Life of a Trainee Paramedic

On Thursday I spent that day on the Coronary Care Unit.  All in all the day was quite interesting, there weren’t any seriously ill patients on the ward.  I did however get to see this interesting procedure called a T.O.E (transesophageal echocardiogram). 

This is where the doctor sticks a tube; I swear it was the width of a hosepipe, down the patient’s throat, and into the oesophagus.  This is to get a look at the heart from the inside.  It’s like when a woman has an ultrasound to look at the baby.  The patient needed this as his heart was in an irregular rhythm and he needed to be ‘shocked’.  The echocardiogram was to check that there wasn’t any clots in his heart that could be dislodged during the ‘shock’ and possibly travel to his brain.  He had to be sedated a little so not to gag on this huge tube going down his throat.  It was really cool to actually see the hearts valves pumping, and colour could be added so that you could see the blood going round as well.  After he was given the all clear, the doctor used a defibrillator.  This patient had the honour of being the first person that I’d ever seen shocked in real life.  Half of me was expecting him to bounce up from the bed a little (as seen on T.V), this didn’t happen but he did ‘shock’ as such.

Again the nurses were very pleasant, and they even allowed me to get off early so that I could pack the car and travel home.  The fog was really bad and I was a little scared sometimes, and I even went the wrong way.  You have to hope for the best that you’re going in the right direction as you can barely make out the signs.  In the end I was back home an extra 20 mins than I usually am.  Considering it’s a 2 hour journey, it’s not bad.  I’m off to my old works Christmas do tonight, which should be a good laugh.  I’m really looking forward to enjoying Christmas.

I hope everyone has a Merry Christmas, usual Blogging will return in the New Year.

TP

Well I now have one day left of my first block of placement.  On Monday I was in the Major Emergency Admissions Unit (MEAU) at the local hospital, and this is where patients generally get moved onto from A & E, but they can also be admitted through their GP.  Generally these patients are quite ill, yet some just are just there for observation.  There was a guy who was younger than me who had taken a drug overdose (not hard drugs), and not the first time apparently.  He did a runner.  Obviously he didn’t want people prodding around in his life, but he’s not going to get the help he needs if he keeps running away.  There was also a male in his early forties who had suffered his second stroke and who is now going to be in hospital for at least the next 2 months.  He had a Son my age and it really makes you see how absolutely crap the world can be sometimes.  I didn’t really have anything to do on this ward though, so it was a little boring, as I can only really do one or two things and there wasn’t that much to watch. 

The highlight of the day was looking into a doctor’s eyeball.  I got to use an Ophthalmoscope (see picture) and finally look into an eye.  He also went through the stroke patients CT scan, and where the regions of the brain are affected, it was really interesting, and I was grateful for the doctor taking the time to show me.

The last 2 days, I’ve spent on PTS, where we’ve dodged the fog and the accidents that result due to people’s stupidity when there driving.  It seems that some people do not know to take extra care when their visibility is reduced to a few bus lengths.  We were taking this patient out of hospital who had been in there for 18 months, back home.  When we were nearing his address, we asked him if he recognised anything.  No was the response.  We plodded along until we found the correct address, yet he still did not recognise it.  It turned out that he had never even been there before as his partner had to move to a bungalow so that equipment could be installed for his condition.  That why he didn’t recognise it.  Today I treated the PTS staff to a box of biscuits for putting up with me for 4 weeks; I’d like to think that they accepted me as part of the team.

This will probably be the last time I’m ever on PTS now as tomorrow I am on the Coronary Care Ward.  This should be interesting as I’ll get to learn a little more about ECG’s and the different types of rhythms.  I’ve got a book about ECG’s and there are loads to learn! We shall see.

TP

Yesterday I was down a local supermarket doing a little shopping with my friend so that she could get some food that she actually likes.  I forgot that it was Christmas time until I got there, it was packed.  When we got to the outside of the store, there was only the big ‘mom with 3 kids’ trolleys left.  I got one of those but then managed to spot one of the smaller ones lurking by the front door.  I don’t know why but I feel stupid walking round with a big trolley when I was only going in to get a few things (more than a basket’s worth).

While I started to walk toward this trolley, I spotted this older gentleman eyeing up the same trolley as me.  Now I thought I better speed up a bit here or I’m going to miss it, but this guy obviously thought the same and speeded up himself.  Now I got there first, but not before this guy could get his hands on my trolley! After a little friendly banter, he came out with the age old adage, of that I was younger than he was.  Now most would have taken that as a compliment, apart from being the bloody obvious, yet I really wanted to be older so I didn’t have to give up the trolley. However, he was right and it’s Christmas so I thought I’d be nice, rather grudgingly I admit. His wife, who was walking up behind me (with daggers drawn I bet) said thank you in a happy way so I wasn’t bothered.  I think I need to rein in my competitiveness before the games begin at home!

I’ve had a really nice weekend with my friend, I finished off my Christmas shopping, which was kindly wrapped, and I explored a little more of the area.  When I went to drop her off at the station, the trains had now become coaches for some reason.  I laughed out loud when we were waiting to put her bags on the coach, when a lady came up to the coach driver and asked ‘is this the train to stupidsville? The coach driver, very professionally, politely told the lady that this was a coach and not a train.  I was not so restrained.

This is my last week of placement.  I’ll be spending a day on the Emergency Admissions Unit, two more days of PTS, and to finish with a day in the Coronary Care Unit.  I’m looking forward to going home to have a break and get a little spoilt by my mother.  I wonder if she’ll mind me bringing back my washing????

TP

Well unfortunately I didn’t get to spend another day in A & E.  I had got into contact with my PTS co-ordinator and he said he was going to come down and see me within an hour of my call, this was around Monday lunchtime.  He never did, and due to the fact that I knew he was racked off about one of my colleagues not turning up when he should, I thought I had better ring him at the station early in the morning, so that I didn’t go the A & E when I was expected on PTS.  I didn’t want to step on anyone’s toes so early into the course. I don’t know why he insisted that I go onto PTS as one of my other colleagues finished at 12 that day so she’s lost out on placement hours when she could have been with the crew I was and I could have had a day learning something.  Oh well.

It was a pretty routine day otherwise, although I do seem to get really tired in the afternoons on PTS, it’s probably because I’m not actually doing that much, and getting comfy in those chairs on the nice warm ambulance is deadly.

Today, I was in the X-Ray department.  I had an interesting morning, boring middle, and then an interesting later afternoon.  In the morning I was in the A & E X-Ray area where there is generally a continuous stream of patients.  The radiographer there was very nice and explained things to me.  An example X-Ray below (obtained from http://gamma.wustl.edu/pt144te183.html) shows the chest area, and you can see the outline of the lungs which is the black area.  On the right lung (the left side of the picture), you can see something that is distorting the lung, this is probably cancer.

Then I was really just left in the office not really doing anything for 1.5 hours, and then it was lunch, which to be honest I didn’t really enjoy.  There were about 12 people in there and no-one was speaking, it was silent.  Everywhere I’ve been so far, everyone’s been talking and joking, so it’s been fun, not in X-Ray.  It was only after that I’d finished eating my food that started talking to the Australian next to me.  I tried to ask as many questions about

Australia as possible, so stretch out the time.  Don’t get me wrong, they were all nice people, they just didn’t seem to like to converse that much.

The afternoon, I was in the CT scanner room.  It was interesting to look at the screen showing this ‘blob’ which was actually a cross section of an area of the patient.  Looking at the pictures that were coming through, I had absolutely no clue what I was seeing, it would obviously take quite a bit of continuous training to be able to recognise what things were.  An example ( www.ddc.musc.edu/…/case_studies/case003.htm)  is below:

There was a 70 year old male who was having a CT because of some abnormality that was detected in his bloods.  Unfortunately he had secondary liver cancer, probably from the bowel, and it had metastasised (spread) throughout his body.  He didn’t know yet.  Looking at screen, and then to the gentleman sitting on the scanner, you knew that he was a dead person walking.  I felt really, really sad for him.  He still looked well, the cancer hadn’t started taking an effect yet, but I knew he wasn’t going to last much longer, yet he was still completely oblivious, and it is obviously going to be completely devastating when he finds out.  It was a worse feeling than when I assisted the resus in A & E, yet the radiographers in CT see that everyday. 

I hope you like all the pictures, i’ve been told that I dont put enough in.  One more day this week on PTS, and then a friends is visiting at the weekend, im hoping to go Ice-Skating, without breaking any bones!

TP

This is the result of reading an article in the local paper that gave me the material for this post.  What you need to do is reading the following sentence once, and only once and count how many ‘F’s there are in the passage.  You must only read it once, and read it normally.  See how many you get.

FINISHED FILES ARE THE RESULT

OF YEARS OF SCIENTIFIC STUDY

COMBINED WITH THE EXPERIENCE

OF YEARS

I’m sure most of you will find as many as I did. Please do it fairly and post a comment to how many you get.  I will put an update on soon to explain.

Enjoy.

TP

Today I was in the Accident and Emergency department at the local Hospital and I absolutely loved it.  I had a great time; it was a really interesting and informative day.  It was actually a very quiet day according to the staff but there was still some interesting things that I was able to see.

First of was a 58 year old man who had cut himself on his leg with a newly sharpened chisel while at work.  After the doctor had finished with the stitches, I was able to clean up with wound and apply a bandage under the direction of the nurse.  Something so simple which the nurses have done thousands of times, yet for me, it was great, I was actually getting hands on.  He was quite a funny patient, as to say he didn’t like needles was an understatement!

The 2nd was an 73 year old female that had slipped and fractured her right arm.  I was able to help the Doctor pull it back into place by applying traction to the arm so the Doctor could manipulate it back into position.  This was really cool, and the lady was very pleasant with both the Doctor, the Nurse and I.  I also got to see how Plaster is applied. that things sets really quick!

The next was to a gentleman, who I would have said was in his 30’s, was brought in with a spontaneous pneumothorax (air in the cavity between the lungs and ribs).  Apparently it is quite common in tall, thin men, although I have no idea why. Perhaps someone could enlighten me!  This is a potentially life threatening situation yet it was really simple to resolve.  Simply insert a needle into this space and drain the air out a little bit at a time.  Overall, there was 2 litres of air in this cavity, so it was squashing his right lung quite severely, and once released, the patient showed a marked improvement.

Then I had my first death.  It was an 83 year old male who had been broughtin by ambulance following collapse at his home.  I assisted with the breathing using the bag while everything else went on around me. This gentleman had been down 30 minutes before he got to us, and we continued for around another 10 before the consultant called it.  His family were on their way and had to be told.  I was surprised however that the staff continued to talk to the gentleman while they cleaned him up.  It was a mark of respect for him, and they continued to treat him like a person even in death.  This did impress me.

Shortly afterwards there was an elderly lady that was brought in who had collapsed and hit her head and was unable to get help until today when her niece arrived.  I helped to clean her up and sort her out.  She was friendly all through out, never once complaining.  some tests were done, and she was sent down to the Emergency Admissions Unit.  I hope she is ok.

We also had a Surgeon come down who had been experiencing abdominal pain.  She made me laugh as when it came round to have her blood sugar tested, she positively threw a fit, she REALLY didnt want it, but she had to have it.  Its only a little prick of the finger, and being a surgeon her reaction amused the nurse and I.

The last patient of note was apparently a regular at the hospital, who had self harmed and tried to cut his wrists.  I did wonder if he was suicidal but this is apparently not the case with this individual.  I was shocked when I was told that this was the 49th time that he’d been in, and absolutely gob smacked when I heard that was nothing and that someone had over 400 admissions.  This is absolutely ridiculous and the Government should start taking note and penalising the offenders who abuse the system.  Somehow I doubt this is going to happen.

I think I’ve swindled another day in A & E tomorrow so hopefully I’ll have more tales.

TP

I think this would have to be my first post where I’ve actually been moved to write.  I’ve just finished watching Miracle on 34th Street (the new version) and it involves a debate around whether Santa Claus (Kris Kringle) is real or not.  Now I don’t believe in the version that exists today of an old man who stops time to deliver presents to the worlds children.  Yet while watching the film, it got me onto thinking what is the meaning of Santa Claus?

What type of feelings does the name invoke?  I would be very surprised if the feelings weren’t ones of happiness and were able to make people smile.  It was then that I realised that I really do believe in Santa Claus.  Except this Santa Claus exists in our hearts.  The generosity and goodwill that we show at Christmas is a reflection of this. 

Generally people are happier at this time, its one for celebration and for spending time with family.  Everyone comes together and ‘Merry Christmas’ replaces the traditional goodbye.  There is no one that can say that is a bad thing.  I know that I’m in a better mood, and when someone says Merry Christmas to me it makes me smile.  People are generally a lot nicer to one another.  This is the meaning of Christmas.  Santa Claus is just the embodiment of this, and it’s up to the individual how they portray it.  I have a good feeling when I give my friends and family gifts and see them smile.  Now though I do believe in Santa Claus and no one is going to be able to change my mind.

TP

Well today I have been pleasantly surprised.  I had a good day in physiotherapy.  I spent the morning on the outpatients department, which was really good, and then the afternoon doing orthopaedics, which to be honest was a bit boring.  The two physiotherapists that I was with were really good and you could tell that they knew there stuff.

The outpatient’s patients were 4 knee injuries and 1 shoulder pain.  I was told that they don’t usually get that many knees and certainly not all after one another so I didn’t really see that much of a range of techniques.  Everything was explained to me about why a certain treatment was used and I was able to ask any question I wished and it was always answered.  The patients were all willing to have me there as well and I was able to palpate (touch) some of the more interesting injuries.

In the orthopaedic rounds I came across two interesting situations of note.  One was of an 11 year old male who had been hit by a car while on his bike and had fractured his left tibula and therefore had his leg in plaster.  The plaster came to about 2 inch’s above his knee and was apparently heavier than normal.  His right leg was perfectly normal and there were no other injuries.  The physiotherapist and an assistant tried both crutches and a Zimmer frame yet the child seemed really reluctant to use both, his right leg seemed to miraculously stop working.  The child’s mother was sitting right behind him yet offered no encouragement what so ever.  This was one thingthat I noticed, as if it was me at that age, my parents would have encouraged me to use my other leg, like the Physio was telling him.  Coming from the Physio might be scary for the child but some encouragement from mom wouldn’t have gone amiss.  I also noticed that the child looked like a bit of a wimp.  I know that may sound harsh, but the Physio assistant thought it as well.  The child didn’t seem to want to hop at all, even with direction.  Remember there was nothing wrong with his right leg and combined with the mother’s lack of help meant that it was going to be a wheel chair job.

                                      Plaster

The other was a 90 year old female who’d had a fall and hit her head.  She had been laying on the floor in her nursing home for around 30 mins, and was shouting for help and what not during that time.  Due to her head injury, she has developed some form of dementia and was only saying the words that she was when she was on the floor. PLLLLEEEEAAASSSEEE and HEEEEELLLLLLPPPP were her favourites, and I know she couldn’t help it but I couldn’t help but laugh when the lady in the bay next to her told her to shut up or she’d be putting in a complaint.

I also had a scary moment when going onto one ward, 2 nurses not knowing that I was with a Physio said ‘ooohhh, fancying doing some cannulation’, I said a very quick ‘nooooooooo’.  We are not allowed to do any cannulation until we’ve qualified and are doing our time in the operating theatre.

                                 Cannulation

Got the courses Christmas party at the weekend which should be fun, and then the essay hand in on Monday.  Can’t wait for that!

Have a good weekend!

TP