I told you all about my decision to finally go to the doctor and take care of myself…
Well I did it. My doctor agreed with me that my symptoms seem very much like Adult Attention Deficit Disorder. She prescribed be Strattera, rather than one of the controlled substances(per my request) so that I a) won’t have to worry about habit forming medications, b) won’t have to worry about work drug screenings.

While the medication has only been in my system for 4 days, I feel better already. It most certainly is partly placebo effect, but whatever it is, I am happy to have finally done something about it.

I am dedicated to being a better person–at home and at work, and this is my first step in that direction.

I feel like I can think clearly without my all too common cloud of thoughts bouncing around. I hope this works. I really do…

Godspeed, Friends

m3

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Obviously I have been absent from posting here at medicthree.com. Part of this has been due to my efforts over at rootmedic.net, but mostly it has been due to a gamut of things… For a long time I have suffered from anxiety and some depressive tendencies. I have tried various PPI’s over the years with limited help. Mostly I suffered from the side effects rather than benefited from them.

For a long time I have gone med free and it has just proven too much. Every day I wake up tired, unfocused, with a cloudy mind. I am easily irritable, easily frustrated, and easily overwhelmed. While I am fully capable of doing my job–I feel that I am not doing it at 100%. I lose my train of thought and often can’t pay attention during classes or training.

I think I have Adult Attention Deficit Disorder. In the morning I am going to call my doctor to meet. Obviously I am not qualified to self diagnose… But I do know how to recognize these symptoms. I do know that prior attempts with common medications resulted in a more complicated set of symptoms. I do know that I am sick of doing nothing.

It is hard for me to say this, because I think ADD in children is grossly over diagnosed. It is often an excuse for parents who cannot reign their children in. While legitimate cases exist, it is often used when good parenting is all that is needed.

Another frustrating part is that Doctors are often inclined to just diagnose anxiety or depression for these symptoms. I don’t think that is the sum of my problems, but more an element of my symptoms. This is just my thought though, so I will only “guide” my doctor so much…

So wish me luck. I miss writing here, but I just haven’t had the energy. I am hoping to figure something out and admitting that something is going on is the first step, right? After being tested for Celiac, food allergies, and the like, I can only assume my intestinal problems are psychologically related as there seems to be no medical cause. Because of this I have to do something now.

I want to be well and I want to be a good father. I don’t want to be one of those people who have an excuse for why they aren’t well. I just want to be well.

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As usual, the EMS blogosphere has found itself in yet another little tiff. This time Timothy Clemans and Medic22 are in a bit of disagreement about proper use of ALS, among other things.

Timothy seems to believe that ALS skills are wasted on patients that are not in risk of losing life or limb. While Medic22′s way of responding to him might be over the top, I can TOTALLY understand how and why that would happen. See here and here. We all take this pretty damn seriously, so I understand the frustration.

Because I agree with Medic22′s thought process on this, I thought I would chime in a little bit.

If it was up to me I would eliminate prehospital ALS except in cases where ALS care prevents the need for hospital/clinic care and in cases where evidence demonstrates that ALS saves lives. That said, Medic 22 did bring up an excellent point about prehospital pain management.

Is it really that simple? Simply put, I’m out of a job. All of us are. In a system with 11,000 calls a year, we’d be able to pay one medic. Thats it. After the sob story of me being unemployed is over, we’ll address the real issue: why is it that you have to be dying to get compassionate, adequate, respectful care?

If you are sick or injured, but not dying, Timothy is saying that you should only get a taxi ride to the hospital(where you will wait in triage for an hour(or more) and then wait for a nurse to complete an assessment, then a doctor, then maybe get your treatment started).

Are there ALS skills that need to be reviewed? Absolutely, but until you have had to sit in a truck with patients puking their brains out(on your new, shiny boots) you will not understand the validity of our skills that are in between taxi driver and super hero. Pushing Zofran for that nausea not only helped to relieve the discomfort for that patient, it also helped prevent them from further dehydrating themselves (or like a patient a week ago… going into vfib every time she puked… Seriously).

Managing pain in patients is one of the best skill sets we offer(and either the most avoided due to paperwork or most abused by patients).  Allowing grandma some comfort for the 15 mile ride through my Wintry Mid-Western city riddled with potholes and ice chunks is the least I can do after she allowed my whiny ass to stay alive all this time.

I can’t agree more with you! I have been battling this topic for 7 years to no avail. At one point we had our agency MD on board yet the other program MDs in the county voted against it! Again, “nobody ever died of pain” was just one reason. Another was/is the potential abuse issue, especially with fentanyl compounded by the fear ketamine could be stolen off the trucks by youngsters for their Rave parties. Subsequently, our patients receive a proper induction via etomidate but very infrequently the administration of diazepam and morphine post intubation (only a few of us religiously use the agents). What you end up with is a patient who doesn’t remember undergoing paralysis and intubation but wakes up being paralyzed and intubated on a bumpy ride to the hospital.

All this says is that local MDs have zero faith in their medics. If you can’t secure your narcotics, you have no business being in this business. There are dozens of ways to secure them. This is simply an excuse for someone who is afraid to allow their medics the ability to treat.

Medic 22 a dehydrated girl with a low BP and tachycardia needs a line and a fluid blous. That’s ALS. Not an emergency… but something that a paramedic can, and SHOULD do.
Me: what’s the benefit of the prehospital als in that case? if it doesn’t save a life or shorten hospital stay what’s the point
Medic 22: It’s GOOD PATIENT CARE. Its what competent, caring prehospital care providers do.

If the care by paramedics could prevent the need for hospital then I’m all for it. Unfortunately in the case wouldn’t you just be delaying hospital care and doing something just to do it?

First of all, you are assuming we are delaying care. Like I said before:

My scene time consists of a brief primary assessment, possibly a 12 lead and loading the patient where I begin the rest of my treatment–unless the patient absolutely needs other interventions prior to departure. That being said, when I am 15 minutes away from the hospital with someone puking(and further dehydrating themselves) or someone who has moderate wheezes, why shouldn’t I begin treating them?

Again…. It seems that you assume there is some abundance of Life or Limb calls in EMS. Honestly, those exciting calls just don’t come all that much. What we get a lot of is sick baby boomers, indigents, drunks, and people who don’t know any better. Does that mean we shouldn’t treat them while we can?

It is our job to treat patients, and as long as I have time in the back of my truck, I am going to do everything I can to make them more comfortable, happier, and healthier–if at all possible.

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I am a stubborn guy. I know when I’m right, and I don’t back down. As a matter of fact, my insistence on being right has alienated more than one person in my life. I just can’t handle people who won’t admit they are wrong.

That being said… When I’m wrong, I admit it. I might not be happy about it–often I beat myself up over simple things. But I admit I’m wrong. In this line of work admitting you are wrong is more important than always being right. Knowing when to ask someone smarter than you is one of the most important things in EMS–hell, all of medicine.

If you can’t admit you are wrong. If you can’t understand that asking for help is a virtue, not a fault… Then maybe this business isn’t for you.

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En Route to a Code 3 “Sick Person” my partner says….

“Oh, this should be good”

Why?

“Dispatched as a sick person, stumbling, falling down. Great. Another Fucking drunk”

Oh. You listen to that crap? After the address and the part about going fast or slow, I quit paying attention. Literally.

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Part of my continual writers block is overcoming the starting point. I have always been a “title first” kind of writer. I come up with an idea based on some title or thought. From there I work.

Here are some of the Draft Titles sitting in my “posts to be completed” pile:

• The Losing Game
• Turn The Wheel
• Ummmm…..
• Dialogue
• Complacency Killed the Cat… Err… Patient…

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In EMS there are a few tools we use as coping mechanisms. CISM(Critical Incident Stress Management) is the most common, despite many organizations not having active CISM systems. While I find CISM to be useful, it is rarely deployed for run of the mill EMS calls. Death and Dying is our business, and if we had a CISM meeting(which includes everyone from first responders to ED doctors and Medical Directors) for every death in the field, we would spend more time in meetings that in our trucks.

This leads many of us to find our own personal stress management tools and techniques. Some people vent to coworkers, some people blog… Some people pray, or drink, or work out, or smoke. Me…. I drive home.

Every morning when my shift gets over at 0700 I hope for a partly cloudy sky. This winter has been good to me. With crisp, cool winds, light cloud cover and beautiful sunrises, I have done more call reviews on my drive home, alone with Country Music in the background than any CISM meeting or Jack and Coke could provide me.

I use the 9 mile long, 15 minute drive to go over the night before. By the time I am home, I always feel better than I started. The roads are clear in my direction, everyone headed into the city for work while I head out on my way home. I drive a hilly road straight into the sun and every morning is a great reminder that the cycle keeps going.

People live. People die. In between we can only keep on trying. Finding a tool to review, learn from, and sometimes forget bad shifts is one of the most important things I have done in my short bid in EMS. Without my drive home to a different kind of chaos, I really don’t know what I would do.

Fortunately I don’t have to.

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I’ve been a paramedic for about 19 months. Not very long, really. My first year was spent working for two teeny tiny services with teeny tiny call volumes. The last seven months with a service that runs right around 10,000 calls a year with 3 trucks covering. Needless to say, I have experienced a lot more in the last 7 months than I did in the year prior to this.

I have been a father for just under a year. 11 months and 7 days, to be exact. As a father I know I will be learning what to do for the rest of my life. My son is amazing and if I didn’t have the amazing wife that I do–well, there isn’t a shot in hell I could do this on my own.

What I didn’t expect was for the lessons EMS would teach me about being a father. The skills I’ve learned since becoming a father are less about medical procedure and more about communication, lessons, and reality.

Reality is the hardest part. Shit happens. Inevitably Asher will get hurt. Inevitably Asher will get sick. Inevitably Asher will make us mad, and I’ll be forced to discipline him. Some how, working in EMS has taught me some skills to be better prepared(or so I am hoping!).

The most surprising skill tune up I’ve gotten while working on the streets came in the form of communication. My communication skills suck. I bottle things up, take them out on those I love, and then don’t understand when they get mad about it. I can be hot tempered, ill mannered, and down right inappropriate. Dealing with frustrating, rude, and down right worthless patients over the last 19 months has taught me that sometimes despite what you think and feel about someone, you have to be able to do your job with self restraint.

Self Restraint. Compassion. Patience. Even now when Asher is so young and innocent, these qualities are getting more fine tuned. After a long night at work, coming home to a screaming baby isn’t easy. Then again, Mrs. MedicThree was home alone with him all night–I don’t imagine me coming home and ignoring them helps her get out the door much either. Before being a medic, father, and husband it was all about me. Now, it rarely is.

Being a medic has taught me how to diffuse situations that could otherwise end badly. Calming a psych patient down, giving stern advice to someone abusing the system, and making sure I am doing so within the bounds of being a Paramedic–and not a judge–is more than a challenge at times. When I first started doing this, I would jump down someones throat for “wasting my time”. Now I understand that sometimes it is easier and better to spend a minute or two trying to figure out(and make the patient) what the hell is going on.

When it comes to life at home, it is more logical to take a breath and treat my family with the respect they deserve. Does this mean I am always cool and calm? Nope. I get stressed. But I like to think that when big things come up I can handle myself–this is something that prior to EMS I’m not sure I could do.

The most unexpected part about being an EMS dad is how being a dad has changed being a medic. Pediatric calls give me a different chill I couldn’t imagine pre-fatherhood. The way I communicate with patients and families has evolved greatly since being married and becoming a father. I spend a little more time trying to make my patients feel better than I did before–most of the time this is done by talking. Sometimes I am a little stern–call it honest–but sometimes that is exactly what the patient needs, and sometimes it is what they want.

Trying to pick and choose the parts of EMS I bring home to my family is the hardest part. Learning how to cope with the realities of my job and the challenges of being a husband and father will continue to be the hardest thing I encounter on a daily basis–but I’m excited for the challenge.

In this line of work it is easy to try and separate your personal and professional lives completely–but it is impossible to succeed. Finding a way to allow them to compliment each other is the key to survival.

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colleague (plural colleagues)

Pronunciation: \ˈkä-(ˌ)lēg\

1. A fellow member of a profession, staff, academic faculty or other organization; anassociate

http://en.wiktionary.org/wiki/colleague

The EMS definition of Colleague:

colleague (plural dumb asses)

1. Another EMS provider who will hang you out to dry in an attempt to make themselves look better and feel smarter
2. An EMS provider who is burnt out, unprofessional, and condescending to other EMS providers and patients.

Bet you can take a guess how I feel about some of mine…

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As EMS providers, we have a very limited scope of tools to help our patients. We are obligated to follow our protocols and treat was is evident from our assessment. This means your assessment is likely the most powerful tool you have in providing medical care. Ironically our most powerful tool, communication, is often completely forgotten by EMS providers.

The hardest part about our job is being honest with patients and their families. Often times we are present in end of life situations. These are difficult in controlled atmospheres–let alone the seemingly claustrophobic nature of EMS scenes. When a patient is dying we need to be honest with them and their loved ones. We need not be brutally honest, but most certainly we can not allow false hope.

False hope is a natural defense mechanism in the grieving process. Denial. Even as EMS providers we sometimes hold on to false hope in difficult calls to get by–but this is neither practical nor healthy in the end. Allowing and providing for false hope will create more shock when reality strikes. Death is a natural process–not always a pleasant process–but natural none the less.

As providers it is our duty to assist our patients and their families in understanding the reality of their situation. Does this mean saying “you’re going to die”? Not at all. But it does mean being clear that the patient is very ill, and you are doing all you can but 1) they need higher level of care 2) they may not make it to that higher level.

Does this make the process of dying easier? Absolutely not. For patients and their loved ones knowing their impending doom can be equally troubling. But it is still our duty to be truthful with our patients. Where I believe this honesty to provide an important relief to EMS is in the all to difficult cease or withholding of resuscitation talk we find ourselves in during these types of calls. Being honest with a patient and their family gives them more time, possibly only seconds, for reality to sink in.

When termination of resuscitation becomes part of the discussion, patients families are often unprepared. Giving them the truthful answers to questions about the reality of the condition of their loved ones will certainly help them to make the decisions to terminate care when necessary.

How do you handle these difficult moments in patient communication?

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