Flight

Working for an aeromedical transport team wasn’t always a goal of mine. It wasn’t something I’ve always wanted since I was little (although there is a picture of my 3-year-old self wearing a medic’s helmet and grinning broadly in a helicopter in a photo album somewhere). It wasn’t part of the reason I got into EMS. But my fascination and desire to earn my wings grew steadily over my short medical career.

The first time I ever saw a flight crew, they were coming to pick up our patient in the hospital. My preceptor tried not to smile when he saw the awestruck look on my face. They  were  calm, and collected. They walked with a swagger into our ER. They asked these questions with big, fancy words. And, okay, I’ll admit it, they looked so cool in those swanky flight suits. As they loaded up and prepared to head back to the helicopter, a nurse asked one of our paramedics if he could help carry some equipment back to the bird. He agreed, before handing a bag to me. He knew how badly I wanted to watch a helicopter take off, and that I’d never seen one before. I carried the bag with pride out to the helipad, and watched with total awe as they took off. When I got back to the ambulance, my preceptor chuckled at my obvious excitement. I told him I wanted to be just like them. Always supportive, he told me that one day I could be.

To this day, watching helicopters take off and land through my classroom’s window is a great tangible reminder as to why my butt is growing numb in those awful plastic seats. I can do this. I will do whatever it takes, and I will get there. It won’t matter how many all-nighters I pull, how many tears I shed, or how frustrated I get. I will get there, some day.

Just imagine my elation when my old preceptor handed me a ride-along application packet for a aeromedical critical care transport service. When I was accepted, I marked the date down on my calendar. It gave me something to look forward to, amongst the boring clinicals, personal problems, and seemingly impossible countdown until graduation. Soon, I would finally get to spend a few hours living the life I wanted so badly.

That day has come and past. The experience was a mixed bag.

I loved the crew I was with. Everyone was so friendly. There was such a camaraderie, and it was everything I could have hoped for. It just made me want to be a flight nurse or medic that much more. I was practically shaking with excitement went the helicopter was pulled out of the hangar. Everything inside me lit up with happiness as we lifted off.

The flight made me feel a little funny. I wasn’t exactly nauseous or dizzy. I just felt that familiar general strangeness I get whenever I fly in airplanes. It’s not uneasiness or sickness. Just this very subtle difference. When we landed, we piled into the back of an ambulance. It wasn’t anything like the ambulances back home, but it was oddly comforting to me nonetheless. I was standing in the ER, maybe a full three minutes after we’d landed, when it hit. I was overwhelmingly nauseous and dizzy. I leaned up against the wall, and tried to pay attention to what was going on. (I wasn’t allowed to engage in patient care–even to help lift–anyway, so I wasn’t missed terribly.) Now I started shaking with nerves. What was I going to do? Here I am, feeling absolutely awful, and I still have two more flights ahead of me? There’s no way…

Oddly, when we got back into the helicopter, I felt fine. The patient was hardly labor-intensive, to put it lightly. But the nausea and dizziness just evaporated. The flight was flawless. Again, maybe three minutes after we’d landed, I felt that disorientation, dizziness, and nausea creep back into my body. Nobody else seemed to notice, but then again, I wasn’t needed or asked to do anything. I continued to feel crummy for the flight back to the hangar. Although I started to feel better back at the hangar, my stomach didn’t fully recover for an hour or so afterwards.

There were so many things I loved about my opportunity to fly. But, it’s all dampened by this huge overwhelming fear: what if I can’t do this? What if I’m extremely prone to being airsick? This isn’t something that can be fixed with better grades, more studying, more experience, or more certifications. This is something I can’t control. To be stripped of this dream terrifies me. It has completely flipped everything around. It’s made me question and worry about so much. I hate to have this goal, this dream, this desire that has fueled so much, be completely snuffed out. All because of one glitch in my stupid body.

I’ve talked it over with a few people who have flown. Most have told me not to worry about it. I had literally scarfed down an entire Tupperware container of ravioli in three minutes before the mission because I could practically feel my blood sugar dropping. (I hadn’t eaten all day because I was so excited…don’t do that.) I had slept three hours the night before, worked the entire day before, and slept another three hours the night before that. It’s safe to say I was pretty sleep starved and running off of pure adrenaline, excitement, and caffeine. I’d also never flown in a helicopter like that.

I’ve been told that practically everyone feels airsick at some point in their flight career. That I’m willing to accept and take as it comes. My fear is that airsickness is my baseline, but I won’t really have any way of knowing right now. Is it possible that my sickness (which oddly only happened after I landed) was mostly due to the fatigue, overly full belly, and inexperience? If it turns out to be a more regular thing, is this something you can “train” yourself out of? Would frequently spending time in a small plane help accustom me to being in the air? Could medications be effective?

I’m so desperate for any answers that will tell me that my dream doesn’t have to disappear. I just want a glimmer of hope or good news that says I don’t have to give up and throw everything away. That is perhaps the most devastating part.

November

Physically, the drive to Major Medical Center is a little easier when driving a car instead of an ambulance. There’s not nearly as much surface area for the wind to toss the vehicle around when I’m cruising down mountain roads in my car. The drive goes by a little faster when listening to loud music in the confines of my personal vehicle. Emotionally, however, this drive is a completely different story.

In the ambulance, I have protection. Occasionally, old memories start to stir in the back of my mind. But they’re easily buried beneath the more intense focus I have when driving this large vehicle. I can hide in the professionalism I put on with my uniform. I can drown it out when chatting with my partner. But in the car? I have none of those luxuries. It’s just me, the radio, and this long drive that does nothing but dig up old memories.

A year ago, almost to the day, I was making this same journey in this same small vehicle. The same jagged lines of mountains and valleys lay just beyond the metal guard rail. The same bare trees stood in the piles of dead, reddened leaves. The same enormous building sprawled out before me, patient windows glittering in the afternoon sun. The same road wound past the ambulance entrance, where I’d parked my truck many times before, and continued down to visitor parking. And an eerily similar sense of dread settled into my stomach when I put the car in park.

A year ago, I made that drive knowing that, once at my destination, I would play a part in making that ultimate decision for my grandmother: comfort measures only, or aggressive medical and physical therapies. I felt fleeting emotions in a numb, hollow space in my chest: fear, sorrow, grief, strength, anger. It was an awful experience I wouldn’t forget. I just didn’t realize that a year later, I’d be making this same journey.

This time, I’m driving up to go see my father. It was supposed to be a relatively simple surgery for a relatively simple problem. Instead of this quick, easy procedure and recovery, we were met with complications and phone calls, sleepless nights and unknowns, running nurses and worried doctors. A week-and-a-half later, time and progress feels as though it’s standing still.

Something about November, Major Medical Center, and my family. I hope with all my heart that we don’t have to make the same decision this year.

Please keep him in your thoughts. Thank you.

Saving My Life

I need to hear that shrill tone. The one that pulls me from my day and thrusts me into that of another’s. The one that orders me into my little car, and sends me to the station. The one that sits me on the bench of the ambulance, soaking in the smell of plastics and chemical cleaners. The one that captivates my attention for an hour or two.

I need the illusion that I belong. That what I do matters. To justify my reason for being. I need the excuse to keep me here another day. I need the time to think about something other than whether I should stay or go. Other than if my mistakes of yesterday outweigh my possibilities of tomorrow.

I need to feel like I’m part of something bigger than just me. Bigger than the emotional storm clouding my thoughts, raging in my head and my heart. I need to be given a few hours where I can stop worrying about yesterday and tomorrow. Where the only thing that matters is right here in this moment. The only thing that matters is the person whose hand I’m holding; the life that I’m caring for.

I need that tone to go off. Just one more time. I just need one more day to figure this out. Just get me through today.

EMS is saving my life. Hopefully, one day, I’ll be able to say it’s saved my life.

Only One Pair of Gloves Per Call

“You must only use one pair of gloves throughout the duration of a call.”

I’m looking around the inside of the ambulance for a little plaque or a sign that says this. I already checked the protocol book…it’s not there either. I’m willing to bet a week’s pay that such a rule does not exist. So then why do people act like it does?

Let’s get specific here. Someone calls 911. You show up in your shiny truck with your partner. Turns out, the guy’s not feeling super well. In fact, he looks almost as icky as he feels. Poor dude. Better get him to the hospital and see if we can make him feel a little better. So you do your on scene assessment (and, assuming you’re doing it right, you’re touching your patient), load him onto the stretcher, put him in the truck, and help your partner get some things accomplished in the back.

After a few minutes, you look at your partner and say, “Ready to go? Need me for anything else?”

And he’ll say, “No thanks, buddy, I got it now. We can get going.”

“Righty-oh,” I hope you don’t say, and then get in the front of the ambulance and drive.

With your freaking gloves on.

The very same gloves that were just all over Mr Sicky back there. You pretty much just rubbed your patient’s body all over that steering wheel. And if you did something more invasive? Like check his BGL? Or start an IV? Or intubate? Or suction? Then his blood/saliva/vomit is all over that steering wheel too.

I don’t know anyone who ordinarily drives (non-emergency, like between calls) with gloves on. So, if you are in that category of people who puts your gloves on when arriving on scene, then doesn’t take them off until you’ve transported the patient to the hospital…then you just inadvertently exposed yourself, your partner, and anybody who drives that truck, to the very things that you wore gloves to protect yourself from.

Maybe I’m crazy. That kind of thing just drives me nuts. Take the gloves off–And throw them away!–when you get up front to drive. If you can use some sort of hand-sanitizing product after taking off the gloves, even better.

In the meantime, I’ll keep looking for where that sign is…

Unprofessionalism in Education

We’re gonna play a little game today. Yep. You and me. I’m going to write a quote here that took place at school the other day, and you’re going to guess who said it. Okay? Great!

“So Elise emails me this question the other night, asking me about complications of placenta abruptio. (laughs) Seriously? How do you not know this? Like, really? How about bleeding out, Elise? That’s gonna be a pretty big problem pretty quick if you don’t see what’s so wrong with having placenta abruptio. I can’t believe she asked me that.”

You probably have a decent picture in your head. Some mouthy nursing student (similar to ones I’ve previously posted about here and here) that has nothing better to do with her time than put down the others, most likely because she’s insecure herself. But you’d be wrong.

That quote was from one of our teachers.

That really grinds my gears. I am somewhat shy, but I used to be much much worse. Speaking from experience, shy people can get incredibly uncomfortable about asking questions in a public forum (ie, a classroom.) Why? Because we’re afraid everyone’s going to think we’re stupid. At least that was my fear. So emailing a question is a nice, private way of learning while successfully avoiding judgement. Right?

Wrong, apparently. I guess now it’s okay to make a mockery of a student by name–who fully intended to speak with you privately–and flaunt it to other students. I’m proud to say that none of the students in this room so much as chuckled. No one said anything. We all just stared at her, occasionally exchanged glances with others, and waited for her to finish her rant. When she was done, there was an instantaneous understanding amongst all the students in the room. We could never feel comfortable asking her questions without fear of her making fun of it to other students. Creating an environment that discourages questions from being asked is to essentially kill off the possibility of gaining a full and comfortable understanding of subject material. Inquiries are at the heart of learning. And now, everyone is afraid to ask. Super.

I’m completely disappointed and continuously discouraged every time something like this happens. To any of you educators out there, I am begging you…please never do something like this to your students. Ever.

Are You Taught To Hate Your Field?

Why on earth is the healthcare provider education system so hell bent on burning people out before they’ve even got their license in hand?

At least that’s the way it seems. Maybe it’s just a regional thing. Maybe all the schools in my area are teaching using similar techniques, and all the teachers subscribe to a similar mindset. Or maybe I’ve officially lost my mind (I am certainly not ruling that out).

This post is going to mostly be about nursing school, because that’s what I’ve experienced. But, any new-grad paramedic I know has talked about similar problems.

For any of you that actually read my rambling, babbling, nonsensical drawl, you know that I am unhappy in nursing school. Yes, I do feel absolutely miserable. Every week, I find myself up in the wee hours of the morning on the verge of a mental meltdown. Every drive to school is filled with anxiety, and every drive home is filled with discouragement. It feels almost like a trap some days. The further into the program I get, the worse I feel, but the more obligated I feel to finish it. At my worst, I find myself panicky, physically sick, unable to sleep, and waking up with horribly graphic and disturbing nightmares. Sometimes I start wondering why I ever decided to go into nursing. In my stress, I start to look for other careers I could do. Maybe I’ll find my calling in something else. In the past, I’ve considered going to paramedic school. Currently, I have some wild aspiration to go into law enforcement…which I’m sure would be greatly discouraged by anyone who actually knows me. I have to stop and wonder if these aspirations are real, or if I’m just looking into them because it’s something other than what I’m going through right now.

I’m in an associate’s degree program, so it’s only 2 years long. Most paramedic programs are about that long as well. It’s a short amount of time in which to learn a lot of important things. It’s not like earning a typical degree…after we get out of school, our decisions could greatly impact the lives of others. The stakes are very high, and it’s incredibly important to learn as much as we can in the short time that we have. Maybe these programs are just too short to be reasonable. I find that students in these shorter healthcare degrees/certification programs are just so stressed out and inundated with schoolwork that they find themselves discouraged or disliking the career they are about to enter. It’s heartbreaking to work so hard towards something, and then to be almost directed to hate it.

Maybe I just don’t love my potential career enough. Maybe I’m not dedicated enough. And like I mentioned before, maybe it’s purely a regional thing. Regardless, something should change here. Maybe it’s just me. Or maybe it’s the healthcare system. Or perhaps something in between.

Are any of you having problems similar to this? Or did I really just plain old lose my mind.

“I’m on the phone!”

We roll up on scene to find our patient standing outside on her cell phone. Figuring she’s still on the line with 911, we get out of the truck and approach her to see what the issue is. Something scared her enough, hurt her enough, or made her sick enough to want immediate evaluation. As my partner and I approach, we see she’s talking to her boyfriend, using the same attitude that would make your mother snap back, “Don’t you use that tone with me!”

“Ma’am? I’m P2P and this is Partner. Did you call for an ambulance?”

We receive a glance, before she goes back to arguing with the boyfriend. I give it about 30 more seconds.

“Ma’am?”

Then comes the eye roll. “Yes, hold on, I’m on the phone.”

After another 30 seconds of uncomfortably shifting around, I ask, “Ma’am, could you please put your phone away?”

Up comes a raised index finger, the unofficial sign for “Wait a minute, I’m too busy to be bothered with you right now.” Then a pair of incredulously raised eyebrows. And the hissed statement, “Would you shut up?! I’m on the phone!”

“Oh, my bad, ma’am. I’m sorry. See, when you called 911, we thought you had an emergency, so we came over to see if we could help. Because, well, that’s kind of our thing. Sorry to interrupt you. Is there a better time for us to come back? Like maybe, oh, never?” I replied, right before climbing back in the ambulance, leaving the supposed patient to finish her argument uninterrupted, and riding off into the sunset, never to deal with her again.

That’s not true, actually. That’s just what my brain fantasized about.

What actually happened? After asking if we would shut up, she saw the expressions on our faces, and the glance I exchanged with Partner. Then she huffed and mumbled into the phone, “I’ve got to go….” before hanging up. And then we went on doing our evaluating our patient, and doing the ambulance thing.

God. I hate patients on cell phones.

Celiac Disease and Dining Out

And now, for something completely different…

The concept of celiac disease shouldn’t be that hard to grasp. And yet, people interpret it in the weirdest ways. Hell, you don’t even need to know the nitty gritty and all the science behind it. I’ll over-simplify it for you. “I have an allergy to gluten.” And because most people kind of furrow their brows and go, “Huh? What’s a gluten?”, I usually follow that up with a list of things I can’t eat…wheat, barley, rye, oats, modified food starch, etc.

Now, when someone says, “I have a peanut allergy,” people go way out of their way to make sure there are no peanuts anywhere near that person or the food that person will eat. In elementary school, one of my classmates had a peanut allergy. Our class had to eat at tables in the hallway outside of the cafeteria so there’d be no risk of her getting a whiff from some kid enjoying a PB&J. None of us were allowed to eat peanut products in the hallway. If we had a peanut-y lunch, we had to go in the cafeteria to eat it, and wash our hands and brush our teeth when lunch was done before we returned to the classroom.

I don’t expect that level of avoidance or safety with my celiac disease. But my point is, people go out of their way to make sure the allergy-sufferer is safe. If someone added peanut butter to a slice of bread with a knife, most people would think twice before using that same knife to prepare food for a person with peanut allergies. People get that. Whether or not they realize it, they understand the concept of “cross contamination.”

So when I say, “I have a severe allergy to gluten. Which means I can’t have croutons in my salad. They will make me very sick. In fact, you can’t even pick the croutons out. It will still make me sick,” I expect a server–particularly one in the food serving/preparation business–to say, “Hm. She’s severely allergic. She specifically emphasized ‘no croutons’. I shouldn’t put croutons on her salad.” I would hope that most people would realize that it wouldn’t be okay to pick the croutons out of the salad afterwards, but I tend to explain that as well. You know, just to clarify. Which I don’t mind doing, especially because it is going to keep me safe.

So when I find a crouton like half-deep into my salad, yes, I’m going to be pretty annoyed. And when you tell me, “Oh, I forgot to pick that one out,” I’m going to be even more annoyed.

And I’m met with a shrug of the shoulders, and, “Oh well.” Because my diet is much harder to stick to than most other allergies, does that make it less severe? Does that mean it’s okay to be less stringent? I just don’t get it. No, I won’t go into anaphylaxis, but judging by how ignorant these people are about gluten allergies and celiac disease, they don’t realize that. Even if they did know that, I can guarantee you that being very very sick for a week or more isn’t much fun either.

What makes it so different?? Why is this such a difficult concept???

Paramedic or RN?

Well, here we are again, internet friends. Back to the soul searching and looking for advice from my favorite anonymous third party!

Firstly, if you’ve been following my whining about nursing school, you know I’ve been dealing with several really mean individuals. I’m happy to report that most of them will not be in my class this coming semester. Yay! There’s something to be said about karma, I suppose. Well, that and hard work.

During my Christmas break from school, I picked up more hours at my department. Going back and being able to do something I love…that all by itself makes me happier. Plus, trying out my new ALS skills has been really exciting too. Anyway, with all of these additional hours, I’ve obviously been to area hospitals more often, and to the local nursing homes as well. It just seems to remind me more and more that EMS is where I belong.

That, combined with some major screw ups at my school (losing my tuition, for instance) is making me rethink the whole nursing thing. I’m planning on applying to transfer…the problem is, should I transfer into another nursing program? Stick with it? Bridge to paramedic later? Or scrap it, become a paramedic, and bridge to RN eventually? It seems like the RN-first path means I’ll have lots of years doing things I hate in order to get where I really want to be (pre-hospital medicine, although ER would be fine too). Paramedicine, however, means putting my time and energy into a field I love.

I understand the RN position would be more financially stable, and I would have the opportunity to change specialties and get out of the emergency scene if it gets to be too much for me. But the idea of being a paramedic still pulls at me. So, here we are. Paramedic? Or RN?

 

Time For Soul Searching?

I think I’ve finally had enough, and some soul-searching might be in order.

Recently, my grandma unexpectedly got very sick very fast, and was placed on hospice for a short while before she passed away. For about two weeks, any moment not spent in school was spent driving back and forth to distance major medical centers or her residence, spending what time I could with her. Her wishes were to be buried in her hometown in New York. When she finally passed, we had to travel for the funeral. In the middle of all this, I had a major paper due. My teachers were aware of what was going on, and granted me an extension on that paper. Certainly not something I asked for, but I was very grateful when it was offered to me.

When I came back to class, one girl had the stones to tell me, “I can’t believe you used a death in the family as an excuse. Must be nice to have family emergencies to give you even more time to get work done. Instead of just pushing through it like the rest of us.”

Once the urge to kick her in the head subsided, I felt hurt. Most of the drives home from school feel that way too. Which translates into commutes to school that are filled with anxiety and dread. Comments like the one I made above are made just about every day. I thought we were in college here. I thought the bullying was supposed to be over by now.

As hard as I try not to be, I’m a sensitive person. I’m much better at letting things roll off my back now than I used to be, but the right comments at the right time still get to me. So I vent to my friends who currently are nurses up at our little ER.

The popular response? “Yeah, nurses eat their young. That’s kind of normal. But in a year and a half, you’ll at least be making good money.”

That’s what I have to look forward to? A pay check? Let me be abundantly clear. Being paid is not and will never be enough compensation for daily emotional abuse. At least the patients who are mean are sick. Well, sometimes. Regardless, they won’t be in my care forever. But, I will have to be around mean coworkers all the time. And I don’t know that I can do that.

The school work is hard. But I know I can do it. I’ve been more proud of how much I’ve accomplished and pushed through this semester than I’ve ever been before in my life. It’s the fear that my working career will be just like my academic career–full of mean people who will say and do anything to cut you down. I don’t expect to be coddled and held and adored all the time. I don’t belong to that annoying mindset that I deserve a pat on the head and unabated praise for taking a poop every day. Although I’d like someone to joke around with, I’d be perfectly fine with neutrality.

Yes, I understand the world is full of mean people. But there are lots of really nice, caring, and wonderful people in the world too. Usually, I’ve found it’s a good mix, even leaning towards the good more so than the bad–at least in my small corners of the world. I’m talking about entering an environment daily that is nothing but cruel. And yes, I know, not all nurses are these awful and mean people. But it seems that that has become acceptable and normal; like kind coworkers are an exception. Therein lies the problem.

So do I keep on with nursing school, and hope that in a year-and-a-half, my career and coworkers will not seem as bleak and terrible as they’ve been made out to be? Or do I cut myself off from all the negativity now, and pursue something else? If I do that…then what else would I do?

Any insight? Support? Slaps in the face? Shaking in of common sense? Suggestions? Any and all of the above would be appreciated.