I had classroom ladder class on Tuesday. I had seven pages of ladder homework. Okay, I know it’s the fire service, but how much can you say about ladders? I know all about ladders now. Well; not quite true. I’ve got book learnin’, but no fetchin’ up, as my dear old dean used to say.
So, tonight I was supposed to go to the other part of ladder class, the part where we dress up in our heavy suits, don heavy air-tank backpacks, and go play with ladders; carry, raise, shift, climb.
I didn’t go.
We had a houseful for the past several days; twelve people, in all. It was great fun.
My sister and much of her family came to visit (not thinkingcapp, but personwithoutlj). They arrived on Saturday and stayed through this morning; they went skiing at the nearby mountain. Actually, Monday it rained; they wisely didn’t go skiing in the downpour. Tuesday, O1 and I went skiing in the morning. My sister’s two oldest boys were skiing by themselves, but the other two boys, my sister and brother-in-law, O1, and I skied together.
geckospot and writergurl91 also came to visit on Saturday. They departed Tuesday. writergurl91 was going to go skiing Monday, but didn't due to the rain, boo, hiss. Next year, writergurl91.
I didn’t get very much sleep last night. I was at the hospital for my third night in the emergency room. Just as I was about to leave, at midnight, two new cases came in that might have required IVs, so I hung around to see. It turned out that one of them did. Now, I have thirteen starts left to do. I am getting more comfortable with it… It’s actually pretty cool.
Which is funny; needles used to totally skeeve me out (which, really, was probably an excellent attitude for me to have for a few years in there). But now I’m quite comfortable with them. Sure, if you’re poking me, I’d rather have a twenty-seven-and-a-half-gauge subcutaneous than a twenty-gauge intramuscular, but I’m okay with it, anyway.
I’m not perfect with the cannulation thing yet, of course. It’s interesting; as warned in class, some of the nurses are really cool and some are not so cool.
One of the nurses I work with will grudgingly let me stick her patients, but if I miss the first one, she takes over.
All of the rest of the nurses are better or worse, depending on your perspective, by expecting me to actually start a line. This means two things; first, if I miss with the initial stick, I still have to find the vein. This consists of leaving the needle in (if it’s pulled out, it’s no longer sterile), palpating the vein with your finger (since you often, it seems, can’t see the veins), and going for the vein with the needle under the skin. From experience, I can tell you that it’s not terribly painful but still uncomfortable for the patient. After you fish around for a bit, you either find the vein or give up and pull out. Then, the second part starts; repeat on a different site.
One nurse in particular is very supportive; not that she’s at all friendly to me, so to speak, but she has me do her starts (as opposed to me watching the patient charts for IV access orders and finding the attending nurse for the case and asking if I can do the start), she gives me good advice, and she is constructive but not negative when I have problems with a start. She is the local expert with IV starts, from what I’ve seen. The other nurses get her to help when they can’t get starts… And sometimes they can’t.
Last night, she asked me to do a second start on one of her patients; this patient had chest pain and was getting nitro by drip. Local protocols dictate having a second access when a patient is on a nitro drip. Lots of meds are given through the IV ports, and if someone codes, it’s difficult to get a second line in place due to the collapsed vessels. No pump, no pressure. There’s really no time to put one in after a code, anyway.
I got my gear together; a syringe of 0.9% NaCL (normal saline) attached to a needleless access port device, stuck to a ‘j-loop’ tube with a second port and flushed with saline to remove the air, gloves, rubber tourniquet, clear plastic dressing for the site, tape for the tubing, alcohol swabs, catheter, all thrown into a small pink kidney-shaped emesis dish. I went over to the patient and got started. Of course, the nurse was there when I arrived and started to set up; peel a few tape strips, stick ‘em to the side of the bed, rip one in half, put the tourniquet on the patient, find a vein (a slow process, fraught with uncertainty and indecision), clean the patient’s arm, get the cath out, spin the cath on the needle to make sure the cath itself will slide easily off the needle.
About the time I was getting ready to actually stick the patient, the nurse disappeared. I hemmed and hawed for a minute, waiting for the nurse. She didn’t seem to be coming back, and worse, there was actually a doctor speaking with the patient. I really felt I needed to do something, I didn’t want to waste the setup by going to find the nurse, so I stuck the patient. And missed.
I fished around for a minute, couldn’t find the vein, pulled it out. The doctor took pity on me, was completely nice, and validated my choice for a second site. I got the second one in without too much difficulty and got it all set up, drew a tiny bit of blood into the tubing to make sure I was actually in the vein, flushed it with saline, and shut the port.
Finally the nurse comes back, checks the setup. “Nice start,” she says.
I had done the first start on the patient, too, several hours earlier, although I got that one on my first try. I had poked the patient three times, successfully twice.
After the last start, the patient asked me if I ever felt like a vampire.
So, here I am, hanging around emergency rooms, waiting for hurt people to show up so I can poke them with metal pins.
So, after the two cases came in and I was ready to go home, it was 12:45 in the morning. I got home around 1:00, then relaxed for a bit and enjoyed a beer. About 1:45, I happened to check my Red Menace mail and found that I had been assigned a bug to fix with the highest priority, a bug blocking ‘everybody’ in India from doing work, and that the people filing the bug felt that it had something to do with work that I had been doing recently.
I knew immediately from the symptoms that the bug wasn’t with my stuff but I still had to work it; I finally was able to get to bed around 3:00. Something woke me up around 6:00 and it took me some time to get back to sleep. Then I got up to go out to a send-off breakfast for my sister and family at 7:00.
So I was tired, but that’s not why I didn’t go to ladder class.
On the way back from breakfast, rabidkitten dropped me off at the four corners and went to take O1 to the mountain. I walked over to the fire station took care of a chore (calibrating the gas detector; has to be done every thirty days), went by the post office, and walked home.
Did I mention that our driveway washed away on Sunday? Somehow, the runoff patterns changed on our mountain, and now there’s a spring rivulet that comes through the side yard and down the driveway.
The driveway is totally impassable. In some places, the channel is three feet deep.
O1 and I kind of like it, although it does mean that we have to park on the road and hike up. The weather has been pretty nice, though, so it’s not too bad, other than contemplating the price of fixing the driveway.
I came home and worked for a couple of hours. I conference called and wrangled O2 while rabidkitten went to the dentist.
Then I napped for a few hours. It was great, although I really should have gone to my client’s… Nothing critical is going on there, but I need to put in more time there.
But I napped. I couldn’t see going to ladder class exhausted.
Late in the afternoon, I got up and got ready to go. rabidkitten and the O’s were in the tub. Just as I was about to leave, my pager went off; a structure fire across town. My department was called as mutual aid to come help fight the fire with our sister department.
I said goodbye to the family and went to the fire station. I got into the second engine to leave, Engine 1, along with the chief. I drove across town to the fire scene. Along the way, we could hear the arriving unit giving status reports, describing the fully-engulfed building.
We arrived on scene. A one story house was on fire. It was already a write-off.
The owner had been working on his motorcycle in the basement. Some gas had got spilled, then ignited. That was that.
With my chief’s permission, I went up to the fire and presented myself to the scene commander, the chief of the department across town. He told me to get a handline, so I did, going to a nearby truck, grabbing a matadale (another name for a cross-lay preconnect) and dragged the hose and nozzle to the fire. Other firefighters helped me get the hose pulled up and laid out, and finally the hose was charged with water. I fought the fire for the next two hours, alternately spraying lots of water into someone's house and breaking things with heavy tools. It was fun. Way better than ladder class.
There were quite a few departments at the fire. Two of my instructors and several co-students were on the scene, so I won’t have issues with missing the class.
After some time, we started to tear the building apart and soak the embers. At one point, I was spraying water into the basement from outside. There were bright lights projected on the scene from several trucks, and there was thick steam. At times, I could see nothing, standing in the bright fog, unable to see my hands or feet, but with a cacophony of sound all around me. At one point, a hard stream from a high-pressure hose slammed me in the side of the head, a wet fist from somewhere in the fog; conveniently and luckily, I had my face shield down and Nomex hood up so I was just surprised and a bit damp.
Once the fire was out, I was released from firefighting and went back to the truck to help break down. The single-lane dirt road was clogged with trucks and hose; from the water supply (portatanks, quick-setup swimming pools holding thousands of gallons fed from tanker shuttles) to the fire itself was about a half a mile. We started to break down the half-mile of three-inch hose that made up the primary water supply line. The auxiliary arrived with refreshments so I took a short break and had a sandwich, chips, and a candy bar, then went back to rolling hose.
About three hours after I got in the truck at the fire station to go to the fire, my chief and I left to return to our station. We still had an engine at the fire but the chief wanted to relieve the firefighters from a neighboring town that were providing cover for our station. We got back to the station and sent the cover department home with our thanks.
By the time I finished rinsing the dirt off Engine 1, Engine 3 returned. Although Engine 1 had not had any items removed, fourteen hundred feet of three-inch hose had been laid on the road by Engine 3. We spent about another hour putting Engine 3 back in service, arranging dry hose in the hose bed, and then laying out the dirty, wet hose we'd used at the fire in the parking lot to be washed and rolled tomorrow.
I don’t know when I’ll have to make up the ladder class. I guess we’ll see.
Tomorrow night, it’s back to the hospital.
The hospital. Here’s what’s cool; CT scanners. Here’s what’s not; Foley catheters. I've got over eighteen hours in, and I'm not quite halfway done with the number of sticks I need. Seven down, thirteen to go. I'm guessing I'll get done with under sixty clinical hours.
This weekend, I go to Burlington for the state EMS conference. That should be fun.
Next Friday, I meet rabidkitten in San Francisco for the weekend. That should be even more fun.