Life in Manch Vegas

Updates, Etc.

noreply@blogger.com (Walter Trachim) — Wed, 18 Jan 2012 19:00:00 +0000

A couple of up-to-date notes to put up…

Martha was released from CMC Sunday afternoon. The migraine was brought under control through the help of good care and good chemicals, namely, Imitrex. Two doses over two days seemed to knock it out, so she came home after the second one did its job. She has to follow up with a neurologist, and I know it will be a challenge to get her to do that. It seems we – anyone who works in health care, medicine, or public safety – are our own worst enemy because we don’t always follow our own advice. So getting her to make sure she does this may be a little daunting.

She called me at about 2:00 yesterday afternoon to let me know that her blood pressure was not right (unusually wide pulse pressure) and that she was dizzy and nauseous, and did I think she should be seen in the Whidden’s ED?

What do you think my answer was?

Two hours later I got a text message from her letting me know that she’d been triaged and was in a treatment room. Probably 30 minutes after that she called me to let me know she’d gotten a liter of fluid and was due to get more. As she didn’t know how they were going to proceed, I figured it was in her best interest if I got down there, so I got in the car and headed to Everett. Normally about a one hour drive from our house in Goffstown, it took me better than 90 minutes. When I got there, she was on her third liter, they’d given her anti-emetics, and she had gotten some pain medication. While the nausea was pretty much gone, the pain persisted. So she got another dose of Imitrex (a bit more than 48 hours later than the first one) and a 1 milligram dose of Ativan. By the time we left at about 10:30, she was almost pain-free and not caring very much about anything. And my car is in Everett, so we have to go get it once she wakes up. It is approaching 2:00PM, and I don’t know how much longer she’ll sleep.

This past Saturday I was injured on the job. A 400-plus pound cardiac arrest patient caused by me and one of the Paramedics that works for me to get hurt. Sean, the medic, ended up with an injury to his back, and I tore my right bicep. His injury occurred on scene and mine happened when we were unloading the patient at the hospital. Whoever was pulling the stretcher out of the back of the ambulance was a little bit overzealous and the safety bar hopped the arresting hook that is on the deck. I was holding the lower bar with my right hand while untangling IV tubing and ambu-bag tubing from the locking mechanism, and not a second after getting it freed I heard “the wheels aren’t down yet!”, and then the stretcher (with this very large patient still on it) dropped off of the back of the truck. I still was gripping the bar, and the next sensation I had, as the stretcher was dropping, was that my arm was being ripped apart.

I had a similar sensation when I fell and ruptured my Achilles tendon in 2008. At least this time I could walk.

So we went inside – all 8 or so of us that were wrangling this patient. Chris, the other medic on the truck, helped me get back on my feet. Once we were all inside, he and Sean did what they needed to do in terms of handing off care and I directed the rest of the traffic as best I could. Sean came back out and had to sit down, but he couldn’t turn his head. And my right arm was frozen.

The patient didn’t survive – his downtime was unknown, and we found out from one of his daughters that he’d been complaining of not feeling well for two days before this event happened. I have to think that he had an MI and it spiraled down from there.

Turned out Sean had an injury to one of his trapezius muscles, and it appears that I have a torn bicep. Right now it’s not too bad, but I suspect it will require surgery to fix. I have full range of motion of my arm and shoulder, but I have a lot of discomfort when I extend my arm. Flexing is less painful, but I have a bump of tissue at the mid-point between my elbow and the center of my humerus. And – it is starting to bruise.

Dealing with the workers compensation carrier hasn’t been bad – yet – but we’ll see what happens. It’s been a bit of a bad experience dealing with the orthopedic surgeon as his insurance coordinator, whom I’ve spoken with twice, appears to be a bit of a knucklehead. I’m not really happy about that; she had no recollection of our conversation on Monday. It’s a good thing I’ve been keeping copious notes, and I have a strong feeling I will need them. If I’m right, this could shape up to be a totally different experience than the one I had with my Achilles.

So I’m out of work indefinitely. The only silver lining is that classes start next Tuesday and I won’t have any work-related distractions. On the other hand, if I have to have surgery it’s going to require a little bit of fancy footwork on my part to not get lost. I’ll make it a point to talk to the two professors I have this semester (I had both of them last semester) and with any luck they’ll help me out.

Stay tuned.

Abusive Behavior

noreply@blogger.com (Walter Trachim) — Wed, 18 Jan 2012 18:27:00 +0000

How would you feel if that happened to you? More importantly, how would you respond?

I read this story a little while ago, and it made me sad, angry, and sick. If the crew on board this ambulance did what was reported, then they should be disciplined, at the very least. Sanctioning the crew members (“sanctioning” is a politically correct term for firing or terminating), in my opinion, wouldn’t be out of the question.

If there is more to the story I would love to hear it or read it.

Probably the thing that angers me the most is that the patient’s wife is a nurse practitioner with a boatload of clinical experience. Now I know what many EMS providers say about nurses – I’m sure I’ve said many of the same things myself – but this is one of those situations where even though measures were being taken, supposedly, to resuscitate her husband, she should have been given the opportunity to be with him. As it is, the report says she was doing compressions on her husband in front of the EMS crew!

As far as I’m concerned, it falls under the heading of abuse and neglect, at the very least. I think I’d want a piece of each member of the EMS crew, if it were my spouse being treated that way.

My opinion, of course…

Sitting Tight

noreply@blogger.com (Walter Trachim) — Wed, 11 Jan 2012 19:51:00 +0000

I'm sitting in a hospital room as I write this, watching Martha sleep, or try to. She was taken by surprise a couple of days ago by a migraine. It's the first one she's had in close to 3 years, and so far no success in trying to wrestle it down.

I brought her to the emergency room yesterday after almost 2 full days of her trying to manage it at home with no luck. Treatment in the ED went nowhere, and she was admitted as an in-patient at 6:30 this morning, 16 hours after arriving. Since she's been up here, she's been seen by a hospitalist - one of the docs that sees in-patients - she's gotten medication for nausea and pain (with more of the same result), and supposedly neurology is coming to do a consult. From what I'm seeing, the nursing staff up here are really busy but they are doing their best, and Martha actually appears to be asleep. That is good, considering she hasn't gotten a lot of rest since Monday.

I remember one other time this happened probably close to 10 years ago. Same circumstances, except it was a different hospital. The care was about the same but she was a lot sicker. I was terrified then. Not so much now, but still worried.

I have a feeling she will be here again tonight, but I don't know that for certain. At least she's reasonably well hydrated now as the doc ordered her IV fluids stopped. Now she's got to continue to drink as best she can. I'll work on that. Depending on what time neuro gets here will determine whether or not I go to work tomorrow. Plus we're supposed to get thumped with snow. I will believe that when I see it.

For now, we wait and see what will happen next. And I'll continue to watch Martha sleep.

2012's First Post - Baseball, Bandages, and Blogging

noreply@blogger.com (Walter Trachim) — Wed, 04 Jan 2012 19:15:00 +0000

I actually started this post Tuesday - yesterday evening. So now I'm getting back to it, and I think I have a fair amount to write about

I'm hopeful you all had wonderful holidays. I and my family did, and considering I worked around them ( like many of us who work in EMS) it could have been much worse. In any case, it was wonderful to be with my family.

I have been reading Glenn Stout's "Fenway 1912: The Building of a Ballpark" over the past couple of weeks. It was a Christmas gift from Martha, and it is a really fascinating read. It is an account of what happened in the first year of Fenway Park's existence as well as how the Boston Red Sox handled moving from their home field that was on Huntington Avenue in Boston's Longwood Area (the former ballpark property is now part of the campus for Northeastern University). The characters are, for lack of a better word, characters. It's interesting to note that personalities don't differ much from generation to generation, and the game of baseball was played differently in those days. Based on the descriptions, the game was much more of a defensive battle than the offensive one that is much more prevalent today.

Don't get me wrong; I love baseball. I don't care what two teams are playing; it could be anything from two major league teams to two teams of little-leaguers - it doesn't matter. It is a great game, and it always has been. And I'm always reminded of baseball's beginnings when I read historical accounts like this one. Even though there have been changes to rules in the relatively recent past (the Designated Hitter in the American League is one that sticks out for me, and I really wish they'd do away with it), the game of baseball really hasn't changed a great deal. Sure, the uniforms are no longer made of wool; now they can breathe, and ball players don't feel like they are wearing horse blankets when they play. Catchers are protected in a much better fashion than they were 100 years ago. Probably the most telling thing is that the baseball player of today is a high-quality, high-speed athlete, and I don't think that was so much the case back then. It's not to say that there was no athletic ability present; you have to have athletic ability to play any sport at any level. But it is different now, even more so than, say, 40 years ago.

The last of my grades are in: a B- in Statistics. I was actually expecting to do worse because I thought I totally blanked the final. However, I didn't, and I can say without reservation that I'm glad I won't have to do that again. It was easily as difficult and challenging as Organic Chemistry was, and I suspect that the next semester won't be as bad. And I figure that if I could survive this semester, I can survive PA school. As it is, I'm trying to set up shadowing time with a PA or even a Nurse Practitioner - either would be acceptable - and I placed a call with the education department of one of Manchester's hospitals as there are supposed to be opportunities available.Hopefully there will be a call back soon with the ability to have a conversation with someone. We'll see.

It is incredibly cold outside today - 18 degress Farenheit as I write this. Perfect weather for hypothermia and frostbite. It is only a matter of time before we deal with some of those cases; last year we dealt with a number of them. None were horribly serious, but it's always serious when someone is in danger of freezing to death. The only thing with that in mind is when someone is that cold everything slows way down. And the conventional wisdom is that "a person isn't dead until they are warm and dead."

If I run into that situation this winter, we'll see if it proves to be any different.

The Word Of The Day: Google+

noreply@blogger.com (Walter Trachim) — Wed, 21 Dec 2011 21:46:00 +0000

So I went to put up a new post, and when I started the editor I use (I went back to Blogger's default editor a couple of weeks back), and I was greeted with the whole Blogger/Google-Plus (Google+) enjoinment message.I figured, "why not?" It makes sense to consolidate some of this stuff. In doing so, I suspect some things might look a little bit different. And if it does, it shouldn't be a bad thing by any means. If it is, I have 30 days to switch back. We'll see.

Some of my grades are available. Organic Chemistry: B. Biology I: B. Statistics: unknown as of yet. I suspect it will be around the same ballpark, though.

I am not surprised at the Biology grade; it could have been better, but I stumbled at the very end of the semester because I worked like a dog to get ready for the Organic Chemistry final, which was 10 points better than the mid-term. I was extremely happy about that, and I was just as happy about the final grade. Now I'm awaiting the Statistics grade to see how I did there; I am not sure how the final exam went, but I can say that it was a bit more challenging than I would have liked because of all of the cumulative material the professor put on it. That said, I think I may be okay. As long as it was better than a C-, I'm not unhappy, and I think it will be.

Yesterday and the day before I spent with my mom. She is dealing with some significant medical issues, one of them being a condition known as Myelodysplaysia. It is a syndrome where bone marrow becomes increasingly unable to produce red blood cells, and it is classified into different types. I don't know which type she was diagnosed with, but she has been dealing with it for close to 15 years. One of the side-disorders that goes along with it is pernicious anemia, which she has. For a considerable amount of time she has been getting Procrit to help her produce more red cells, but when she saw the hematologist this past Monday we were told that it needed to be stopped because it has become increasingly ineffective for her. Yesterday she received a blood transfusion - 2 units over about 6 hours. I stayed with her while she was having the transfusion. She slept for the most part, and I read or listened to the news.

I'd forgotten how tiring it was to sit and do almost nothing. And I think my mom got a good night's sleep when she got home.

On the was back to her house after she was released, we were on the highway getting ready to turn off at her exit when about a quarter mile ahead of us a vehicle went over the guard rail and into the median. The vehicle (a Jeep Grand Cherokee) rolled end-over-end at least 4 times before coming to a stop. When it went up over the rail there was one of those large, high-visibility road warning signs ("buckle up", "click it or ticket", "texting is illegal", etc.). The sign got bashed as the car went over.

It was a spectacular sight. My mom and I were chatting and we both happened to look over at the same time. We both saw the same thing and couldn't believe it. So I pulled over, as did a vehicle in front of me, and called 911. The other driver that stopped also called, I think. But we both went over - as did a number of other people who stopped - to see what was up with the driver. My Mom, to her credit, stayed in the car.

The Jeep was on its roof. When we got to it, some of the other people there were trying to right it - the worst thing anyone could do under those circumstances as it was unstable and things could have become much worse for the driver, not to mention the problems that the people who were trying to move it could have brought on themselves. As it turned out, there was an EMT-Basic and a nurse that had stopped as well, which was all fine and good, but since none of us had rescue equipment, it didn't mean a thing.

I got down as close as I could to talk to the driver - he was conscious, he could wiggle his toes and fingers, and he didn't remember what was happening prior to the crash. I'm pretty sure he was belted but from what I could see his airbags had both deployed and both his windshield and rear window were popped out. And I stayed with him until Fire and Rescue arrived. State Police got there almost immediately after I called, and the trooper was good once he knew there were medical people on scene. When he was finally extricated from the vehicle - it took about 10 minutes to extricate him - EMS determined that he needed to go to a trauma center. So the highway got shut down for a landing zone to be set up. And we got out pretty quick after that.

My mom had expected that the driver was killed, but she was totally blown away when I told her he was alive and talking to me. She was also pretty impressed with how quickly everyone arrived; I don't think she'd seen anything like that. And it was a bit of excitement she didn't expect added to her day.

For that matter, I didn't expect it to be added to mine, either.

It's Over - For Now

noreply@blogger.com (Walter Trachim) — Wed, 14 Dec 2011 18:46:00 +0000

I survived the semester.

All of my final exams - three of them - were scheduled for yesterday. I got through all of them, although I'm not certain who well I did on any of them. The best I can say is that I was able to finish them all on time. And none of them were especially easy; I think I had the hardest time with, surprisingly, the Biology final. I had to sort of sacrifice for that one, though, because I was so worried about Organic Chem. Between that and Statistics, I spent a lot of time getting ready for them, and I spent a lot less time on Bio, so if I did tank it, I shouldn't be surprised.

The thing I am most happy about is that the semester is over. It was extremely difficult; in a way I guess I bit off more than I could chew, so I have nobody to blame for that but myself. In a perverse way, however, I got more out of the semester than I expected; I know what an Eniantomer is, and I know what Chiral Compounds are; I didn't know those things at the beginning of the semester. I now have the skills to at least get a basic idea of what is on an IR Spectrograph as well as an NMR display (either H1 or C13), and I can predict substitution and elimination reactions.

I know how to set up regression analysis, I can do chi-square calculations, and I now know how to conduct a one-way analysis of variance with more than two variables.

I got a good review of the Krebs cycle and electron transport chains, I know what proteomics and genomics are, and I learned about the Calvin cycle - this was something I'd never been exposed to.

So whether or not I got decent grades this semester, I think I at least came away with some knowledge and skills I didn't have before. And next semester promises to be a continuation of this one. With Biochemistry, the second semester of Biology, and a survey course on existing diseases, it should be very, very interesting. And I am going to try to get on top of things before it starts.

For now, I'm going to take a couple of days of well-deserved rest. My brain can really use it.

Wiki Site

noreply@blogger.com (Walter Trachim) — Wed, 07 Dec 2011 22:34:00 +0000

As promised, I have the address for the Wiki I created for the Organic Chemistry project I did. It can be found here. I hope you find it to be informative. I certainly did when I was doing the research...

Another Edition Of Experimenting With Apps

noreply@blogger.com (Walter Trachim) — Mon, 05 Dec 2011 17:44:00 +0000

I run the Google Chrome browser on both my notebook computer and its ersatz companion for Android on my tablet. Lately I've been looking at the Chrome applications and widgets, mainly because I've been curious as to whether or not any of them really work, and over the past few days I've added maybe a dozen extensions to the browser on my computer to play with, and so far, the numbers look surprisingly good.

I'm writing this post with the Blogger extension. Usually I write with Windows Live Writer, which is okay, but I wanted to change the way I look at the screen. I did this mostly because I want to write more than I have been, and I have to think that part of the reason I haven't been writing is that I've been bored with the user interface. That probably sounds a little strange, but it is what it is. So we'll give this a try for a while and see if I'm any more productive with this than I was before.

On another note, I'm working on the finishing touches to a Wiki site I've been putting together for an ongoing project this semester. When it is complete I will share the URL here as well as on my Twitter account. I've been looking at what is involved in breaking down a Clandestine lab, specifically some of the science behind it. It has been truly educational; I knew on the surface how bad they are, but I had no idea what some of the substances were that are found in the sites. Very scary stuff. And I hope my finished product is at least somewhat educational.

What follows is the end of the semester, final exams, getting ready for Christmas, and all of that. Between being really, really busy and then getting sick (every member of our household got that really nasty cold that has been going around plus it's possible that my grand-daughter has conjunctivitis - more to follow on that) we haven't had time to decorate our house. It's not that we make a big deal out of it - we really don't, and we keep it pretty simple - it is just that there has been no motivation so far. I imagine that will change over the next week or so. Further, the weather we've had lately, pleasant as it has been, is not contributing to the holiday attitude. But I'm not horribly upset about that either.

Now it is back to work on the Wiki. I'm going to try to get it completed this afternoon so that I can start working on getting ready for final exams. And this semester can't end soon enough, at least for me...

Thanksgiving 2011

noreply@blogger.com (Walter Trachim) — Thu, 24 Nov 2011 17:24:00 +0000

It’s hard to believe there is just over a month left of this year. It went by so fast…

As I write this I’m at home taking a little bit of well-deserved down time and spending it with Martha. My kids are all spread out this year, as usual; Kerry is with her boyfriend’s family, and Nancy and Jon are with their mother. Peyton, the little one, is with her dad for a chunk of the day. And I’m working tonight – my normal Thursday tour, to be sure, but I am still working on a holiday (again). At least this year I am not working on Christmas or New Year’s Day – I did that last year. I am, however, working both Christmas and New Year’s Eve, and both of those days have the potential for being much worse, especially New Year’s. Because of this, I suspect that this year is going to not just be different, but busy. I could be wrong, and I’m hoping I am, but I won’t believe it until I see it.

Even though it is a break from the classroom and all that goes with it, I still have work to do. A paper that needs to be written for Biology, the Wiki page that I’m working on for the Science and Technology symposium at UNH-Manchester on December 6 (I’ll post the link to it when it’s done), and the never-ending homework. I expect to work on some of this later today/tonight/tomorrow and Sunday (I’m working Saturday in Boston, per usual), and I need to get cracking.

With all of that said, I have a lot to be thankful for. An awful lot. The list is like this:

Excellent health
The love of a wonderful woman and an awesome family that I simply couldn’t live without
A grand-daughter that, if she weren’t here, would leave a huge hole in her wake. This is a person who lights up everyplace that she goes. I would do anything for her
My friends – people who keep me grounded and remind me who I am, every single day. I thank you all for that, otherwise I would be shiftless and have no foundation. I appreciate that more than you will all ever know
The opportunities to keep my “mental muscle” in excellent condition – thank you to those who challenge me whenever I am in the classroom, both teachers and fellow students alike. I am living proof that you can “teach an old dog new tricks”
The ability to do the work I am doing – as arduous and hazardous as it has the potential for being, I wouldn’t want to do anything else
Men and women who are willing to stand on the wall – we simply can’t thank them enough. And whether or not you agree with why they are where they are, remember that these are the same people who would be on the wall here if it were necessary
The freedoms we enjoy, along with the ability to make the right choices to keep them
A good life. I can’t ask for more than that

Happy Thanksgiving, everyone.

Kids Victimized – Again!

noreply@blogger.com (Walter Trachim) — Fri, 11 Nov 2011 04:05:00 +0000

I’m sure by now many of you are aware of the events at Penn State. When I heard and saw the news reporting, I was sickened. It brought me back to a couple of different places, namely all of the stuff that surrounded (and continues to follow) the sex abuse scandal within the Catholic Church, and the personal trials I went through when I was young.

The reports surrounding the arrest of Jerry Sandusky get worse – allegedly, according to some of the press reports, he was pimping out some of these kids. Joe Paterno was fired – he blew it. As far as I’m concerned, it was appropriate at the very least. The firing of the president of the university was also appropriate in my view.

In a press conference held last night some really callous reporter asked who would be coaching for this Saturday’s game. I couldn’t believe that when I heard it as it made me incredibly angry that someone would have the gall to ask that question.

Even so, I have to remind myself that nobody has been convicted of anything yet. Just the same, terrible things happened, and I’m no less angry about any of it. And I have to wonder about something: has anyone given any thought about the kids? I haven’t seen anything in the press coverage giving any service to whether or not victims have been considered. Is that going to happen? From what I can see, it is anyone’s guess.

Catching My Breath (Just For A Minute)

noreply@blogger.com (Walter Trachim) — Sun, 23 Oct 2011 19:46:00 +0000

I really should be studying. And I am going back to the books after I write this post. I’d planned to write this week but I simply needed a couple of days to just breathe.

This past Tuesday was the mid-term exam for Organic Chemistry. It was not my finest hour. For that matter, I think most of the class took a bath with this exam. It was challenging, and I thought it was fair, at least initially, but now I’m not so sure. I’m sure the questions (there were 50) that I missed were ones I missed legitimately, but I don’t know where I went wrong. Since I have to go over to school tomorrow to take care of some business (making an appointment with a tutor to go over a paper I have to write for Biology and setting up an appointment with my advisor for next semester’s course load) I will probably stop in and see the professor tomorrow afternoon to get a look at my exam.

In all of the conversations I’ve had with people about Organic Chemistry as an academic subject, I can say almost without exception that everyone I’ve talked with has pretty much said the same thing: it sucks. And it does; academically, this is the most difficult class I have ever taken in all of the years I have been in and out of school. It is even more difficult than either the advanced mathematics courses I took years ago when I was working on my bachelor’s degree or the rigors of going through Paramedic school with all of that anatomy and physiology crammed into 18 months of the program.

With all of that said, it’s clear that I’m going to have to step up and work even harder than I already am to earn a reasonably decent grade in the course. I still have opportunities to do that; between all of the homework assignments (40% of the course grade), a symposium project due the week before final exams (20% of the course grade) and the final (exams are 40% of the course grade), not to mention the labs (based on a separate grading system), I have the potential to come out of it at least a little less pummeled than I would be if it all were to end right now. And I am going to do everything I can to make that happen.

Once I sign off of this post I have to continue preparing for a Statistics exam I have this Tuesday as well as work on the Biology stuff I have going on.

On other fronts, I have been doing a bit more clinically-oriented stuff at work over the past few weeks. During the tour I worked in Boston yesterday I responded with one of the Newton ALS units to an unresponsive in a vehicle. Turned out to be a 77 year-old female who in fact was dead. As it was, there were bystanders who called it in – the person who actually made the call said that she’d been there for quite some time before anyone noticed that something was amiss. Regardless of her status, the effort was made, and when I arrived maybe two minutes after the ALS unit and the engine company CPR was in progress and she had no shockable rhythm. So the full court press was turned on. As it happened, one of the Paramedics on the truck was having trouble securing her airway; her glottic opening was really anterior so it was tough to get a look at her vocal cords. I offered to look and he let me, and I found that with a little bit of changed positioning, cricoid pressure, and some gentle persuasion I was able to pass an endotrachael tube that worked. That I was able to get the tube where it belonged was a bit of a surprise because of her anatomy – afterward I said it was a “Hail Mary” attempt at intubation that happened to be successful. In the end, however, it didn’t really matter because within a few minutes of us arriving at the ED with her she was pronounced.

Last week I started off the tour with this crew and a cardiac arrest as well. That one was witnessed, the ACLS guidelines were followed nearly to the letter, and it was a save situation; the patient regained pulses and started breathing on his own as they backed the ambulance into the ED entrance. Not this time, though.

This past Thursday (in Goffstown) I worked with a brand new EMT. A young woman – Stephanie is her name. She is a really nice person, she is extremely intelligent and learns quickly, and she knows her role. All of that said, she is new at this business. And for her I had to dial back the speed just a little bit. We got sent out at 4:30AM for a chest pain. She wanted to drive, so I was okay with that. Got us to where we needed to be, maybe a little slower than I would have liked, but I had to remind myself that patience was in order. Arrived on scene, 64 year-old female, onset of pain about an hour before we arrived. It woke her out of a sound sleep, and she reported that it hurt more on inspiration. But it radiated down her left arm, so I had to think of the possibility that this was a cardiac event, and I dealt with it accordingly. Serial 12-lead ECG’s were unremarkable for ectopics, her blood glucose level was in the “normal” window, and her vital signs were all good. She was pink, warm, and dry, alert and oriented properly, and she did not look like she was 64 years old. It was obvious that she took good care of herself because I would have put her between 7 and 10 years younger. With all of that said, I still did what was necessary under the Acute Coronary Syndrome guidelines. And I had Stephanie do a lot of the work because she needed to experience what it was all about. There were some things that I couldn’t let her do (like start an IV or give some drugs) but she could do just about everything else. And she did fine. Plus she had lots of questions afterward, so I didn’t leave work Friday morning until about 8:15. And I needed to be in Manchester for the 9:00 refresher class.

So even though I took a couple of days to sort of lean back and rest on the fence post, I was still busy. And I’m back at it again. It never ends, does it?

The Stressed

noreply@blogger.com (Walter Trachim) — Sun, 09 Oct 2011 20:59:00 +0000

This one isn’t a school-related post, believe it or not…

I worked yesterday in Boston. The shift I didn’t give up – I still have command on Saturdays of all the Boston-based crews as well as the city of Newton. It was one thing the manager I work for asked me to keep, in terms of work schedule, only because of the people that are there. For reasons I still don’t understand, many of them seem to like having me around. To be totally honest, after almost a 18 months I still haven’t figured out the reason why.

It was an interesting day. Because it was Yom Kippur Friday and yesterday, that added the possibility of things going wrong. But as it turned out, there was only one call that I am aware of, and it was a refusal. An 89 year-old male who was a little dizzy and blacked out for a minute. Probably because he did the 25 hour fast that is part of the observance; at least that’s what we (and his physician, who was also there) suspected. He refused to go anywhere, so the crew who responded let him be.

The one incident I went to turned out to be a problem for more than just me, and I wasn’t even directly involved. A 51 year-old female being transported from one of Boston’s major hospitals to one of the hospitals outside of the city to be evaluated for suicidal ideation. From what I was able to gather, she was on the verge of losing her home and the stressors were just too much for her to handle. So she told her family she was going to hurt herself.

The only history I am aware of is one of hypertension. She has no other history, medical or psychiatric, that anyone was able to learn anything about. Also, English wasn’t her primary language; I believe it was Portuguese with the ability to understand Spanish.

I was told that until the crew who was assigned to transport her arrived, she was cooperative. When they showed up, however, the situation changed; she didn’t want to go anywhere, she wanted her family, and then she started being physically abusive to everyone around her. I guess she started biting, kicking, and spitting. That was enough to bring out the chemicals and the physical restraints, but in talking with the ED staff later on, they didn’t want to “snow” her; they just wanted to get her out of there. And they have a point; while chemical restraint is practiced regularly in many places, you can’t put someone down to the point where they aren’t able to make some choices. And one of the hallmarks of Psychiatric care is precisely that; the patient has to have the ability to choose. At the same time, there has to be some level of safety for the people around her, which was why the physical restraints were used.

In my assessment after this was all done, there were things that should have happened which didn’t. First, the crew should have called for help if there was an issue. They didn’t do that. In fact, the ED nurses who were taking care of this patient showed no indication of any problem with the way this was going. The crew told me that it wasn’t that they weren’t comfortable with the situation, but they were concerned about this patient’s safety. Also, the sending hospital didn’t notify the receiving hospital that the patient was going to be restrained. If the receiving hospital had known that, they could have prepared for it. As it was, the Administrator On Call (at the receiving hospital) told the staff that if anything like that were to happen again they wouldn’t take anymore patients under these circumstances.

One individual I didn’t mention was the Psychiatrist who was the attending at the receiving hospital. He told me he had no knowledge of this patient’s impending arrival. Apparently, the doc on the receiving end who accepted the transfer wasn’t even in the building, but her name was on the paperwork. When I brought that up to both hospitals, neither one seemed to know what I was talking about. That made me just a little angry…

My concerns in all of this were for the patient and for my crew. What if something had happened to either of my crew members or to that patient during transport? Potentially, if something were to happen it could have terrible consequences. And – it was a stressful situation for all involved.

I hope to never have to handle something like that again, but the way things go, anything is possible.

Projects And Deadlines

noreply@blogger.com (Walter Trachim) — Mon, 03 Oct 2011 18:11:00 +0000

This semester there were projects assigned in all of my classes. Two of the projects are due near the end of the semester and one is already ongoing. All of them put strain on the workload, but they’re all underway.

Biology’s project is a research paper. The topic I picked (and I hope it’s approved) is related to tissue engineering and how feasible it is to grow peripheral nerve tissue. I submitted the proposal a week and a half ago and I have to get started on the research over the next week or so. The sources we’re being given are limited – I can’t go to journals. I have to stick with “mainstream” publications, which might make this a little more difficult than it needs to be. That said, I’m pretty confident that I can get it done. I’m not certain, however, that it will be in the manner I would like; the research may take me in a completely different direction. But we’ll see.

Organic Chemistry’s project is just that: a full-fledged project. It involves research and writing, and there is a creative component involved. I’ve decided on the subject of how to deal with the waste stream generated at the site of a clandestine drug lab. It will involve a lot of research – just dealing with the toxicological aspects of the chemicals will be almost a project in itself. And I’m only looking at organic compounds; I’m not even considering the inorganic stuff because it isn’t appropriate in the scope of this project. I am studying organic chemistry, after all… The part of this that I’m pinning creative usage on is in the form of an interview with at least one subject matter expert. I’m looking either someone from Law Enforcement or the Fire service, a chemist with expertise in dealing with mitigation of stuff like this, or a physician familiar with the long-term impact on the health of anyone exposed to these chemicals. I may have to narrow the scope of this some and deal with one or two chemical compounds. But – that is something I’m sure I’ll talk with the professor about.

The third – and ongoing – project is the statistical analysis being done with SPSS. I completed the first of four assignments late last night and will surely see the next one tomorrow. So far I’ve found that SPSS is not a bad application. Supposedly there is interoperability with Microsoft Office, and to a degree I was able to move output object data from SPSS to a Word document with relatively little difficulty. That made it easier for me to format the output and use less paper to print it on. If I had used raw output from SPSS it would likely have been a little less neat. I’m not unhappy about that; even with my relatively inexperienced eye I can parse the output with little trouble.

As I sit and write this I do have homework to complete. Chemistry problems need to get done and problems related to Probability Theory need to be worked on. I’ll catch up to this later in the week and maybe I’ll have some EMS-related stuff to write about. The Paramedic refresher I’m taking starts this Friday and runs for six consecutive weeks. One problem that it causes for me is that it takes a study day away; I’ll lose my Fridays during the course of the refresher. But I may be able to work study time into breaks, after I get off shift early Friday morning, and in the afternoon. We’ll see what happens.

Until next time, my friends.

On Study And Practice

noreply@blogger.com (Walter Trachim) — Wed, 21 Sep 2011 17:32:00 +0000

As I said in the previous post that I wrote, I had forgotten how challenging it is to be a full-time student. I wanted to elaborate on that some because it is close to the surface for me. It has been since the semester started, and I have a strong feeling it will continue to be that way for quite some time.

Both Jon, my son, and Nancy, my daughter, are full-time students. Jon is in his fourth year as a Psychology major at Keene State College. Nancy is in her second year as a Nutrition Science major at UNH in Durham. She originally majored in Biology but she was always really interested in the subject of nutrition. They both carry full academic loads and they both work incredibly hard. Sure, they have other things going on – they both have jobs and they also both have social lives – but they are, in effect, already working full-time at being students.

When I originally pursued a college degree many years ago, I did it in a sort of piecemeal fashion as I was working full-time and, when the kids came, working on being a parent as that was always first on the list of priorities. When I was going to classes, I made it a point to always do every bit of work that was required and to stay on top of the material because that was the only way that passing a class was assured. That has not changed. However, even staying on top of subject matter doesn’t assure the earning of a passing grade because it is always possible to stumble and fall at the last minute. That happened to me with one course I took, and I never forgot the lesson it taught me.

This coming Tuesday I have to take a major exam in Biology. It covers the first two units of material covered in the course so far, which is approximately 7 chapters from the text. The professor who teaches the lecture part of the course is really good about providing materials for study and review – she has published all of her lecture notes and she also has convenient office hours. I am in the midst of reviewing for it now, and this post is a break in the middle. As far as other work, I have a lab report due tomorrow for Organic Chemistry, and last night I took the first major exam in Statistics. I felt okay going into it but there were things I wasn’t really sure about afterward. All I can do is wait and see what happens. Plus, after the exam the professor started new material, including introducing us to a software package called SPSS. It’s been in existence for a very long time and has been modified repeatedly over its lifespan. The class is going to have 4 assignments due as part of the grade for the class, and while I think I will be fine with it, it adds to the learning curve of software use in the courses I’m taking. The other is a program called OWL, used for submitting homework assignments in Organic Chemistry. I imagine it has applications with other courses as well. We have all learned it on the fly, and while it is powerful, it’s not especially user-friendly. I’ve run into problems, as have others in the class, with doing problems where you know the answer you’re submitting is correct but it isn’t totally correct according to the user interface because of syntactical problems or usage of the IUPAC rules for naming compounds.

It’s hard work, and the details can sometimes be frustrating. But I am being constantly assured that I will do this, and I know I will. So far, I think I’m doing okay. I’ll have a better idea about that within the next couple of weeks. Until then, the work continues…

Missing In Action

noreply@blogger.com (Walter Trachim) — Wed, 14 Sep 2011 17:21:00 +0000

As the title says, I’ve been missing in action. I haven’t written anything since back in July, and I am feeling rather remiss because I’ve been unfaithful to myself and to those who read and follow my blog. For that, I apologize. But there is a lot to talk about because there has been much going on to cause my writing to come to a standstill.

First things first: I am back in school for the fall semester. This time it’s as a full-time student. I took a look at what I need to get done for it to be possible to apply to Physician Assistant programs, and I have a lot of work to do. This semester I am taking the following courses: Organic Chemistry, Principles of Biology I, and Statistics for the Behavioral Sciences.

A number of people have asked me if I’ve left the reservation. The question actually makes sense; if you think about it, how many almost 50 year-old individuals do you know that have willingly gone back to college? Bear in mind that I’ve been in school at a part-time level for a little over 3 years, and that in itself is something that many of my friends, family members, and acquaintances know. But my doing this is important, at least to me and to my immediate family. Martha knows how much I want this and she has been incredibly supportive and loving throughout this whole evolution. I can’t thank her enough for that. Besides, she’s said on many occasions that when I’m done, I’ll be able to “support her in the manner in which she is accustomed.” It’s a funny statement, and it’s been an ongoing joke between us, but at the same time she has carried the load for both of us and for our kids for a long time. It is the least I’ll be able to do.

I am still working, although not full-time. There is absolutely no way I would be able to do both, so I cut my work schedule back as well. Cataldo Ambulance, my employer, has been extremely understanding and gracious, and Chris, my manager, has been awesome. Both he and Ron, our Chief Operating Officer, wrote letters of endorsement for me when I submitted the admission application to UNH-Manchester. They were incredible – I can’t say enough good things about them or how appreciative I am of their support.

I won’t let them down.

Probably the one person who I am most accountable to with this whole endeavor, ultimately, is myself. I’m not only motivated to get this done both to the best of my ability and in the most effective manner, but it is also a matter of pride. I took this on of my own free will, and I have no plans to mess it up or sabotage myself. Not to mention that if I do crash and burn it’s going to cost me a substantial amount of money. So I need to ensure I get the most out of this investment. And that is what this is, after all: an investment in both my future and the future of my family.

There has been another reason why I haven’t written, one more basic than anything else: I hit a huge stumbling block over the summer. Part of the reason for that was that there really wasn’t a lot to talk about. I’d had no real interesting cases to discuss; much of what I’d been doing, in terms of call volume was pretty routine stuff, and there were really only a couple of things that could have been worth mentioning. Even those, however, were not keepers, so I really didn’t think of putting them out there as food for thought.

Right now my work schedule consists of a 16 hour tour in Boston on Saturday and a 12 hour overnight in Goffstown on Thursday. I can pick up shifts in Boston if I need to, but looking at my workload in school I suspect that will not happen much until the semester break. Right now the academic load gets priority over work, and it has to be that way whenever I’ve got school-related activities going on.

I’m hoping that the classroom load will inspire me to write about some of the things that are going on there. And there is some opportunity, I think, for that to happen. I have two major projects to do this semester, one in Biology and one in Organic Chemistry. And I need to buckle down this week and start looking into some ideas that I can submit for proposals to the instructors teaching the courses. So, in addition to the regular review of material (plus preparing for a Statistics exam this coming Tuesday) I’ll be doing that.

I have to say that I’d forgotten how much work being a full-time student is. Up until this semester, as I said, the load had been part-time, and I could handle that. And I’m handling the full-time load pretty well, all things considered. But it is a different animal; the perspective is certainly different, plus I’m considerably older than many of those that I am in classes with. That makes for some interesting exchanges, mostly with others who need help occasionally and for some reason think I might have more of a clue than others around them… I can say with reasonable certainty that this is definitely not the case; most of the time I am just as clueless. After all, isn’t that what part of being a student is about? Being clueless about a subject and wanting to learn about it? Ideally, that’s why any of us should be there, but I know that many of us (including myself) are there to fulfill requirements that we need to go further. On the other hand, and I’ve said this before, I like to learn new things, and I’m not ashamed to admit that there is so much that I don’t know. That is why I’m there: to learn. More importantly, I think it is necessary to understand what it is we learn and how it applies to what we do. That’s something I’m trying desperately to get a handle on. It’s coming, but I have a long way to go.

All in all, I believe I’ve found a source of inspiration – something I can use as a springboard for being able to write. Of course, if anything worth talking about happens with work-related events or with my family, I will certainly continue to talk about those as well. If you, dear reader, are willing to continue following my (mis-)adventures, I will continue to write about them.

And I thank you for reading this. I will make the effort to put out more as time goes on.

A Black Cloud

noreply@blogger.com (Walter Trachim) — Tue, 19 Jul 2011 16:21:00 +0000

Jokingly, that is what my friends are telling me that I am these days.

Over the past few weeks, whenever I’ve shown up for work it has been bad news, in terms of calls and patients. I worked this past Sunday night in Goffstown on a swap – I need this coming Thursday so that I can work on the Komen medical crew, and one of the younger guys was going to the NASCAR event up north so he couldn’t work. All things considered, it was just as well that I did work Sunday; we had double-medic coverage with myself and my friend Cheryl. I don’t get to see her very often, but she and I have been friends for a long time, and she’s one of those that I learned my trade from as she’s been a Paramedic for a little over 16 years.

I trust her completely. And we have always worked well together; it’s funny when you don’t see someone for a while and you still click…

The best part was that she didn’t know I was working Sunday, so it was really funny when I walked into the firehouse and I was greeted with this “Faux Frenchman” chortle that we’ve always hailed each other with. Just think of Pepe Le Pew in some of the old Warner Brothers/Looney Tunes cartoons, a little bit of Lumiere from “Beauty and the Beast”, and John Cleese in “Monty Python and the Holy Grail” when he’s up on the wall in the French castle (“your mother was a hamster, and your father smells of elderberries!”) and you’ll get the idea.

About an hour into our tour we were dispatched for a medical alarm activation in East Goffstown. Now, in terms of area, Goffstown is about 70 square miles in size. Not that big, but when you think about the roads and the layout of the town, to get from where we are posted at the Village Fire Station to the address we were sent to, it’s not a straight line.

An update while we were on the way was that it was for a party that was in respiratory distress and couldn’t speak between breaths. Not good – the pucker factor increased substantially in a very short time.

We had an engine company dispatched from the firehouse at that end of town, and they arrived on scene a little before we did. They had to travel a little less than a mile, and we had to travel approximately six. When we arrived on scene, we found that there was also a police officer present. Turned out the house was locked up solidly; the only access was through the bulkhead into the basement of the house, and even then it had to be forced. Once we got inside, we found our patient, a 58 year-old female who was in big trouble. She was sitting on her bathroom floor, barely conscious – a good descriptive word for her would be “obtunded” – and she’d been trying to give herself a nebulizer treatment but it was doing no good as she was sitting on the tubing. A quick assessment revealed severely diminished breath sounds, a respiratory rate of 8-10 shallow breaths per minute, and a radial pulse of 120. We got her up and out of the bathroom and onto our stair chair, which was really easy since she weighed just over 100 lbs., extricated her out of the house, and loaded her onto the ambulance. By this time her mother and brother arrived on scene plus we had additional help as one of the off-duty Paramedics arrived, and we were able to get her going pretty quickly.

We got a working breathing treatment started, got vitals and put her on the cardiac monitor. She was in Sinus Tachycardia with a rate of 116, no ectopy showing. A 12-lead was unremarkable, which turned out to be significant later on – I’ll get to that shortly. We got IV access and gave her a dose of Solumedrol while we were en route to CMC. During the transport she perked up considerably, became alert and able to speak in full sentences. She was oriented properly, but she was a little confused about the time of day as she was surprised when I told her it was 7:15PM. She thought it was the next morning. At about that time she started coughing – she brought up some brown sputum, an indicator that she has some sort of infection in her respiratory/pulmonary system brewing. Found out her history was significant for emphysema; her brother told us she was a two pack per day smoker and had been most of her life. That didn’t surprise me; her 79 year-old mother looked to be not only about the age that her daughter was, but was also in much better physical condition.

We arrived at the hospital, were greeted with “you cured her!” when we brought her into the treatment room, transferred her over, then restocked and got out.

About an hour after we returned, we got dispatched to the opposite end of town for a 21 year-old female having an asthma attack. That was about when the “you’re a shit-magnet” complaints started to roll in… We got to the scene of this call and found Mom and Dad at the car with the daughter, our patient, sitting in the back seat in severe distress. Dad was planning on driving to the firehouse with her in back – I had a word with him after all was said and done, basically telling him that his wife did the right thing by calling 911 and staying put, but he wasn’t listening to me until I told him that if he had just driven off he could have killed his daughter.

That made him stop and think, but I’m not sure it changed his mind.

In any case, our patient had gone for a hike earlier in the day. She is also allergic to animal dander and the family has two long-haired dogs. With no real air movement in the house, it’s likely that this kicked off an attack. So we got her out of the car, onto our stretcher, and into the ambulance. I made a quick call to our medical control physician giving him a heads-up and doing a quick double-check to make sure he had no problem with us giving her a dose of Magnesium Sulfate to relax the smooth muscles in her respiratory tract. He had no issues, so we did that as well as doing the rest of what we needed to (Duo-Neb, Solumedrol, and Epinephrine).

It’s nice to see medications work as advertised. And in her case this was no exception. We were able to turn her around and save her from certain intubation. She was much better when we arrived at the hospital – she went into the room next to the patient we’d brought in earlier, which brings me back to her. We were notified that her Troponin levels were through the roof, even though nothing showed up on the 12-lead that we did. She had an NSTEMI, or a “Non ST-Elevation Myocardial Infarction.” Also called a “Silent MI”, or “Silent Heart Attack.” We surmise that this probably happened because of the amount of time she wasn’t getting Oxygen to her heart.

But it doesn’t end – we got sent out a 5:00AM the next morning for a fall with unknown injury (and our tour ends at 6:00AM). Again, no access to the house. Fortunately, the police department was able to get in touch with one of this party’s family members who told them where a key was located. So we were able to get access to the house, and found an 81 year-old female who fell out of bed, landing on her bottom. Happened while she was putting on a housecoat. At the same time, two other calls came in for the town: another fall (who turned up the gravity?) and a standby for a Psychiatric evaluation. So we picked her up and evaluated her – she complained of hip and knee pain, and she wanted to be seen. Probably a good idea, considering she didn’t have the pain prior to the slide off of the bed. We transported her to the hospital – a much easier transport than either of the others that we did during the tour.

When I walked out of the firehouse at 8:00 yesterday morning, I realized that I hadn’t had a shift like that in town for all of four days. It was a near replay of the previous Thursday. And that was a replay of the Wednesday night prior in Newton.

So maybe I have become a black cloud. We’ll see what happens at the Komen; maybe if I stay away from patients it won’t be a problem. To be honest, however, I’m really not convinced.

Short One

noreply@blogger.com (Walter Trachim) — Sat, 16 Jul 2011 09:20:00 +0000

The view out the front door at 5:15AM. It is going to be another typical summer day in these parts.

Don't forget to stay hydrated, and if you have access to air conditioning, take advantage of it.

Now it's time to go to work. Peace out.

Not Because I’ve Wanted To…

noreply@blogger.com (Walter Trachim) — Mon, 11 Jul 2011 16:52:00 +0000

I’ve been away from this venue for a few weeks.

As usual, it’s the same sort of thing where I’ve been too busy to even talk with my family. I’m not sure it’s ever really going to get better, but at least I had a little bit of down time yesterday where I could spend a little time with Martha, and I even got to cook dinner. She appreciated that as she has been pretty busy and wiped out herself. And next week is the Komen walk. I’m going to attempt to get photos and post them, but we’ll see how that all goes as in the midst of the event things can get really busy. And they usually do.

So, what’s been going on over the past few weeks? Well, my grand-daughter is growing like a weed. I don’t mean that in a negative way, of course, but she is definitely coming into her own as a human being. She knows her mind (and lets everyone else know it as well), she is rampantly mobile, which in principle is a wonderful thing but sometimes it can be really tiring, and she is very, very smart. She learns really quickly. And she is simply a wonderful child.

I have to admit that I laugh at some of the things she does which could be construed as misbehavior. I watched my kids do the same things when they were that age – I didn’t have the pleasure of Kerry in my life until she was 10, but Martha has told me about some of her antics, and it is funny to watch Peyton do some of the same things now. It drives Kerry crazy. Scotty, on the other hand, is much more patient than Kerry is, and he handles things so much more in stride than Kerry does. As I write this, I can hear the back and forth going on in the other room and I am chuckling quietly because I know the apple simply doesn’t fall far from the tree.

As for other things… I’ve been undergoing treatment for tendonitis in the flexor tendon in my left hip, also known as the Iliopsoas tendon. For months I hadn’t been able to flex my hip up without pain, and I couldn’t figure out why. When I followed up in early June with my Primary Care physician regarding the blood work I’d had done in March, I asked him for a referral to a Physiatrist that I have been a patient of off and on over the past 5 years. Considering this is the sort of thing that a Physiatrist does, he was more than happy to set that up.

I have to put a shameless plug in at this juncture of the post. I don’t do this often, but I think it’s worth doing now. Kathy Leahy, DO, is the Physiatrist I see. She and her colleague, David Lewis, DO, are really good at dealing with issues like these. I first saw Kathy a little over 5 years ago when I wrecked my back on a 575 pound patient. She had me up and going in a little less than 6 weeks, and I was extremely pleased about that. She set me on a treatment plan for this issue, and it has worked well. I have a follow-up with her tomorrow, and I expect she’ll discharge me from her care. As it never affected my ability to do my job, that never came into question, so I don’t have to worry about that.

Speaking of work-related issues… This past Wednesday/Thursday was a busy and nasty tour. On the evening and overnight I worked with Mike, one of my absolute favorite people. He is a young guy, all of 22 years of age. But he is a solid human being, a really nice person, and a damned good medic for someone as young as he is. I have been consistently impressed by his skill level, and he works at a place that many experienced medics I see don’t work at.

I almost wish I could have him as a permanent partner. But I’m happy with my lot right now as Jason, the person who is my permanent Wednesday partner is doing fine. He is also proving himself to be a good, solid performer when it counts. I can’t ask for much more than that. Plus he’s doing a good job learning Newton. I think once he’s got the city figured out he’ll be fine.

Back to the story. Two calls that happened almost back-to-back were enough to mess the whole night up. As it turned out, we did five between midnight and 6:00AM, and we transported three of them – all sick or injured people. The first was for a fight at one of the hotels in the city. Arrived on scene, two people, on a 26 year-old female, the other a 51 year-old male. Together. Decided to ingest a whole lot of substances. I was told between the two of them they consumed a 12-pack of beer each and did a total of 5-6 lines of Cocaine.

Then they started fighting. The cops figured out that she started the festivities. He punched her in the face to defend himself, but he ended up with a broken nose and what we suspect is a closed skull fracture due to the depression we found at his occipital-parietal line. She ended up with facial injuries and a pair of silver bracelets on her wrists when she was taken into police custody and arrested for assault and battery.

As stupid as this guy was, I felt kind of sorry for him. He was certainly nice enough, and he was incredibly polite. He was just in a bad situation of his own making, and he knew it. But he needed to be treated for his injuries, so we did what we were supposed to do. Our job.

The second one, which pissed me off incredibly, was a call to one of the local favorite nursing homes of mine for the unresponsive female. We arrived on scene to find the district engine company present (we spent a lot of time with these poor guys during the course of the tour; as much as we all get along as well as we do, the joke was that we had to simply stop meeting like this). They informed us that we had a 56 year-old female, known diabetic, with a glucose of 17. We got into the room, found our patient totally unconscious and really gorked out. One of the nurses was there as well – the charge nurse for the floor who I’ve had to deal with in the past and is a real challenge. She is from the West Indies – I think she is from Haiti, but I’m not certain – and her attitude is rather, for lack of a better word, indifferent. We started to assess her ourselves and found some disturbing and alarming things.

First, when we re-checked her sugar, our glucometer read “low”, which indicated to me a glucose lower than 20. Second, she was hypotensive with a pressure of 56/38. And she had a heart rate of approximately 50. She also was recovering from a fractured right tibia/fibula, she had an episode of compartment syndrome in her left leg, cause unknown, and she had grafts all over both of her arms from all of the times she had cut-down access done on her. Plus, she was a known diabetic (big surprise there – staff put her to bed with a glucose of 89 and did nothing about it) and she was in end-stage renal disease and was going to dialysis three times each week. No fistula noted on either of her arms, and we found the Hickman catheter implanted in her chest wall. To top off everything else, she was incredibly obese. We put her weight at between 375 and 425 lbs, and she was maybe 5’4” tall at the most.

So we tried to get access on her – no good. The cut-downs were all over the place and in the way. Because of her legs we couldn’t use an IO gun to drill either tibia, and she had no neck – no access to her external jugular veins. And she’d gotten two doses of Glucagon prior to our arrival.

It was a bad situation. The best we could do was to package her, rapidly extricate her, and get to the hospital as quickly as possible. We took a driver from the engine company and Mike and I did everything else we could in the back, in terms of managing her airway and getting another dose of Glucagon into her. The third brought her glucose up to 42, which under the circumstances was an improvement but it was still not nearly enough.

When we arrived at the emergency room, as we expected, the staff was not happy with what we brought. The attending doc who was working gave us (specifically me) the third degree about what we had and why we didn’t do more. I didn’t say much, but I was pretty upset. Considering how frustrating it was to deal with this patient and not be able to do much for her, you would think that she would have seen that and not been so bitchy about it. I wouldn’t be surprised if she files a complaint with her medical director. And if she does, I’ll simply tell him what happened.

Under the circumstances it’s the best we could do. But it’s still frustrating.

Summer

noreply@blogger.com (Walter Trachim) — Tue, 28 Jun 2011 15:48:00 +0000

We finally have some weather worth talking about. Sunny skies, temps in the 80's... It doesn't get much better than that. And a holiday weekend that is imminent.

I'm writing this from the Barnes and Noble in Manchester, and I'm doing this purely because I'm procrastinating; I have an errand at this end of the city that needs to be done, I finished up another session of physical therapy about an hour ago (a story for another post; maybe the next one), and I desperately needed a strong cup of coffee. Much as I'm not fond of Starbuck's, it is about as strong as it gets around here. If I were in Canada I'd go to a Tim Horton's and get some of their high-test brew. It is very good plus it will cause hair to grow in all the wrong places...

This morning (early - approximately 2:30AM) we were dispatched to meet police for a checkup of a subject. We arrived on scene to find them with an approximately 35 year-old male standing in front of his car. He had apparently stopped on the side of the road to relieve himself (turned out he was somewhat impaired - a surprise? I think not) and fell headlong into the woods.

When we got to him his fly was undone, he was behaving rather belligerently, and he informed us all (me, my partner, and the two police officers) that he was a black belt martial artist. As soon as he told us this he decided it would be a good time to put on a show. He tried to go into a combat stance but the cops immediately took him down,cuffed him, and put him in the cruiser.

My partner and I observed all of this and decided it would be a good idea if we went to the booking area to get a better look at him. When we arrived we found him seated in the booking area, still handcuffed, giving the officers present awful attitude. As soon as he saw us, we became the object of the same diatribe.

I have to be honest: I thought it was pretty funny, especially in light of being told earlier in the tour by a sick elderly gentleman we transported to "shut up" when I was explaining what we were doing. That was also amusing, but at least he had an excuse. This guy was just being really stupid.

So he kept at it, threatening to kill the officers as well as us if the handcuffs weren't removed. It's needless to say that he was kept restrained.

Yet another example of alcohol-fueled stupidity. Other than the relative entertainment value and his being unwilling to let us properly check him for injuries, it was the last call in what was another event-filled tour on my hometown. We had three others earlier, and they were all legitimately sick or injured.

This guy was just a knucklehead.

The New Gadget

noreply@blogger.com (Walter Trachim) — Sun, 19 Jun 2011 23:24:00 +0000

This post is coming courtesy of the tablet I gave myself as a birthday gift last week. An Acer Iconia - comparable to the Motorola Xoom' and cosiderably less expensive.

So far I like it, and I'm still working on learning the features. And I expect to put up more posts with it.

Regular posting will resume soon.

In The Kingdom Of Peace

noreply@blogger.com (Walter Trachim) — Wed, 08 Jun 2011 16:31:00 +0000

Amen, amen, I say to you, unless a grain of wheat falls to the ground and dies, it remains just a grain of wheat; but if it dies, it produces much fruit. Whoever loves his life loses it, and whoever hates his life in this world will preserve it for eternal life. Whoever serves me must follow me, and where I am, there also will my servant be. The Father will honor whoever serves me.

--John 12:24-26

This is an especially tough post to write.

One week ago a dear friend of mine died, and I’ve been struggling with the best way to remember him. At best, my recollections will be imperfect as I may have gotten some of the information wrong. If I have made errors, I apologize in advance and I will gladly correct them.

I first met John Westhaver almost 9 years ago. Martha introduced him to me – he was the pastor of the church she was going to. “Pastor John” or “PJ”, as he was known, was an ordained minister with the United Church of Christ (the Congregationalists) as well as a member of the American Baptist Conference. When I met him, he’d been at his church for about 6 years. His wife, Karen (who I occasionally talk about or reference in this blog) was the Director of Music.

Since then, I’d gotten to know John – not incredibly well, but I think well enough to get a pretty good measure of who he was. And I am amazed – I probably always will be, in fact – when I think about where he’d come from, what he did, and the life he led.

He was born in Melrose, Massachusetts – something I did not know. I did know that he grew up in Franconia, New Hampshire and Cazenovia, New York, along with a brother and two sisters. He served in the US Air Force as a young man. He was trained as a Russian linguist; this was a subject that he and I had many conversations about as I have struggled to learn that language off and on for a number of years. John still spoke it – rather fluently, in fact – and he was able to help me with some of the finer aspects of the language. I still don’t speak it well; as it is, I have trouble with in under any circumstances. If nothing else, his advice helped me learn to listen better. At least now when I’m trying to figure out what’s going on with one of my elderly Russian patients I can sift through what I don’t know to pick out words I know with a little bit more accuracy than before.

Because of this skill, I have no doubt there are things he took with him that will only be shared between him and God Himself, mainly because He has the security clearance to discuss them.

He studied at Boston University with the intention of going to Law School afterward. However, he was called to go in a different direction. So he enrolled at the Andover-Newton Theological Seminary, where he earned a Master of Divinity degree (an M.Div., as my friends in the Catholic clergy like to call it). He was ordained to ministry at age 28, and it took him to many different places, from parish churches on both coasts of the United States as well as to places in between. It took him back to the US Air Force. He served a tour as a chaplain in Vietnam – something else I didn’t know. His service was actually rather extensive; I don’t know all of the places he’d been, but I do know that he retired serving the members of both the New Hampshire Army and Air National Guard. And he was involved in the civil rights movement in this country due to his association with the Southern Christian Leadership Conference.

He worked as a counselor for a time. Karen, his wife, was the director of a Christian counseling service where he worked, and he was well-respected both for his listening skills and his insight.

Mostly, I remember him for that ability he had to listen. I remember his manner: he could be incredibly forthright and outspoken when circumstances called for that (when this happened, it was something you probably didn’t want to be the object of), but he was also one of the gentlest human beings I have ever encountered. He would often listen to me just run my mouth, and he would offer his encouragement just by letting me do that. And I appreciated his ministry, much more than I would ever admit or let on. He didn’t care about my Catholic background; he welcomed me into the community he led without judgment or prejudice.

He officiated Martha’s and my wedding ceremony. That is something that I will always be grateful for.

He baptized Peyton, my grand-daughter.

He ministered to me personally when I was injured. On the Easter Sunday that I was laid up in a hospital bed he came to visit me, and he brought Communion to me. We chatted for a few minutes afterward, and he was surprised (pleasantly, I think) that I recognized the liturgy he used, as it was from the Book of Common Prayer. It wasn’t hard to spot for me; I was brought up on it.

Up until about 3 years ago – I’m not sure of exactly when things started to change for him – he’d been an active, healthy individual. But he’d gotten sick through contact with someone that passed a virus to him. It affected his heart, effectively bringing on an onset of Atrial Fibrillation and enlargement of his Right Ventricle. Over time it had gotten to be more pronounced; he’d had to start a regimen of anti-coagulant drugs an be outfitted with a pacemaker. Gradually it had gotten to where his heart just couldn’t meet his body’s demands, and he went into failure.

I visited with him the Thursday prior to his death. He was an in-patient at one of the Manchester hospitals, and it had been decided that he’d be going to a hospice for whatever time he had. For what it’s worth, I was able to look at him from both a clinical and a non-clinical perspective. Clinically, it was clear that he was failing; he had fluid accumulation in his lungs which I could hear when I sat next to his bed. The Coumadin that he was taking had definitely affected his circulation as he had bruises on his arms that were visible. He was on supplemental Oxygen and yet he was still slightly cyanotic around his mouth. And he looked incredibly tired.

On the other hand, I took in his sense of peace and his resolve. He was awake and alert, and he knew what was coming. And he told me – quite directly, in fact – that he was ready to go.

The following day he was transferred to one of the hospice facilities in our area, and the day after that he slipped into a coma. Two days later, he passed away.

He has gone to the Kingdom of Peace.

Rev. John D. Westhaver, Jr.

December 4, 1935 – May 31, 2011

Peace I leave with you, My peace I give you. I do not give to you as the world gives. Let not your heart be troubled, neither let it be afraid.

--John 14:27

Memorial Day, 2011

noreply@blogger.com (Walter Trachim) — Mon, 30 May 2011 18:05:00 +0000

“Nobody loves peace more than the soldier, for in war he pays the biggest price.”

–Attributed to Major General Smedley D. Butler, USMC

Over the course of my relatively short life (my 49th birthday is in less than two weeks) we as a nation have been in a combat posture for most of it. As I mulled that over, I thought about and made a list of the places where the US has sent a military presence or already had one when we had people become subject to hostile fire and, in many cases, be injured or killed. It is as follows:

Vietnam
Operation Mayaguez/Koh Tang Island
Operation Eagle Claw, Iran
Lebanon War (Lebanese Civil War, Phase III)
Operation Urgent Fury, Grenada
Libya
Panama
Operation Desert Shield/Desert Storm
Khobar Towers, Saudi Arabia
U.S. Embassy Bombings, Tanzania and Kenya
The events of September 11, 2001
Afghanistan
Iraq
Libya

Notice I have Libya listed twice. If you don’t remember, we bombed Libya back in 1986 in retaliation for a bombing of a night club in what was then West Berlin where American service personnel were injured. That bombing was attributed to Khadafi’s regime and was cited as the last of a list of incidents that started in 1981 with an air combat incident in the Gulf of Sidra where Libyan jets tried to pick a fight with American Navy F-14’s. As I recall, they lost.

There are a couple of places listed where I am intimately familiar with what happened. I’m referring to the civil war in Lebanon, for one – in 1983 US Marines and Navy SEALs were sent to Lebanon as “peacekeepers”, along with British, French, and Italian forces, to help oversee the withdrawal of the Palestine Liberation Organization (PLO) from Lebanon. A major part of the reason this happened was due to an agreement with Israel, who had Beirut surrounded and, for lack of a better word, besieged. Gradually, the Marines, who were mostly positioned in a warehouse building at the Beirut International Airport, were subjected to increased hostility from those supporting the PLO (mainly Druze and Shiite militias supported by Syria and Iran). The climax of this hostility happened on October 23, 1983, when the barracks where the Marines were located, as well as the headquarters of the French airborne regiment in Beirut, were destroyed by suicide bombers. 241 Marines and 58 French paratroopers were killed in these bombings.

It was the biggest loss of life for the Marine Corps up to that time since the battle of Iwo Jima. And for me it was personal; six of the Marines who were killed were people I knew. And a week prior, one of my friends who was there was shot and killed by a sniper.

I have a friend, a retired Army officer, who led troops on Grenada when we landed there. He told me that it wasn’t the Grenadian military or police that they had to worry about; it was the Cuban regulars who engaged them.

Panama was much more difficult than the media reported; remember that the US trained many of Panama’s military officers as well as troops, and for many years we had a presence there (Howard AFB, Fort Clayton, the Rodman Naval Station, etc.) until 1999. All of the facilities – I believe there was 15 US installations total – were affected by what happened, as were the people, both military and civilian, caught in the middle.

The reason I mentioned all of the above is to remind us all that our young men and women have been sent to places that the vast majority of the rest of us can’t even imagine going to. Many have had to become active combatants. A number of them have died. And we all know people, especially recently, who have either been wounded or killed in the current operations we are involved in, or we know others who have children, spouses, or parents who are there now serving. Whether you agree or disagree about whether our leaders are doing the right things, when it comes down to our troops it doesn’t really matter. They serve to protect the rest of us. And on this Memorial Day, please keep that in mind.

Stay safe.

Tikki Masala, Strange Languages, And Sugar

noreply@blogger.com (Walter Trachim) — Thu, 26 May 2011 01:54:00 +0000

“Engine 4, Medic 2, respond to the possible stroke, 70 year-old female, conscious and breathing.”

When we arrived on scene, we were immediately faced with a potential language issue. Hindi. She spoke limited English. Fortunately, her son and daughter-in-law were with her and they both speak excellent English.

Her son reported that she was cooking dinner (it smelled wonderful in the house, but I couldn’t quite identify what was on the stove) when she started complaining of arm numbness and an apparent change in mental status. When we assessed her, it was as though she was looking right through me. But she seemed to not have any weakness on her right side, where she was supposed to have had deficit.

A quick check of her medical history showed hypertension and non-insulin dependent diabetes. And a quick check of her blood glucose level showed us right away what was going on.

It was 38.

So we got an IV established and gave her an amp of Dextrose. Immediately prior to my partner giving the Dextrose she was still looking at me like I was invisible. As soon as it started working she woke up, looked at me, and started chattering away at me in Hindi. Her son and daughter-in-law both started laughing, and when I asked them what she was saying, her son told me that she said I was scary-looking. And that made me laugh.

When we re-checked her sugar, it was up to 289. And when we offered to transport her to be evaluated, she adamantly refused. Wanted no part of a hospital visit in any way. So we released her. Got her to sign our refusal. And documented the call thoroughly.

Her daughter-in-law offered to send some of the Tikki Masala (I thought that’s what it was but I wasn’t sure) with us back to the Firehouse, but we’d eaten dinner about a half-hour before the call (homemade Mexican), and we were still good with that.

But it’s the thought that counts.

Finally – Nice Weather!

noreply@blogger.com (Walter Trachim) — Wed, 25 May 2011 17:07:00 +0000

It took long enough for it to show up, and I am happy to see it.

We actually have sun, some clouds, and dry air. My joints don’t hurt for the first time in almost two weeks, and I can breathe. That says a lot. I am pretty tired, though; I haven’t slept well for the past week, and I suspect the bad weather we had is maybe partially responsible. Perhaps this signals a change in my ability to get a good night of sleep. That will not happen tonight, though, as I’m working.

Grades haven’t posted yet. I’m still waiting on the results of the past semester. More on those when I know how things went.

At least for the time being I am working with partner du jour on Wednesdays. Today’s is Jeff, a reasonably well-experienced Paramedic with a good sense of humor and a decent attitude. That is nice. And today is the first time in over a month (I think this is either six or seven weeks, in fact) that I actually got to put my hands on patients. Because I’ve been training new people, it’s been tough to not step in and do things, but I’ve had to refrain, and I’ve had to provide constructive criticism and pointers on how to do the job better, etc. That is always a learning experience for me, just because there are always new ways of getting that sort of information across to someone who is being precepted. But it is nice to have a break. And it is always good to do what is the real work in this business, that of providing care for the sick and injured.

I got a call from the duty supervisor today. We’re supposedly going to be getting a visit from the Indian ambassador to the United States during the course of the day. Apparently he’s doing a healthcare tour in Boston, and we’re on the list of places he may visit. I don’t know if it will happen or not, but I think it’s interesting that he’d be brought to a Firehouse to see ambulances and meet crews. Maybe there is more to it than that, but I’m not sure it’s much more than a dog-and-pony show. If it amounts to anything I’ll talk about it here.

On an end note, I am working on putting my textbooks in a format that I can back them up in more easily. Right now I can open them and read them electronically, but I’m not sure what will happen when the subscriptions expire. So I figure that by doing this I at least am saving the content in the event that they become unavailable. It is just labor intensive. But that’s okay; it should be worth it.

Now – back to enjoying what is turning out to be a really good day.

A Non-Titled Post

noreply@blogger.com (Walter Trachim) — Mon, 23 May 2011 16:39:00 +0000

The only reason I used that as a title is because I can’t think of one. At least not yet. If I do, then I’ll change it. And I’ll probably leave this in just because.

All things considered it was a pretty good weekend. I took Saturday off from work, which is an incredibly rare thing for me to do. Martha had an event Friday night – bowling for charity – that she signed up us for. It was a lot of fun, but for the past three days I have been sore everywhere. With luck, a trip to the gym will loosen me up enough so that I can function. At this function I won a gift basket full of Italian specialty items, mostly foods, demitasse, two bottles of San Pellegrino sparkling water (great stuff), a bottle of Chianti which I am looking forward to opening, John Grisham’s novel “The Broker” (I am a Grisham fan), a couple of movies on DVD, and a CD entitled “Mob Hits”, which is music from various movies with the Mafia/Mob theme (“Goodfellas”, “The Godfather” series, etc.). The basket is sitting on my kitchen table waiting to be unloaded and homes found for all of the items inside.

Saturday we spent the day in Boston, mostly killing time because Jon, my son, flew in from London after being away since January. While we were in the city, we did a few things. We went to the Gardiner Museum, which I drive by all the time and have never, ever been to. It is located within walking distance of Boston’s Museum of Fine Arts, and it has an incredible collection of items that Isabella Stewart Gardiner collected over a period of approximately 40 years. The museum was also the sight of a tragedy: in 1990, thieves disguised as police officers stole a number of items that have not been returned as of yet. The empty frames are still present on the walls where the items had been. And security in the museum is everywhere. But there is construction being done on a new wing as well as refurbishment of parts of the existing museum. I would really like to go back and see what it looks like when the work is complete.

We also spent time wandering around like tourists, mostly at Quincy Market and Downtown Crossing. It is funny doing something like that because I am in and out of the city all the time, mostly with patients or dealing with various people from hospitals or other agencies, and I don’t get to see things from the perspective of a normal bystander. And it was interesting.

At the same time, Urban Shield, an anti-terrorist, anti-threat exercise went on for 24 hours over the weekend. If I had been working I would have been an active participant. But I wasn’t aware of it until Friday, and I had the time off scheduled well in advance. I’m told it was busy. Beyond that, I don’t know too much about how it went.

I am trying to get my act together for the day, and I have a lot to do. One of the things I need to work on is getting my stuff together for the admission application I’m submitting. I have two of three letters of reference in my possession; both the manager I work for and the COO were gracious in writing them for me. Now I’m waiting for a letter from the chief of the Fire Department I work for. I should have that soon. I also need to make arrangements for official transcripts to be sent and I need copies of my resume and my DD-214 (my record of discharge from the US armed forces), as well as other documentation. It’s almost all together, so I just need to package it. That will be this week.

For nothing to say, I think I said more than I planned. With any luck, I’ll be able to write about more over the near future. At least I’ll keep making the effort.