Justice made me laugh while I was in the midst of swallowing… and I started choking pretty hard. Was still getting air flow, but not quite enough, so was starting to panic… but it eventually cleared itself out (after I just about threw up, yehaw.)

Still, scary as hell, tears streaming down face, whole nine yards.

And the whole time, all I’m thinking is … okay, I’m still coughing, so I have air flow. Nobody should touch me, this will probably work itself out. But what if I don’t? How do I communicate how to treat this to anybody else? God damnit, WHAT IF I’M THE ONLY ONE AT THE DINNER TABLE WHO KNOWS HOW TO DEAL WITH AN FBAO?

But it’s okay — Nick was sitting by with a knife so he could trach me if necessary. So helpful, honey. Um, instead of jumping straight to jabbing a hole in my throat, maybe try abdominal thrusts? Just a thought.

Anyhoo, so as previously mentioned, Nick works for EA Blackbox. He’s currently wrapping up work on Skate 2. Amusingly, when he was a kid, he was into video games and skateboarding. His parents always told him he’d never get anywhere in life if he didn’t shape up and start doing something more productive… well, now he makes video games about skateboarding. Guess he showed them!

So today, in my random clicking, I came across the Hall of Meat online game. Lucky me, I’ve had a chance to fool around on the in-production version of the game, but knowing approximately bupkis about skateboarding… well, flinging myself off of large cliffs and seeing how badly I could hurt myself was the highlight for me. And now that we have this, heck, I don’t even need to play the actual game!

My score at the moment: 9654 . Two broken wrists, broken pelvis, broken right fibula & left tibula. Meh, I watched that go down. We’re talking full spinal immobilization, the tib/fib’s are likely open fractures, and I’d be concerned about some serious ligament damage…

I suppose it’s a good thing that my initial reaction to just about any injury (fake or not) is “Hmm, how would I treat that?”

So I’m driving home from work (rare, I almost always take transit, but wanted to go to Burnaby on my lunch break… so, needed car) and when I get to Victoria & Hastings, there’s a lot of honking. I peer through the line of cars, and see a guy lying on the ground, obviously trying to pull himself back off the street.

I became slightly inflamed that the reaction of my fellow drivers to someones obvious plight is not to help, but instead to honk. Nice, Vancouver.

So, I deke into the gas station across the road, park, and jog over to see what’s going on. Ah. Now I understand why nobody was stopping. Because this wasn’t some soccer mom or well dressed businessman, it was a native guy, obviously pretty drunk — slurring his words, having major difficulty walking, and reeking of cheap cologne and heavy booze.

Because you know, drunk people don’t deserve help, no matter what.

And you know, even if you’re a compassionless jerk who thinks that alcoholism is a self inflicted problem, and if you’re drunk, you’re your own problem and the kindness of strangers doesn’t apply, you couldn’t really tell he was drunk from far away. I didn’t know until I got close enough for the reek of booze to hit me. Maybe I’m just naive, but I could think of a hundred other reasons for why he was lying on the ground trying to pull himself off the road. Like, perhaps he fell down and needed help. Oh wait. That IS what happened.

I helped the guy to stand, but it was pretty obvious that he wasn’t going anywhere under his own power — not only was he reaaaally shaky, but he’d hurt his leg a bit when he fell. I took a look, and it was nothing major. Probably a nasty bruise tomorrow at worst, but nothing needing medical attention. Still, made it even harder for him to walk, and really he didn’t need anything making it MORE difficult.

I asked him where he was going, and he pointed across the street to a set of apartment buildings, about half a block away. I offer him a hand, and we shuffle off, him holding my arm, and me keeping a firm grip on his windbreaker so I can stop him if he starts to take a header. But hell, he outweighed me by about 70lbs at least, if he decided to go over, there wasn’t much I could do but go over with him… but at the very least, I helped him steady himself a bit. Luckily, no further headers occurred.

Got him to his apartment building, figured he could take it from there. Drunk or not, I’m not really into going up to some strange man’s apartment by myself. (No, really…) At the very least, he could get himself inside where it was warm, and if he hung around in the hallway for a bit until he could walk better, no harm done. He thanked me profusely (well, a bit slurred, but profusely nevertheless) and I headed back to my car… feeling good about myself (altruism feels nice!) and at the same time, pissed off at the rest of the world for having a severe lack of compassion. Seriously, there were about 7 or 8 cars being blocked by him, and let’s not go into how many whizzed by on Hastings … and the only response ANYONE gave was to honk?

Sometimes, people piss me off. A lot.

“No mate, I’d rather come out to someone who is thinking they are having a heart attack than to come out to someone lying dead on the floor because they ignored their heart attack”.
 

My grandmother had a heart attack Christmas day in 2001… but didn’t want anyone to make a fuss over what she thought was indigestion from a big Christmas dinner. After almost a week, she mentioned that she still had that same damn indigestion. What? Damnit, Nana! Her doctor was called who, of course, demanded that we call 911 immediately. Even then, she was of the opinion that it wasn’t worth the fuss, and asked the dispatcher not to bother with the whole lights & sirens thing… don’t want to wake up the whole neighbourhood, after all. Don’t want to make a fuss.

Of course, they told her to shush, and of course they were going to go lights & sirens, you silly old bat. This isn’t something you fuck around with… FOR A WEEK!

She died in hospital three weeks later. We don’t know what would have happened if she’d mentioned the pain earlier — she was pretty old (87), and heart trouble runs in my family (both of her sons have had open heart surgery). She’d had an aortic aneurysm a year prior, requiring a shunt to get put into her aorta to keep it from rupturing — that’s one of those “ten seconds and you’re dead” sort of things if it does — and it was luck of the draw that it was found to begin with. So, we were pretty happy to that she’d stuck around an extra year. Still… would we have had her a bit longer if something had been done sooner? Who knows, but maybe she’d have survived long enough to see her newest granddaughter learn to crawl, instead of dying when she was a month old.

This is a fantastic video. Watch, listen, and remember that your paramedics would rather give you an unnecessary ride to the hospital than a necessary ride to the morgue.

This morning, I was running a little late for work, so when I saw the bus sitting there when I came out of the building, I started running. Then, I saw a crowd of people around the bus. Hmm. Odd.

Then I saw the guy lying on the ground in front of it. Shit. I kept running.

Male, mid-to-late 50s, lying prone with some people crouching around him. There was a bag of empty bottles & cans, and a case of empty Corona’s nearby, a few of the bottles smashed. I went up and said that I have paramedic training and squatted down next to him. Someone else was already talking to him, getting his phone number so they could call his wife. Another woman was crouching, so I checked with her to see what had happened.

Turns out, the guy was riding a bicycle down Dundas when a brown (or beige or taupe or something like that) GMC pick up with an Italian flag sticker hit him from behind, right in front of a bus. The bus stopped, and 911 was called from the bus. The guy in the truck was seen to be on the phone, and everybody assumed he was also calling 911…

…until he took off.

Update from my mother (It’s fun when you get all the transit-related details too): … it sounds like the guy was trying to duck around a bus stopped at the bus stop, and basically ended up squeezing between a bus and traffic… and got hit from behind that way.

Don’t try to squeeze between a bus and a large pick up. Just sayin’.

Worse, nobody got his license plate. Understandable, since it looked like the guy was stopping, but mother of god… a bus with like 30 people, and NOT ONE of them got even a partial license plate number? Shit.

Nobody saw the actual impact, so a spinal injury can’t be ruled out — and I’d be willing to bet he was hit at a pretty decent speed given the location, so without a jump bag, a spinal kit, and oh, other trained responders, there’s exactly nothing I can do other than encourage him to lay as still as possible and reassure him that the ambulance will be there as soon as possible. He was in pain, but coherent — enough to give his phone number — so his level of consciousness was fine. Speaking clearly, so his airway was clear, and respirations were fine. Pulse was pretty normal for a guy who’d just been hit by a truck, and he was sweating a little, but a warm sweat, not cool & clammy so no signs of shock just yet.

So at that point… we just wait.

Within a few minutes, the ambulance shows up and takes over. Sure enough, he’s being treated as d-spine, and they get out the hard collar kit. The lead paramedic does a quick rapid body survey, and they roll him.

Ok, maybe I’m extra-picky about this because I had to re-do my spinal roll about seven gajillion times before I got it right, but … he didn’t do the spinal roll properly. I’ve had it drilled into me REALLY HARD about how to landmark your elbow against your body somehow (generally your leg) so that your hands stay steady while you’re holding the head, and … he wasn’t doing it, and sure enough, the patient’s head moved around a fair amount.

Still, I watched with great interest as they applied the hard collar, got him into the clamshell stretcher, and then up onto the cot and wheeled him away… and felt really, really good about the fact that I could have done that, and aside from hopefully doing the spinal roll properly, would have done everything the “real paramedics” did.

Interestingly, the second paramedic (ie, not the one who did the spinal roll) was a guy I went to elementary & high school with. I think I’ve known him since I was 6, but haven’t seen him in probably 15 years. The only reason I recognized him is because I chatted with him on Facebook about being a paramedic a few months ago, although I thought he worked in the interior. Strike up, “It’s a small world, after all…”

Obviously couldn’t chat with him at all (uh, hello, injured person in an ambulance?) but as they were pulling away, I called out to him, and sure enough, he recognized me. Hee. Cool.

So, instead of being 10 minutes late to work… I was over an hour late to work. By the time the buses started moving again, Nick had come out, so I was able to ride in with him and jump up and down excitedly.

I’m so full of adrenalin it’s crazy. Hot damn, I love this emergency medicine thing.

Interesting side note: due to my chronically low blood pressure (averages 90/60, which is on the low side of normal, more expected to find in athletes. I’m not an athlete. So, I couldn’t take nitro. I suppose I should probably avoid viagra, too. Pity. I’ve heard it does fun things for women, too.

Anyway, a part of my chest pain protocol is that if the patient has taken Viagra or Levitra in the last 24 hours, or Cialis in the last 48, I can’t proceed with administering nitro. And the commercial I just watched indicated that if you have a prescription for nitro, you’re unlikely to also be given a prescription for viagra.

As another side note, more entertaining was the suggestion that you check with your doctor to see if your heart is strong enough to have sex. Please, if my heart is ever not strong enough to have sex, just let me die. I’m just sayin’.

As a side, side, side note: My step-father has gone on record that if he’s ever in a vegetative state, the criteria we should use to decide when to pull the plug is, um, that. If it goes up, he’s fine, let him be in his coma. If not, pull it. Uh, the plug, I mean. Oh god, I’m starting to make myself uncomfortable. Anyway, I’m not sure how to explain THAT to a doctor, so maybe we’ll just let Mom deal with it…

Anyway, so what I have to wonder… does nitro give you a woody? That’d be pretty funny. “How’s your chest pain, sir? Gone down? Excellent. Oh, but something else has gone UP! Well, hello there!”

Answer: Probably not. Viagra is a bit more targeted as to where it dilates. On the other hand, it’s also used to treat pulmonary hypertension (under a different brand name, but it’s the same stuff) — ie, high blood pressure that causes problems in the lungs, vs. problems in the heart (like angina). Can’t breathe? Here, a hard-on will help that!

My skill stations went fine. My full call (turns out, I had to do a full call anyway, bah, despite being told it was just three skill stations) … well, it went GREAT, except for one thing.

The call: Trauma call, patient was hiking, slipped down an embankment about 10ft, and hit a tree. Closed tib/fib fracture, but bent all to hell and back. Bad discoloration, no distal pulses, and about a 45 degree angle in the middle of the lower leg where you really shouldn’t have a 45 degree angle.

I realigned the leg, got distal pulses back and the discoloration improved drastically.

And here’s where I fucked up: I flagged the pt as rapid transport. It wasn’t.

In my defense… Justice Institute standards are such that if any limb has no distal pulses, it’s rapid transport even if you get the pulse back. Turns out, licensing says if the pulses come back, they’re stable. I sort of half realized AFTER the call that … fuck… that was a stay & play sager splint call. But again, wasn’t sure because of what we’d been taught via the JI. Well, maybe they won’t penalize me for erring on the side of caution (ie, getting to the hospital faster.) Hah. Yeah right.

Mother of stupid.

They said they felt really bad about it, because other than miscategorizing the decision point, it went just about perfectly (late hospital update, but everything else was fine.) And they apparently considered just making me do a sager, but … really, it was the decision point that I buggered, and they can’t just re-test me on that.

So, I go back AGAIN for one more full call. *slaps forehead*

And that’s one more thing I include in my JI complaint letter. Seriously, when licensing updates their standards… UPDATE YOURS. Don’t teach us the WRONG thing to do! Why? Why would you even DO that? If the license that you’re training me for has specific protocols and requirements, would it not behoove them to teach us the RIGHT protocols & requirements?

Oh well. I still have another chance. The lead test guy tried to make me feel better by telling me that I’ll likely ace the call on my last try, and my license will be just as valid as someone who passed on their first try.

Still, feel pretty damn crappy about it nevertheless. I KNOW I’m pretty good at this, but … self doubt is a bitch.

Other things that amuse me, after spending an hour playing “Fable” on my lunch break: I’ve started paying attention to camera systems when playing video games. Dear lord, Nick’s rubbing off on me.

Worse… I’ve been googling his game because I’m nosey like that, and found that hey, a teaser trailer came out a few weeks ago. (Why is “googling” not in my dictionary? Is totally a word. Well, at least “google” is. And now “googling” is, too. ‘Add this word to dictionary’ FTW. Wait. “FTW” isn’t in my dictionary either? Damn it.) And watching the trailer. And figuring out where that bloody song he’s been playing CONSTANTLY FOR THE LAST THREE WEEKS came from.

And worst of all, I think it’s starting to grow on me.

I know, hard to believe. Here’s the thing: I’m good at this first aid stuff. This might sound conceited, but damnit, I love it and I think it’s fantastic, and I’m pretty confident that I could handle a good deal of weird shit thrown at me.

This doesn’t, unfortunately, stop me from having ridiculous brain farts.

So my practical exam was Saturday. It went… sort of well, save for some “Seriously? am I THAT DUMB?” moments. The idea was that it would run sort of the same as our in-class practical exams — two skill stations, two full calls. (Well, in class there was only one skill station, but whatever.)

There were four of us being tested that day — me, another potential EMR who’d been taking the part time course at the same time as me, a Paramedic student from the JI in Victoria (so he had three full calls, instead of two) and Cooper, who’d been my partner throughout the majority of my course. Well, THAT’S awesome. We look at the schedule, and sure enough… Cooper’s been assigned as my partner through most of it. Seriously, this was fantastic. One of the things I was nervous about was being paired up with someone who sucked. Not only do I know that Cooper’s good at what he does, but we’ve worked together enough that I felt a lot more comfortable. Excellent.

So, the first thing I had to do were my skill stations — a spinal roll from 3/4 prone, and managing foreign body airway obstruction (ie, choking.)

I choked.

Damn. Ok, the spinal roll didn’t go too terribly — I mucked up a bit by having my partner (who, in this case, was the paramedic) do the roll onto the board from the wrong side. Damnit. I knew that. Amusingly enough, his skill station was next… and he had the same one… and he did the exact same thing. Well, if someone with a higher level of training than me can make the same mistake…

Oh well. What annoys me is that *I* have to redo that skill station, and the paramedic student doesn’t. What? But … you just said that we made the same mistake… what’s the difference? Eh, whatever, not worth fussing about.

The FBAO… went DISMALLY BAD. Holy crap, I’ve never felt so much like I had no idea what I was doing. It’s the freaking HEIMLICH MANOEUVRE, HOW HARD CAN THIS BE?

I had my hand placement totally off. Let’s think about this: They’re called abdominal thrusts. Perhaps try placing ones hands over the ABDOMEN. Evidently MY goal was to break off the pt’s xiphoid process.

Ok. Stupid, stupid, stupid. And NOT helping my confidence any.

When I went into my first full call, I was pretty nervous. I had already blown the first two steps of my examination process, and now the hard parts were coming up.

So my first call was my medical call. The call was “shortness of breath”, but ended up being pretty obviously COPD (in this case, emphysema) causing severe respiratory distress.

I nailed it. About the only thing they could dock me on was that I attempted to assist ventilations a little earlier than necessary — we really don’t want to blow out the pt’s rather delicate lungs if we don’t have to, and it’s better to wait until their level of consciousness starts dropping, even though his respirations weren’t doing much (over 30 is considered the benchmark for “not sufficient breathing”.) Being on home oxygen sucks… being on a respirator sucks more. On the other hand, if it’s a choice between “not breathing sufficiently to support life” and “assist ventilations” … let’s go with assisting ventilations, eh?

I was really happy with how it went. COPD is a bit more wishy washy than a lot of calls. There’s no direct protocol, and a lot of weird things can happen. Hypoxia, for example, is a tricky one to handle as giving them too much O2 can actually make their oxygen saturation worse… which you can’t necessarily judge accurately with the SpO2 monitor (ie, a little thingie that goes on the finger and tells you roughly what % of their blood is oxygenated… a healthy person should have 95-100%, a smoker would be around 92-94%, less than 90% and you better get that person on O2 ASAP, and under 80% is considered “not sufficient to support life”).

Still, getting O2 in is still pretty darn important, so you still bag ‘em… just maybe at a slightly lower flow rate.

Next was my medical call. Turns out, my examiner wasn’t terribly pleased with how I did my primary assessment. Ok, it was a little scattered, O2 got added late, and evidently I fixated on the amputated hand a little too much… seriously, AMPUTATED HAND. Yes, I’m going to take care of that first! But everything got done reasonably quickly. Scenario: Construction worker repairing a machine, gets his hand stuck, falls off the platform. Call comes in as a “fall at a construction site”. I love how descriptive these things are. Sure enough, it’s an amputated hand. Yehaw. In the rapid body survey, I also discovered a femur fracture. Hrm. Ok then.

Our “actor” was fabulous. So funny. When I was working with him, at one point he just started yelling and swearing at the top of his lungs. Scared the hell out of me when he shrieked “motherfucker!” in my ear so loud while bandaging up the amputated limb that the group in the next room heard it. I will note: It’s a FAKE amputation. Really. No missing limbs, no femur fractures. He’s just acting! I swear!

I like someone who gets into their role. We won’t talk about how often I played the “confused old man in the nursing home” in class, complaining about my kids who don’t call and how the government is stealing my money.

Anyway, got through that reasonably well. Forgot to verbalize the contraindications for Entonox, but when she asked me for them afterwards, I was able to rattle them off fast enough that I think she believed me when I said I was checking, I just forgot to verbalize. See? All those times when I’ve been interrupting Nick mid-sentence to rattle of indications, contraindications, and cautions PAID OFF.

So, the final result: I have to re-do three skill stations. The next set of tests are in early September, but you have to have gotten your application in two weeks ago to get into that one. If there’s a cancellation, I have a chance, but … most likely, I’ll be doing them on Nick’s birthday (hopefully it’ll be the day before or after…) Dang. This comes along with recent news that MY birthday (a few days prior) is now an important deadline for the game he’s working on, and we either have to cut the weekend trip we had planned short, or cancel it all together. EA Widow, anyone? (Kidding, honey!)

Anyway. Another hiccup in the path to getting licensed. Woohaw. More studying!

Interesting side note: So for my actual paramedic training, my initial thought was to get EMR licensed, get hired by BC Ambulance (which is a multi-month journey on its own), get PCP (ie, full paramedic training), ???, profit. (Maybe with less ???… and a few years until much profit.) However, getting into the JI’s PCP program takes for-freaking-ever. I had no problem with that initially, as I figured I’d just work as an EMR in the meantime.

Except… I COULD theoretically do it at another institution. There are several smaller joints that do PCP training. Initially, I’d thrown that idea aside because I rather liked the JI’s training, but I’m a bit disillusioned at the moment. The biggest benefit to going through someone else would be that I could probably get my PCP license about a year sooner.

Hmm. Interesting thought, anyway. I’d miss the cafeteria. God, I love the JI’s cafeteria. If I lived in New West, I’d just go there for lunch all the time.