patient advocacy
i can’t quite put into words how i feel at this very moment. i’m certain that most emt’s or people who work in the US healthcare industry have felt how i feel now at some point in their life. something seems awefully wrong with our healthcare industry, the healthcare system’s not far better off but the industry itself is scary.
my partner and i are dispatched to pick up a regular dialysis patient post his treatment this evening. this is someone we know very well, history of parkinson’s, always contracted, ng tube feeding, on O2 at 2lpm via nc just to help him out, anemic, aphasic, perl pupils, systolic pressure’s usually around 110. upon seeing the patient we note that he was not hooked up on o2, fine whatever. the dialysis machine has his diastolic bp at 42 in red, systolic was 76. okay scary, maybe fluke, let’s try it again before loading him up and taking him home. we see that bp cuff is on his right arm, let’s put it on the left arm and get a more accurate reading. bp is now 64/42, not good. no way we’re taking this patient, we’re bls, this is definitely an als call. the charge nurse, who happens to have a reputation for being irresponsible in the world of dialysis staff, who had been ignoring us the entire time suddenly chimes in and shows us her notes stating patient’s bp had been low throughout the entire treatment. once we expressed that we were not taking this patient due to severe hypotension she picks up the phone and got a doctor to instruct us to take the patient home.
as upset as we were, my partner and i loaded the patient up onto our gurney, high fowler as much as possible given patient’s contracted state, put him on o2, loaded him up in the ambulance. i took his bp again in the back of the rig, 76/42, got ready to suction due to cough with audible but not visible blockage. my partner got on the phone with dispatch, got the goahead to divert, lit up and flew to er. took his bp again and again, patient’s crashing.
got the patient onto the er bed within 7 minutes of leaving dialysis center, hooked him up on a 4 lead, systolic bp is now 34 (!!!). i didn’t even know that was humanly possible. er staff is running around, printing strips, trying to draw blood, yelling at me and my partner for transporting such a critical patient while bls when this is obviously an als call. we understood why they were upset but explained to her that the doctor instructed us to take the patient but we had to divert given the patient’s condition.
patient was admitted and hopefully was okay…
what went wrong? why are the higher medical authorities lacking in patient care? why did they seem like they simply did not care?
i don’t care about losing my cert but why are there so many human obstacles present in the attempt to “do the right thing”?
fun calls
it’s not always exciting and non-stop fun with this emt gig, there is plenty of down time. if i’m lucky, i get partnered up with someone who fits my personality and would be willing to explore whatever neighborhood. we recently were 10-19 and decided to hang out for a little bit in the area before heading back to base. so while walking around montrose we wandered into a pet store. the clerk there were either excited to see emt’s stroll into the shop or bored out of his mind because he started unlocking every single cubby hole where snakes and scorpions and tortoises lived. i, being a huge fan of snakes, took it as a great opportunity to hang out with some of the most amazing creatures ever lived. AND i digress…
i did title this post “fun calls” bc in the short amount of time i’ve donned the emt uniform and ridden around on a modified minivan, i’ve already collected enough stories to last a life time, well maybe an hour…the calls don’t usually start out “fun”. typically the calls start out a little scary, especially for a newbie emt like me who’s heard one too many stories about rookie rescues and refuse to become one. if i get dispatched to shortness of breath or chest pain as the chief complaint, i immediately start churning my brain while en route. what tools do i need? do i have my cell phone to call 911 in case they don’t want to? etc. reflecting back on these calls always prompts me to improve upon what my partner and i could have done better and what we did well on.
the last nerve-wrecking sprinkled with fun call i had was to an assisted living home in pasadena. patient was a 65 year old black female (whose skin was simply amazing) complaining of shortness of breath and all over edema. she was a/o x’s 3, no complaint of chest pain, bp was within normal ranges, reactive pupils, normal temperature so we decided to take her. before loading her up, i had thought to place patient on oxygen as i heard my partner ask, “would you like some oxygen?” whoa?!?!?? uh oh…the patient refused. so we loaded her up…en route to the hospital she started complaining of bad heartburn. bp, heartrate, etc remained stable, still breathing rapid and shallow. we get to the er and got her on the hospital bed. i gave the er nurse the report as she looks over the patient. i informed the nurse of the patient’s chief complaint of shortness of breath and edema, also advised her of the heartburn (possible chest pain) while en route. the nurse asks, “you didn’t put her on oxygen during transport, DID YOU?!” ooooh, rhetorical question… 
the nurse then speaks directly to the patient who now is complaining of chest pain! the er nurse gets the patient’s spo2, it registered at 55% (!!!!!) the patient then gets the non-rebreather mask at full blast. I help the nurse change the patient into a hospital gown, made sure the patient’s still alert and oriented, as well as answer all the questions the nurse had. 15 - 20 minutes go by, i’m still there helping the nurse and observing all the chaos of the ecg reading, 12 lead and 4 lead, etc. etc.
another few minutes go by, my partner decides to stroll back into the er after being mia since getting the patient onto the hospital bed. he’s munching on an apple and says to me, “hey, i’ve been looking for you!” the nurse snaps, “yeah! lookin’ real hard!” (i cracked up inside, love this nurse) then she got back to managing the chaos. my partner whispers, “bitch” under his breath. then he threw the apple core away and whips out a bag of peanuts and begins to devour those while watching the patient as if she were a sitcom.
like i said, fun calls.
75% of EMT’s nationwide are over weight!!!
Since my car accident in july and this new position as an emt, I’ve truly had difficulty getting myself to the gym. I’ve always been a big proponent of working out on one’s own, at home, but I can’t even seem to muster any energy to play with some bells at home. The car accident has left my left knee in pain and my lower back intensely still and sore. I can’t seem to be confident of my squats or deadlifts. I know, the chick known for her legs now cannot bang out a good set of squats. This is truly depressing.
On top of the lack of exercise, I have not been eating healthy either. Only one our of my four regular partners actually eats healthy. Everyone else will go for fast food, taco bell seems to be a perennial favorite…I’m trying my best to pack lots of fruits and veggies but it’s still hard to resist eating out WHEN EVERYONE’S DOING IT!
I’m still trying to figure out a way to get in some physical exercise during my down time. Looks like I will have to yoga on the cement floor and play with the jump ropes a bit which everyone else’s chillin in the crew quarters. The other obstacle is in getting sweaty in my uniform. Any suggestions?
Code 3!!!
being a rookie emt is probably the most nerve wrecking period of time i have had in my life so far. i’m constantly on my toes and worried about doing the wrong thing when i don’t even know what are the right things to do.
my partner cc and i were dispatched to a convalescent home. dispatch informed patient is to be transported to er due to possible unwitnessed seizure. holy shit…i’ve only been on the job for a little over two weeks, doing mostly IFT’s and i’m gunna get an er transport of an unwitnessed seizure?! mental check list…okay, unwitnessed seizure, bring trauma bag, possibly need to suction, when was possible seizure discovered by con home staff? patient has history of seizure? patient administered new meds? what’s the pertinent medical history? bring bp cuff, bring steth, bring bring bring….arrrggh…too many things went through my mind. good thing cc’s a veteran emt cuz when i looked over at her she wasn’t even phased, and why should it?!
as we rolled in the gurney, i continued freaking out. clipboard in hand, i walked over the the nurse’s station, told her who we were picking up, asked a bunch of questions then realized i wasn’t even listening to her answers…took a deep breath and started over…okay, per nurse, this is a 51 year old female, aphasic, understands only thai, has a history of seizures, bed confined, no new meds, hadn’t eaten in the last 24 hours. cc was already in the room assessing the patient, she got a few bp’s and it seemed the bp kept fluctuating. cc got systolic bp of 90, then 102, then 94, etc. i tried taking the pulse and it seemed bounding and would skip a beat. patient had chewed up food remains in her mouth, which we got rid of. as we called out the patient’s name, we were getting no response. oh crap, bad bad bad shape patient, obviously outside of our scope but since we were literally across the street from er, we decided to load and go.
got the patient onto the gurney, rushed out of con home, loaded her up in the back of the rig, i hopped in and started to get a bp and cc just stood there holding the back door open…”cc! let’s go!!!” haha, she was waiting for me to get another set of bp, which i was freaking out and just really wanted to make sure i had a live person on my hands.
cc turns on the lights and sirens and took off. as i was still assessing vitals, we came to a hard stop then i heard the rig’s horn, apparently some stupid asian driver wouldn’t get out of the way, anyway, i digress…we rushed to er, wheeled the patient in and got assigned bed 2. wow bed 2, i usually got bed 9 or 7 and never got to see a doctor assess the patient. the doctor came in right away for out patient. i was a ball of nerves, tried giving the report and was all over the place. looking back now it’s slightly entertaining but truly it was nothing but embarrassing. i told the nurse we transported the patient “full code” when i meant “code 3″ which actually didn’t even need to be said. then i told the nurse this is a full code patient and that her dnr is in the file, when all i meant was that she’s a full code patient and the advance directive is in the file. she must have felt bad for me after seeing me slap my own forehead so many times that she slowed me down and i was finally able to give her a decent report.
cc helped them place the 4 lead, which i still need to memorize, smoke over fire, white on rice…i don’t remember…
i had so much fun, even though i goofed on so many little things. in the end we took good care of the patient and responded properly. we drove over to albertsons and got four tubs of ice cream for the station. 
rookie code 3!
EMT Life!
I’m now finally working as an EMT. 12 hour shift, endless (or so it seems) patient transports, continuous contacts with hospital and facility personnel and constant handwashing and sanitizing! My body is always ready to collapse as soon as I get home. Though always tempting to strip off all of my clothes and jump straight into bed, the most minuscule reflection upon my 12 hour shift will prompt me to hop in the shower for a deep and thorough scrubbing session.
I’ve only been an EMT for a week and it seems I’ve already learned more than a year’s worth of experience any academic institution can provide. It never fails to astound me how little I really truly know and how much more I have to learn. Only more schooling coupled with real-life experience will afford me the in-depth knowledge I yearn. As an EMT, I’m constantly interacting with people in their most vulnerable state. The first few contacts with patients in isolation, convalescent homes, post chemotherapy, on the way to or back from dialysis nearly put me on my knees and turn on the waterworks. I come home every night, begging my own mother to please take good care of herself, I don’t ever want to put her into a home or see her in any stage of pain and suffering.
With all that said, my partner and I had a fantastic EMT day on Tuesday. We transported a few dialysis patients, one with decub to a wound care facility, a 400+ pounder and a code brown! I suppose I’m a pretty lucky rookie, seems like I’ve already seen and smelled it all.
Personal life is, fortunately, still pretty amazing. My training has gone from twice a day to zilch. I’ve talked to a few other EMT’s in the company and it seems that it also took them a few weeks to get their bodies adjusted to working 12 hours shifts and still be functional enough to workout before or after. I guess I’ll be patient with myself on that end. There really is not enough hours in a day for me to accomplish everything I would like to do. And now with a boyfriend, it’s even more difficult to cram everything in. Fortunately he’s been nothing but supportive, understanding and encouraging. The older I get the more I come to realize how much time I wasted when I was younger. As always, live and learn.
Corporate Gym Personal Trainer
Bally Total Fitness!
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Since becoming a RKC I’ve been cranking my brain on how to help others, as well as myself with these miracle weight devices from the past. The biggest realization is that most of us somehow believe that a gym membership is required in order to pursue any fitness goal. Fine. Think that if you want. Then the fundamental problem becomes how inaccessible kettlebells are for the normal day-to-day Americans. There are still less than 2000 RKC’s in this nation and kettlebells are still non-existent in the most popular gyms. Why should these devices, perfect for rehab, strength training and fat busting only be accessible to luxury gyms like sports club of LA?
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I’ve decided to expose kettlebells to one of the biggest gym chains in America, Bally’s. tough decision but I’m doing it.
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I’ve now been at Bally’s in Hollywood on El Centro and Hollywood for about a week now. This has been an interesting week and I can already tell how much I will learn and grow in this work environment. Most of the trainers here are extremely athletic and knowledgeable, not to mention genuinely nice human beings. The members are also nice for the most part, though many are afraid of speaking to trainers or have too much ego to be trained in the shark cage by a female. I’m still feeling out the gym members in order to gauge their fitness goals and knowledge of fitness. I remain excited and anticipate a good reception but my plans for their introduction remains under wraps.
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Goes without saying, anyone interested in getting a demo or train with bells, just stop by at Bally’s and we’ll play!
Bally’s in Hollywood, 1628 N. El Centro Avenue, Los Angeles, CA. If anyone feels like making an appointment first b/c you’re anal like that then call 323.461.0227. I’m usually there from 9am - 8pm (long day, i know).
Fire!
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a flight from seatac to lax with dave in late November 2008 somehow led me to pursue the career of a firefighter. dave is four years younger than me yet he seems years wiser. he’s always had a sense of direction coupled with buckets of determination, something i’ve never been able to find in myself. but this time, with piqued interest and unwavering determination, i’m making sure this is my calling.
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LAFD, naturally, is my goal. It is the biggest fire department on the west coast, with immense manpower and unlimited room for growth and opportunity. I can be a firefighter, a firefighter paramedic, engineer, captain, battalion chief, not to mention all the other roles in between, dozer operations, heavy rescue, helicopters, etc etc. the possibilities seem endless yet still provides me with so much guidance and direction.
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I told myself that this one’s mine, this is my decision, finally. I’m finally making a decision for myself in this lifetime. Finally. I’ve never had the balls to do something like this before. I am going to be a firefighter. I would quit my job as an office manager at a law firm, train for strength every single day, put myself through emt school, ride around in an ambulance, test all over the country at different fire departments. My life is taking on its 180. Quarter life crisis? Perhaps.
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First things first. Am I physically ready yet? Nora, my beautiful police officer friend, happens to have a sister who was married to a retired firefighter. He sent me out to 63’s to meet a strong and happy female firefighter. She hoisted down a 98 pound ladder and had me carry it. After a few pathetic attempts and waddling like a duck i’m obviously not yet strong enough. She was encouraging and inspiring as well as assuaged my qualms about being too weak by letting me know that the techniques need to be taught first.
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Second, get past the CPAT. LAFD holds weekly CPAT practice tests at the frank hotchkins memorial center. I finished the entire course with 56 seconds remaining on the first attempt, 1:25 left on the second attempt and had 1:35 left on my formal test.
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Then the EMT-B cert. $1,000 tuition and three weeks of classes later, i’ve officially completed the accelerated emt course at UCLA as of March 14th, 2009.
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March 19th, 2009 – Oral interview with LAFD. FAILED. What happened?! Everything happened. I was under-prepared, over-prepared, too cocky as well as too timid with quite a bit of nerves sprinkled on top. I had worked with 4 captains, 1 chief and not to mention the few wise friends who I enlisted to mock with me. In the end, I was overwhelmed with information. Everyone had something to say. A captain II who used to conduct interviews told me that the conclusion does not matter, scores are already set, nothing more than appreciation needs to be verbalized. Another captain said the conclusion is the most important part. Unfortunately I listened to the captain II. My mission for a spot in the class of 2009 LAFD academy is over, for now.
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I’m taking this experience and tucking it away in my brain. This was a good kick in the gut. I have so much work to do as far as building my resume as well as introspection. I’m done looking for shortcuts and giving up when things do not go my way. Hard work needs to be put in and I’m finally learning that. Until March 19, 2010, I’ll be working as a personal trainer, emt, taking fire science classes, upping my own training, putting myself through a private fire academy and most importantly, digging deep within for strength and goodness.
2009: New Year, New Knowledge?
happy new year everyone!!!
given that we’re still fresh in the year and we’re all big fans of new beginnings, i’d like to publicly say, “let’s make it a good one people!” i know it’s hard to stay optimistic sometimes but let’s use whatever we can as motivation to become our version of the ideal self.
i recently received and forwarded what i found to be a very entertaining email. i think we all know what the famed michelangelo’s statue of david looks like, we’ve all been exposed to this figure of the perfect male physique and can probably conjure it without shutting our eyelids. well, apparently, after a two year stint in the US, even the incredibly perfect figure such as michelangelo’s david can become this:
hope people found this ps’d photo entertaining.
truth is, we’re all capable of turning into tubs of lard, in any country. but why is the US especially suceptible to such a generalized attack? i believe it largely has to do with the fact that this country has established itself as the land of the free, specifically, the only place where someone with nothing can become the most powerful individual of the world. this country attracts the best of the best. perhaps by the simple laws of survival of the fittest, only the cream of the crop make it to this country. now these are the best in every field, the most brilliant scientists, renowned surgeons, legal minds as well as the most relentless thieves, robbers, crooks, etc. we’re all here, in the land of the free, making our mark on this country. i say all that to simply point out that we’ve ended up with a country in abundance, bursting at the seams with technology, innovations as well as garbage. useless toys such as the little dog that barks and lights up when plugged into an ipod, 100 dollar grills specifically designed to make grilled cheese sandwiches were flying off the shelves less than 6 months ago are now suffering because it’s finally hit some of us. some of us have finally looked ourselves in the mirror to see that the more we buy, the more complicated our lives become with the self inflicted clutter. others have simply been forced to not swipe the credit card because regardless of how immune to any sort of a financial crisis, the world’s bleak economic state is on the news all hours of the day, brought up around every watercooler, the choice greeting in many email correspondence, it’s become a fact no one can escape any longer. so, we’re finally realizing that stopping off at the starbucks on every corner is no longer necessary, that weekly extravagant meal along with the generous tip might be getting skipped over more and more often. though still not so great for propelling the economy, this is signaling that we as human beings may be heading toward greatness. through this crisis on the forefront of everyone’s mind, we’re using this problem to become more self-aware and less on auto-pilot.
instead of focusing on just how much money we can save, let’s take it a step further. during any analysis of any purchase, we should evaluate whether or not this particular item will contribute toward the positive in our lives. in other words, if i’m no-joke-broke and am reaching for that loaf of wonderbread while looking at that loaf of cracked oat 8 grain bread next to it priced at $4.50, which should i buy? let’s consider everything for its actual value. how would you feel before and after consumption? how much useful energy will you derive from consumption? will you need to supplement what you consumed by consuming something else within 20 minutes b/c it did not provide you with enough energy? how much will you really be saving in the end? and ultimately, am i putting quality foods in my body to make it run like a maserati? let’s make this the year when we really make every penny work for us.
power on people
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karma
i recently caught wind of my favorite uncle in taiwan’s health situation. he’s about 50 years old, relatively young i guess. he’s been a chain smoker since the age of 18 and used to chew betel nuts all day long. being an extremely sociable person, he constantly entertained friends with alcohol and cigarettes. a few years ago he was diagnosed with oral cancer which prompted him to quit the betel nuts and cut down on the smoking. the binge drinking apparently persisted. well, a couple of weeks back he had to be hospitalized due to “holes” in his colon. he’d always been really thin and never exercised. now it seems the simple pleasures he enjoyed in cigarette smoking couple with a few drinks and betel nut chewing has been completely striped away, not only that he’s severely physically damaged as a result.
guess you can say that what’s happened with my uncle’s inevitable. it’s sad but he didn’t think about the consequences he’d suffer with these poisons he constantly injected into his body.
worse than papercuts
so i think everyone knows that the biggest downside to working in an office is papercuts. since that’s common knowledge, i’m now more inclined to divulge on some of the lesser known but greatly felt disadvantages of working in an office, namely those that can permanently affect our bodies.
i’m right handed and therefore use my right hand to manipulate the mouse, always. about a year ago, the index and middle fingers of my right hand started feeling “funny”. at various times of the day, these two fingers would feel as if they would benefit from some generous spritz of wd-40. othertimes i’d wake up in the morning with t-rex fingers. 
what was going on?! at the time, i really couldn’t figure it out, some insane lines of reasoning kept surfacing. alas, i realized it was the daily non-stop usage of the stupid mouse. at first i began using the middle and ring fingers, awkward! then i ordered a lefthanded mouse, let’s just say that even though it was an expensive, well-received logitech, cindy believes that the technology behind it could use some more work. after returning the lefty mouse and getting back together with the right handed mouse, i’ve been doing more rehab work with the right fingers, hands, arms and shoulders.
in working with kettlebells where the wrists and forearms develop into formidable sources of strength, i’ve never had wrist issues and do not anticipate carpal tunnel. the opposite can be said of many of my co-workers who walk around modeling very fashionable velcro wrist guards.
tight inflexible hip joints is another common injury felt from sitting the majority of the day. this is why i always involve so much hip work to remedy the tightness in those clients who have jobs/lives where not much movement is involved, and of course, in myself.
many of us do not realize that our bodies are held together by our skeleton topped off with ligaments, wrapped with muscle fibers connected to the skeleton by tendons, intertwined with nerves, blood vessels, etc. so therefore should always be thought of as one unit. i am one big moving, functioning, dancing, mouse manipulating unit. when my fingers are bugging me today, believe me the pain is going to travel all the way behind upper shoulder area, urging me to see a surgeon in no time.
shame shame i’m really only 28, my body cannot be breaking down this fast!
being a trainer and an office slave, i suppose i’m fortunate in being able to understand what exactly is going on with my body and do my best to alter the detrimental permanent damages but not all of use know what to do or what exactly is wrong. truth is, many of us who have held office jobs or have been career students have neglected our bodies so much that we simply do not have the core strength or conditioned muscle fibres to hold our bodies in the postures that will prevent future pains and aches.
regardless, most people are aware of what is good for them, the only thing we should all keep in mind is simply that it is never too late to make anything better for ourselves.