Sunday, July 18, 2010

When I am an Old Woman I will no longer worry...

I am beginning to think that this is what I will look like by the time we make it to October. I am worrying myself old! And not in the good or wise or well earned old way. I am just becoming pessimistic and cranky. Just ask my husband!

I was doing really well with all of this stuff up until about yesterday. My patience had been wearing just a tad thin. I found myself happily playing along with the Hubbs' "Ahw babe I'm so tired give me ten more minutes" routine one second and twenty minutes later seething with resentment that I was trying to wake him AGAIN. I am finding myself at shorter and shorter ropes with nebulous time lines and ambiguous deadlines. This is certainly not the Hubbs' fault. Not all of it anyway. Yes, he could decide that my sanity is a teeny bit more of a priority and just suck it up and wake up when he says he's going to. I KNOW how exhausting the half sleep of duty is. Sorry babe but I don't care. I am out there doing it too and I feel it in my bones too. The shitty part is that there is no one to take up the slack for either of us when it comes to shit getting packed, sorted, cleaned. It is either you or it is me. Every day you say you are going to get up and get something done and then decide to sleep in feels like you are saying "Meh, it's not that important after all. Someone else will do it." It's like pouring gasoline on my already, nearly constantly smouldering fire of overwhelmedness and exhaustion. I know but cannot fully comprehend the stress of being the financial 'only' right now. I am sure it puts it's own gut knotting stress on top of the oh, so relaxing act of moving and wedding planning. I KNOW....the thing is that I am drowning. I see all of the shit that needs to be done and all of the shit that is past due. I am tired of being the one who is "on top" of everything, the one who makes sure that things keep rolling. I want help. UNCLE. As sweet as the little sis is I don't want her help I want HIS help. I want to be important enough to him to inspire him to overcome his aversion to taking part of the helm when things get shitty and confusing. I don't love that we have fallen into the habit of me being the only list maker and timeline writer. I want more partnership than that. I want him to get engaged in "making it happen". If he is reading this he is upset with me by now. He is thinking that I am being demanding and overbearing and that I don't get what it is like in his head at ALL! He's right. I don't. Partly because he doesn't tell me. I think he doesn't tell me because he doesn't want to worry me and he is right. It worries me to no end when he tells me all of the things he is afraid of and I am shitty at listening to it.

I think this is my "Wife Work" right now. Just what I needed right? More homework! But this is important shit right here. This is THE stuff our lives together depends upon me mastering. I need to listen without absorbing the awfulness of worry. I have enough worry for both of us and I can learn to just hear his concerns without internalizing it all. I am not entirely sure how I will do this but I think that's what the next fifty years are for. I hope it doesn't take all fifty.

Anyway, the other side of all of this is how well I have been doing. I made it well past a month before losing my shit and then really only lost it after getting the crap news that we no longer had a solid closing date. I feel more and more committed to my life with G and here in the city. I am feeling more and more excited about joining the ranks of the midnight superheros who stand watch so everyone might sleep. I am struggling more days than not right now. I mean really struggling. I miss my folks and I miss summers on the boats and everything seemed simpler. It is hard to keep my forward momentum in the relative moments of day to day. In spite of all of that I have a more absolute sense of peace on it's way. My dear friend S pointed out to me yesterday that I only have to survive 63 more days and then it is all done. I will look around and see my lovely little house, my diploma on the wall, the wedding flowers drying in the window and my warm, wonderful, infinitely supportive husband by my side. I will work hard right up to the end and I will get to look back and feel pride in my efforts and joy, knowing all of this bullshit and indigestion was worth it. In the mean time....I need to keep my mouth shut, practice taking deep cleansing breaths, work hard at interning, eat well, run often and further and further and kiss my Hubbs. We will work out the partnership divide when the dust settles and we can talk without such high risk of hurt feelings. We will take our notes from this war and craft a better battle plan for the next such challenge....Yesterday as I sat at the table crying into a box of packed up dry goods I begged for a promise...."Promise me we will never try to do everything all at once, ever again?!"...He said "Yes honey, next time someone is trying to finish school and we are having a housing transition I am sure we will only have one or two kids and you'll just be pregnant so, yeah, that will be way easier..." He has a point. While I hope to not repeat this cycle of intensity often if ever again, life does not slow down much from here least not for a while. Not until my hair is the color of that woman's and my eyes as wise as I said, that is what the next fifty years are for.

Friday, July 16, 2010

Of First Tubes and Delayed Closings...

The night started out just like every other night...diabetic refusal, drunk and disorderly at the mission. At 2300 we were posted way out east. I had just finished my chart from the drunk and was opening my napkin across my lap, about to enjoy some yummy salad the Hubbs had packed for me. Doot Doot Doot, "Engine 22, Medic 723 respond to a 1432 Sanderson road for PD reporting possible assault. Stage and await PD."
"Damnit! My salad looked so good!" I was pretty sure it was going to be BS but I packed up my lunch and put on my gloves and my eye protection. I even pulled out a set and built an IV lock. I taped a trauma band to the wall so that I would remember to give the number to MRH if it came to that. We drove over to the staging area (out of sight of the address given) and we waited. It wasn't 5 min before the radio chirped "Engine 22, Medic 723, you can clear. Non injury."
"Damnit! I knew it. Crap!"
We went back to our assigned street corner. My preceptor and his partner fell asleep. I played solitaire for a while before giving up and closing my eyes as well.
At 0415: "Doot Doot Doot! Engine 22, Medic 723 respond to 1432 Sanderson road for AS1" (this means someone has been assaulted or at least that is what dispatch is calling it). "Wait a second, isn't that?" "Yup". And we were off, lights blazing, sirens blaring.
We arrived to find the nastiest apartment. It was like some frat boys had moved in and locked the door behind themselves. There were holes in the drywall, dirt everywhere and cans of 4 Lokos in various states of consumption lined up along the sofa and the entertainment center. On the floor of the apartment was a young man. He was face down on a sofa cushion writhing around like a wild animal. He was flanked by his brother and a "friend". His brother was significantly older and appeared entirely sober. The same could not be said for the friend. The brother informed us that he had a seizure disorder and he took medicine for it. He said his friend had called when he had started seizing and he had rushed over. That was about eight minutes ago.
I was still half asleep but mesmerized by this creature writhing about on the floor intermittently drooling and thrashing about and then still, staring at us and demanding to know what was happening. Before long we were in the back of the ambulance (here after referred to as "the car" for you non-EMS type). Once in the back he was seat belted to the stretcher and I set to work obtaining vital signs. I got a manual BP and heart rate as my preceptor turned on the monitor. I was attempting to take a respiratory rate when it dawned on my sleep fogged brain that he wasn't breathing. "Ed, he's, uhh, not breathing...." I trailed off. Instinctively I took my pen and squished on his finger to elicit a pain response as I shouted his name in his ear. "Jake! Jake! You need to breath! Jake! Wake Up Dude! You need to BREA..." "GASP!" He tried to sit up and began thrashing around. "Where's my girlfriend?! What the hell?!" He was "awake" but he was staring right through me. He started wringing his hands together and staring at them in a trance. *Meth? or just the Lokos?* I wondered to myself. Nobody said anything about meth...Not that that means a damn thing.... As I was pondering all of this I was hooking him up to the monitor and putting on the end tidal CO2 monitor. This lets us know A. Is he breathing? B. Is he exchanging oxygen and CO2 properly? I hit print on the monitor as I pulled my pre-made lock off the wall and started an IV. "Guess I get to use this on you after all." I said under my breath. I pulled the strip from the monitor and looked at his wave form (this is the tracing that tells us how well his breathing is working and how regular it is) it was ALL jacked up. There were a few breaths and then nothing. I thought about checking the connection at the monitor but instinct made me turn my head and put my hand on Jake's chest. He wasn't breathing. AGAIN. I shouted and squished his finger. I rubbed my knuckles on his sternum. Nothing. I looked to Ed who was getting out the leads for the ECG and I said "He's not breathing." It was almost like Jake heard me because again, he roared to life. This time making less sense and becoming increasingly wild in his movements. "He's not going to tolerate a non-re-breather mask" I said out loud. "Let's just get to the hospital" Ed said to his partner who was at the wheel. We fired up and as we pulled onto the road Ed looked at me. "He's your patient. Do you RSI him?"

RSI means Rapid Sequence Intubation. It is when you decide that someone is no longer able to control and protect their own airway and you need to control and protect it for them by paralyzing and sedating them with drugs, placing a plastic tube in their trachea, inflating a balloon to prevent anything else from getting into their trachea and then breathing for them with a bag filled with oxygen. RSI is a privilege and a HUGE responsibility. There are many states who do not allow their medics to RSI patients no matter how sick or unstable. It is a highly controversial topic in EMS right now. However, it is the gold standard of care for securing and protecting a patient's airway. Rescue airways like the king or the LMA do not secure the airway if the patient vomits. This puts the patient at very high risk for aspiration pneumonia...the reasons I am a fan of RSI go on and on and the research indicating both its strengths and liabilities are the topic for another post.

"How far out are we?" I ask, my voice catching just a bit. "How far to the hospital man?" Ed asks the partner. "Ehh 5min" he says. Ed looked out the window. "Hmmm. I don't think so. I think we are further out than that. What do you want to do?" I froze for half a second. "He's getting worse. He is spending less and less time breathing and more time apneic. He isn't coming around if this is post-ictal. If he's been drinking he's gonna puke. He's not going to tolerate a non-re-breather. I want to take over for him. Let's RSI him." "Ok" says Ed. "Hey partner, call fire back, pull over and join us. We need to tube this dude."

I jumped into the airway seat and began setting up my stuff as Ed began sorting out the drugs. Partner joined us and attempted to place a mask on his face for a little added 02. He woke up and began thrashing around and wringing his hands. He tried to sit up and appeared to be seeing things that none of us were seeing. *This kid is tweaked out of his mind* I thought to myself. I thought through my airway algorithm as I pulled out tubes and checked balloons. I turned on the suction machine and flipped on all of the lights.
"Etomidate is in.....Versed is in..... Succs is in.....30 more seconds....10..9..8......Ok, go time"

I placed my hand on his head and tilted it back, I opened his mouth and placed the blade in his mouth sweeping his tongue to the side. I looked and all I could see was pink and secretions. I held the blade with my left hand and reached for the suction on the wall to my right. I suctioned and repositioned. I hit the release mechanism to lower the head of the gurney with my knee and it crashed down onto my lap. *SHIT!* "Cric pressure please!" *Oh Damn! There they are!*. "I am visualizing the cords. I am passing the tube through the cords. I am in. Bag please." The partner placed the bag on the end of the tube as I withdrew the stylet. I had a death grip on the tube with my left hand as I fumbled to place my stethoscope in my ears with my right. I listened over the epigastrum and then over the lungs. It was so loud in the back of the car with the suction pumping away next to my head but I KNOW what tube in gut sounds like and there was none of that. I bagged him a few times and as the tape was being secured I could feel his mouth working away at the tube and my fingers. "Guys, he's waking up. We need some more sedation on board". Just then the fire medic arrived and the partner jumped out and back into the driver's seat. We were on our way. Jake was starting to writhe on the gurney again and Ed handed the fire medic the Midazolam. It felt like an eternity passed as he drew up and double checked the dose. Finally, Jake relaxed again. I was able to bag him easily again without the disturbing feeling of trying to compete with his own respiratory drive. It felt like days later, we arrived at the hospital. We piled out of the car just as Jake began waking up again. "Shit! He is just burning through this versed guys" I pointed out. It had only been about 7min since the last dose. We rolled into the brightly lit room and the Doc and the respiratory therapist were waiting for us with arms folded. "Good morning" I said. "This is Jake. Jake was at home partying with some friends tonight and we are not clear what happened but Jake had a seizure. Jake has a seizure disorder for which he takes Dilantin. His family and friend say he takes his meds as prescribed and he has not missed any doses. His buddy says he smoked some weed tonight. We arrived to find Jake apparently post-ictal on the floor. Initially he was making some sense and interacting with us. As we loaded him in the car he began making less sense and began experiencing longer and longer periods of apnea interspersed with periods of violent disorientation. We elected to intubate him. Vital signs have remained steady. He has a 8.5 tube, 27 inches at the teeth and when he is properly sedated he is easy to ventilate. He is currently waking up and starting to buck the tube." As if on cue, Jake reached his hand up towards my hand on the tube.
The doc called for more sedation and the RT offered to take over my spot at the airway. I happily relinquished the responsibility and kept watching what he did as I helped the nurse hold Jake down until the Midazolam took effect. "Let's get this young man to the CT scanner. I want to look at his brain and we only have about 10 min before he needs more sedation" the doctor said. As I was gathering up the wires and cords that were spilled all over the floor the doc looked at me. "Is that your tube?" "Yes" I said. "Nice big one. Good work." I blushed. "Thanks" I said, "It was my first one".
Fifteen minutes later Jake was back from the scanner and being tended to in his room by a troop of nurses and the RT. Labs were being drawn, x-rays shot and the tube backed out a little from it's placement in his right mainstem. I went to the bathroom and slumped to the floor. "No fucking way..." I said to myself as my eyes filled with tears. "No fucking way..." Somehow the gravity of what had just happened hit me all at once and there I was teared up on the ED bathroom floor. Adrenalin was rushing through me. My hands were trembling uncontrollably and I thought I was going to be sick. I took a few deep breaths and started to feel it all. *I helped that boy. I helped him breathe. I just did right by that kid. I DID it*. As Ed bragged me up to everyone on the computer. "She got in there an placed it on the first try. Did it like a rock star."

I have arrived on the doorstep of my education. I am ready to learn now because NOW I understand that this job is about 95% no big deal, diabetic refusals, drunk tank brawls. But it is the 5% that makes it life and death. The 5% that makes all the difference. I understand what it means to have a young man's life in my hands. It is huge. It is a terrifying honor. I am ready to learn how to serve my patent's best interest in the 5%.

As if that were not enough for one week The Hubbs and I found out today that the sewer guy "needs more time" and thus we will not be closing on the first of the week after all. I don't know what that means. I don't know when we will close or when we will move. I cancelled the moving van today and then cried. I cried for the unsatisfactory nature of it all. I cried for wanting it to be over. I cried for wanting my mom. I cried out of exhaustion and exasperation. This week has been wonderful and awful all in one. I think I will lace up my sneakers tonight and take myself for a nice long run. The breeze is cool and the sun has gone down for the day. I won't sleep anyway so I might as well get some endorphins cranked up. Tomorrow's another day, I'm thirsty anyway, bring on the rain.....

Saturday, July 10, 2010

The all you can eat (way more than you want) buffett of life

Name that city.....

If you said Denver Colorado you'd be right! Now why, you may ask, have I posted a picture of Denver? Well its a math problem. I sat down yesterday to figure out when I would be done with my internship hours and thus, when I could take my national registry exam and to my horror I will be taking it to the last few weeks before the wedding. If I manage to get all of my calls in I could be done before September 5th. This means that sometime before Sept 5th I will be able to take my director's oral where I sit down with my medical director and he tests me on drugs and patient care and likely a few critical scenarios. Once that is done I get to go to the testing center and take my computer based written exam. As soon as THAT is done I can take my practical. This is the exam where you suspend common sense and logic and show the NREMT that you know how to read and memorize their often ass backwards way of doing something. It has very little correlation to how things are done on scene, in the back of the car or at the hospital but whatever, they write the test and I have to pass it to become a medic so I will learn to walk on water if they want me to.

You're still wondering what the hell this all has to do with Denver. Well, here it is. There are only so many practical exams offered every year. They are offered all over the nation. Oregon is in the fall. The late fall. I don't have time to wait until the late fall to try to get a job or to let the information atrophy in my mind. California is a favorite. Folks find a car pool buddy and a cheep hotel and hop on down to Cali to test all the time. Maine even has one in Bangor. I could shuck out the 5oo.00 to fly home and then there is no rental car, no hotel, just hanging out with my mom. The problem is the date of the test. California is all at the end of August and likely, before I will be done with everything. Maine is on graduation weekend and I can't really miss my own graduation. So, Colorado is testing in the beginning of September. They are testing 5 days before the wedding. FUUUUUUUHHHHHHCK! It appears to be my best and really only option. The flight is pretty cheep, I found a cheep hotel and a decent rental car. All together with the testing fee it would be somewhere in the 800.00 range. That beats the pants off of the 1200.00 range for California.

The Hubbs and I have done a lot of talking about the wisdom of testing 5 days before the wedding and it is what it is. In the grand scheme, I need a job. The wedding will be wonderful and I will learn to let go. I have worked too hard and too long to not take 100% crystal clear focus to my exam. I will just have to deal with the rest when I get home. I think my mother is going to want to kill me but it is what it is. It is time to test and time to apply for a job.

G was helping me talk through the logic and look critically at the options last night and he said, "I just want to make sure its not too much all at once." I laughed out loud. "Of course its too much!" I said. "This whole thing is too much. Trying to plan a wedding while in school is too much. Doing it while trying to buy a house is too much. Trying to move, pull off a wedding, intern and prep for the exam is ALL too much. THIS WHOLE COURT IS OUT OF ORDER!". We had a good laugh and he said "You're right this is insane. I just want you to have your head wrapped around it the best you can so that you have the best shot possible". Ladies and gentlemen, my husband. The very best guy you could ever hope to have at your side in a shit storm. I think I'll keep him.

Friday, July 9, 2010

Update from beyond the boxes...

So...It is HOT here! Like really damn hot. I was out running errands yesterday and as I was standing talking to the frame shop guy I realized that the backs of my legs were sweating. Not the knee crooks but the actual backs of my legs were generating their own rivulets of sweat. Yuck! I am not a girl who digs the heat. Frankly, I am too well padded. That said, I hate hate hate air conditioning. I would rather be sweating it out then trapped in the "oh my god don't open the door or pull up the blind for fear of letting out the manufactured odd smelling air!" I just feel claustrophobic with the air on. Anyway, I am rambling.

The house: The sellers agreed to our inspection addendum and will be shelling out about 7k to fix the radon problem and the sewer line issue. In fact, they should be starting and finishing next week. I was quite pleased to hear that they got a better bid on the sewer and it will only be 5k instead of the 7k quoted earlier. The radon problem will still be spendy at 2k. Anyway, as I had always said, I didn't want them to suffer hardship on our behalf but as my realtor reminded me...that's the way it goes sometimes. That's the biz. Now all we are waiting for is the appraisal from the bank and the final approval from the loan underwriters and then closing 11 days! Cross your fingers for us! There are a zillion little ways that this could all go to shit but I am doing my damnedest not to focus on those things. If all goes well, by this time next week I will be totally done with the packing and onto cleaning projects. It will be hard with the dogs but I think I can start chasing cobwebs in corners and wiping down window sills and what not. We hired the carpet cleaners for the 28th and for all the carpet it was only $198. I was pleasantly surprised.

The Hubbs and I have been purging shit like we are on the Titanic and someone told us it was a weight problem. We are in the everything must go mode and I couldn't be happier about it. I am one of the biggest recovering pack rats you will ever meet. If you asked my folks they could tell you stories about me hoarding Popsicle boxes and scraps of paper. I have a vague recollection of thinking that they had feelings and that their feelings would be hurt if I threw them out. Well, moving across the country in the back of the Ford Ranger was the first wave of change for my pack rat mentality. I realized what a phenominal pain in the ass moving was and vowed to never acquire that much crap again. Oh how soon we forget. I had way too much shit when The Hubbs and I moved in together and worse yet, I had to pack up and move all of that in the middle of a total freak Christmas snow storm. The Hubbs has a TON of crap. When we first started dating he was in the process of moving. I helped him pack up and move out of his apartment which honestly should have frightened me off. It was one of the nastiest apartments I had ever seen. You couldn't even SEE the sink let alone the counters. I still don't know what kind of surface the kitchen floor was. It was 6 months away from a trail house. To be fair, he wasn't alone in that apartment. There was one steady roommate and a rotating cast of characters who would come, stay, trash and leave. was nasty. The next house was better but still too big and nobody really cared if the toilet talked to you or if the counter was covered in the remains of the last weeks worth of meals. By the time we were moving in together I was just so happy to be in a space that would be ours that I let him pack up and bring anything. BAD plan sister! He had six boxes of random bits of half broken shit. Paper clips and push pins mixed in with a storm whistle and an old tape of something....we don't even have a way to play tapes! Needless to say I had grand aspirations for the next move. The next move happened altogether faster than anyone in their right mind would have planed. We got the letter ten days before Thanksgiving. We had 5 weeks to be out but those were the weeks between Turkey and Ham and in between there were finals and a half marathon in Seattle! FFFFFFFF! No problem! SIL and I set on it like fruit flies to fresh peaches. We had a new house picked out and in process the next day. Four days later the house was packed up and the moving truck was in the driveway. Six days from the day we got the letter we were out and settling in to the new house. We had intended to stay here a while....we were happy with the stuff we had. It was no awesome but it was totally good enough for now. Once we were done with school and ready to settle in to a house that was truly ours we would worry about having the stuff we really wanted. Hell we were so happy with our current station that we weren't even going to register for stuff for the wedding. We wanted to take a medical relief trip. Well, getting that last letter changed things.

We are now registering for stuff. We have begun flushing out the stuff that we don't love adopting the philosophy of "we would rather have a space that we intend to fill with just the right thing than have things that aren't just what we want". It is liberating. It is significantly harder for my pack rat hubbs as he is just now beginning recovery and has backslides regularly. The most recent example is the pile of old, weird, wool, army clothes in the garage. Some how he has convinced himself that in spite of having some the best outdoor gear available, in our closets, if there is "a winter earthquake or natural disaster" he will wear these moth bitten, itchy, 40lb wool pants instead of his waterproof, lightweight snow pants (he has 4 pair). I don't quite understand this and I have begun referring to this behavior as "Zombie Apocalypse Syndrome". It goes like this, the stereotypical little girl has spent a significant portion of her life thinking about her wedding day or having her own family some day. We have plans for the future in our little pink lacy minds. The stereotypical boy on the other hand, has spent a large portion of his life planning for the day when all hell, literally, breaks loose and the great zombie world war or some other unlikely event will take place. They too have plans in their little lug soled, camo print brains. My theory is that the Hubbs is manifesting some of this in his insistence upon packing these tatty old clothes that would be waaaaay better served passed out at the rescue mission down town. I don't get it....Some things are not mine to get though so I permit a great deal more of it than I might think reasonable.

Well, this has been a very long post leading up to the following....

The one thing that I have really really really been looking forward to is a new table. I want a big old farm table. One where you can expand it out to fit all of your friends at a potluck or game night. One where you can stick some benches on either side and pile the kids up next to one another. I feel like the real start of a family is the kitchen table. Here is the one G and I have picked out. We are going to get it once we get all the shit into the new house. It is my major motivator to donate the old crap. It seats 6 as shown but has 2 leaves so it can also seat 8 or 10. I can't wait. I know its silly but it is starting to feel real. I took my Nikki McClure prints to the frame shop and we have picked out the dining room table...hell, someone has already been shopping on the registry and bought us the toaster oven we sooooo wanted. I think we are going to have a lovely little house. Now I just have to get back to the