Uffizi from the river side, via the arches beside the road fronting the Arno River, the Lugnarno Diaz.  A long narrow courtyard, flanked by arched alcoves housing marble and bronze masterworks of sculpture, funnels you to the entrance.  In the high season, the Uffizi is typically a several-hour wait for the unprepared and unconnected tourist.  At five in the afternoon, so close to closing time, the line was a mere thirty minutes.  I gawked, agape, at the public art of the courtyard, some ancient, others modern, a perfect appetizer for the indulgence ahead.  A soul-stirring violin quavered from some shadowed and echoing hiding spot.  Several times, I felt my breath catch in my throat in stifled sobs of ecstatic joy.
I paid a discounted fee for my late and necessarily abbreviated visit, and when I finally stepped through the doors, I had just barely more than an hour until the museum closed.  I adopted a strategy of trotting between galleries and scanning the walls for any famous paintings or sculptures to which I had been exposed in my sheltered middle-class suburban upbringing.  Either my education was better than I give it credit, or the Uffizi just has so many important works of art, but I found something I knew in practically every nook of that beautiful museum.  Even the ceiling is papered with amazing renaissance artworks.  I’d try to lay my eyes on everything in an area and then I would have to move on. 
It was heart-breaking and exhilarating and frustrating and mind boggling.  With so much history, and so many important artworks in that museum, I still feel like I disrespected the original Medici bequest and short-changed myself in the process – insult heaped upon injury.  Ask me now what I saw and learned on that brief, magical evening in Firenze and all I can do is point to the familiar images in the souvenir guidebook I hastily grabbed in the gift shop.  But I try not to forget. 

And THAT is exactly what it’s like to take Anatomy and Physiology in eight weeks.

Paramedichron #5

We're coming into the fifth week of the summer Anatomy and Physiology class, and the subject is the integration of somatic and autonomous neural activity in the nervous system. 

I know.

In simple terms, what you want to do (or don't consciously know that your body wants to do) travels down the spinal cord from the brain or associated structure (descending neural fibers), and information from receptors travel up the spinal column, to the brain stem or your consciousness (ascending neural fibers).  Sometimes, in the case of  a stimulus interpreted as threatening to life or limb (such as grabbing the hot handle of a pot of bubbling spaghetti sauce), before you are even aware that you did something superlatively silly, an interneuron in your spinal cord fires a quick signal to a muscle to contract and, hopefully, pulls your hand to safety.  Then your conscious awareness gets the signal, and you spout some profanity and/or obscenity, while you run your arm under cold water. 

It's truly amazing, but if you've ever done it, odds are split that you might inadvertently slop some boiling tomato concoction on your tender forearm. Which isn't all bad, in that other mechanisms in your central nervous system etch that experience in the neurochemistry of your brain, and maybe next time you'll use a hotpad.