Complications, continued

So there I was - standing in the exam room of a regular doctor's office with a hemorrhaging patient, an attending, "Dr. Green," wrapped up in fixing the problem, and a half-stunned intern gripping an ultrasound with bloody gloveless hands.

"I need 4 misoprostol right now... and bring a runner with you" I stepped out of the room and ran to get the meds, breathlessly telling the other MA "this is not good, we need you in here" as I passed.

Immediately Dr. Green told the other MA to grab another doctor in the office, "Dr. Lee." The doc, an OB GYN as tall as tree, walked in calm and smiling, and Dr. Green showed him the image of the patient's uterus on the ultrasound screen after briefly introducing her.

"See this... on the anterior wall. I don't like it. I think this is accretia. We need to get her into the OR. Can you set that up for me?"

He gazed at the slightly fluxing screen, his eyes scrunched as he deliberated, "Will do, how are we going to get her there?"

"She's going to need a stretcher. I don't know how we're going to work that. Can you get you us a stretcher?"

"I'll borrow one. We'll figure it out." He quickly stepped out of the room. The intern flashed me a wide-eyed glance that I could read as if the words were scrawled on her face... "Can you believe this is happening?"

The office building is located across the street from a medium-sized hospital, and connected to it by a pedestrian bridge. Our practice is actually a satellite of a different hospital and is only at this particular location twice a week, so our doctors are pretty unfamiliar with this neighboring hospital. Fortunately, Dr. Lee works on L&D there all the time and knows it like the back of his hand.

Finally, Dr. Green had a chance to fully explain what the hell was going on to the patient.

"I think that the pregnancy implanted itself into the scar from your c-sections. Now you're bleeding quite a bit. I'm going to have to finish this in the operating room, where I'll have light and all the resources I need, and we can put you under anesthesia so you won't be in so much pain. Ok?"

The patient, who hadn't said a word during this entire ordeal, moaned weakly and replied, "ok."

There was a strong knock at the door moments later, and a stretcher waiting outside the door. We couldn't fit it into the exam room, so the doctor and I supported the patient as she slowly half-stumbled to the stretcher, spattering blood all over the floor as she went and leaving a trail from the exam table to the stretcher. She had probably lost about 2 units in the exam room al0ne. We covered her the best we could and took off, following Dr. Lee's lead.

Rushing across the pedestrian bridge over to the adjacent L&D floor elevator, we nearly ran into a hospital food service guy, who froze and watched us pass in utter shock.

In the elevator, Dr. Green explained to the patient, who wanted 2 more children, that a hysterectomy may be necessary to stop the bleeding and save her life. However, she added, "I'm going to do everything in my power to save you and save your fertility. I'm going to get you home to your kids and hopefully make sure you can have more kids in the future." The patient cried silently... I can't even imagine how surreal and scary this whole thing must have been.

We reached the ER. They were expecting us and had a room ready, and the nurses were obviously anxious and a little excited. It's a small ER with no trauma services, so God knows when they last had a hemorrhage on their hands.

As a million new people did a million things to my patient at once, I briefly stood at the head of the bed and rubbed her shoulder, "they're going to take great care of you." I looked into her eyes but felt she was not really there. The nurses shot me a hundred questions, and it felt strange giving a hand-off report after not doing one for so long.

I met Dr. Green and Dr. Lee outside the room as they were talking to the ER doc, but soon we were following Dr. Lee as he led us up to surgery.

[To be continued, yet again. Sorry guys... ]

Complications

It was a routine dilation and evacuation for a miscarriage. I was assisting the doc, passing off instruments and keeping an eye on the patient. It sounds strange but I like working with miscarriage patients, because it feels like one of the few patient populations that I can really make a difference with. They're going through a rough time, and it seems to me that having a supportive, caring but unintrusive caregiver means a lot to them.

Everything was fairly routine. The doc was a tad concerned that the patient had 3 c-sections and no vaginal deliveries - which meant she really had none of the advantages of being multiparous. If she had given birth vaginally her cervix would have been much more pliable, and we needed to dilate her to about 6 mm. I wasn't aware that the doctor had another concern in mind. We did the procedure under ultrasound guidance by the resident, which is pretty unusual. Usually no ultrasound is needed.

So we're humming along and everything is going normally... until we start applying the suction. The patient started yelping in pain. Now, pain in a D&E is normal and expected. But that little alarm went off in my head and I couldn't really decide whether the woman was just overly expressive or was experiencing an abnormally high level of pain.

I spoke to her softly and tried to soothe her - which is hard to do without physical contact, but I couldn't do that with a pair of gloves on and the doctor constantly needing me to pass off sterile surgical equipment. She continued howling.

Then, by the doctor's facial expression and the way she seemed agitated and rushed when she asked for more 4x4s or more suction or this or that... it became obvious this was far from routine... it became glaringly obvious when we started reaching about double the amount of blood and tissue I'd expect from a 6-7 week miscarriage in the suction containers.

The doctor removed the suction from the cannula in the woman's cervix, and blood started flowing out of it as if it was a kitchen sink faucet at about half of it's max flow. And it didn't stop. At this point, I snapped in to the mode. That zone you get it in when you realize you have a sick patient on your hands and you have to do something about it or they may die.

[I'll finish this later, I need to study for midterms. So I'll leave you with that cliffhanger.]

You're Trouble.

Background: we met at the SAR team's Christmas party. He was a member about 6 years ago, and he's the best friend of the firefighter I had that brief stint with at the beginning of the summer. We didn't talk much at the party. I was pretty mesmerized though. He is disarmingly attractive... with icy blue eyes that make you get that funny feeling in your stomach. An army guy, he was on leave at the time. We didn't talk again until he was back on base, far far away in another state. We started casually chatting online.

And somehow we ended up here, about a month after we first started talking. Through several 4 hour long phone conversations and days spent texting back and forth... we're strangely infatuated. It's completely unbelievable, exciting, and terrifying. I've never found it so easy to talk to someone, and I find myself thinking about him all the time. Most of the time it just feels natural and I don't even think twice about it. But occasionally I stop, take a step back and think "what the fuck is going on?" Sometimes I want to slap myself for it.

We're in this constant tug of war because there's that weird attachment but then there's the fact that we've never really hung out. We've spent all of 2 minutes face-to-face. More importantly, he's fresh from 27 months in Iraq and just about to get out of the army. Talk about a transitional period in life. He's not ready to settle down into some big commitment when he's just trying to sort out what he's going to do now that he's out.

He's getting out late February, and was going to drive around the country a bit before finally making it back home. So we were counting on finally hanging out mid-March. Until he completely surprised me tonight with a flight itinerary. He's coming this weekend. I ran around my house like a little girl jumping and squealing.

Because I know you're reading this -

Hi there. I can't wait. :)

Maybe each of us alone has enough crazy for the both of us.

Today I cried over a boy for the first time in nearly 3 years. If you asked me to explain why, I couldn't give you a good reason.

He could give you all the reasons in the world why right now isn't right. And he is right. I know it. Does it matter? It doesn't make it any easier. He has his personal demons to sort out and I respect that. I'm not trying to complicate the life of someone who is simply trying to get his mental health on track after a long, long time at war. But fuck. Fuck.

Didn't you think about that at all when you told me all the things you did? I didn't get this attached on my own, damn it. I didn't. And honestly, I kind of hate you for fucking with my head so much. It's nice and all that you were courteous enough to stop before it got really bad... but why did you even start?

I know you'll read this eventually...

"It's been a long time since I talked about so much nothingness and so much somethingness with someone."

I want you to know that you somehow manage to simultaneously enthuse, scare and soothe me. I don't know what this all means or where we're going to go with it. All I know is that I want to be around you and I want to know what you think. I want to know where you've been and where you want to go. I want to know what makes you tick - what song you listen to when you want to feel something, what stretch of road you drive when you just feel compelled to drive somewhere, where you go when you want to feel that divine vacancy - that "Ahhhhh".

I know the timing isn't perfect and you have a lot of shit to sort out in your mind. Just know I'm here. I'll listen to you and give you a shoulder to cry on if that's all you need. If you need to disappear, I'll let you go. I don't expect anything from you. I just hope that I can have some of your time. If you need to take your time, I'll wait.

You are one hell of a creature and I know I'll never really understand some of the misery you've been through. I hope that you find some solace. From the bottom of my heart.

Ethics

I'm taking "Intro to Ethics and Society" this semester, a philosophy course. After one day of class, and about 25 pages of reading, my brain already hurts in a good way. I'm trying to think of a way to sum up my general system of values and ethics. It's hard to define. I typed up this general manifesto a year or so ago, and it sums up some of my values, I suppose.

• Altruism is the only answer to hostility. Passion is the only answer to apathy. Curiosity is the only answer to ignorance.
• The harder I work now, the stronger I'll be when it counts - when people are relying on me or when I have no one to rely on but myself.
• People are always worth trying to love, or at least understand.
• Worry is a worthless disease.
• Cowards say "fuck the system" and run from it. The brave integrate themselves and change it.
• Teach all you can and learn all you can from every person and experience.
• Embrace the undefinable as is.
• "These things that I do... so that others may live."

I'm agnostic and spiritual. Therefore, as far as the basis for my values, I try to live my life in a way that in the least does not harm others and at most makes the world a little bit better. My justification is selfish. I feel the most fulfilled when I am benefiting others. It's really as simple as that.

I believe that if there is no higher power, no afterlife, no mystical force behind why we are here, my life will have been worth something if I have made some sort of positive impact, no matter how small. Am I even truly dead as long as my actions have made life better for someone who is still living?

If there is a higher power, and God knows if there is, I have faith that he/she/it will be just, and keep me in their good graces despite the fact that I do not go to church, did not save myself for marriage, and was never baptized.

I believe in the sanctity of life, but I do believe there are circumstances in which taking a life is justified. If a person is suffering, there is no end in sight, and they want to die, let them die for the love of God. It's selfish to keep them here when they would rather be elsewhere. I believe that certain people who have displayed complete disregard for the lives of others, who cause more harm than good by simply existing, deserve to die.

I see the world in existentialist terms. I do not believe there is one right path. Some speak of existentialist angst and the existential dilemma... "Why am I here?! What is my purpose?!". I say it's a waste of time. I value resourcefulness and believe that in absence of a God-given purpose, one should invent a purpose for themselves, whatever that purpose may be as long as it does not involve harming others. I cannot justify why human life has such inherent value. It's just there.

Getting Away

I've had this overwhelming urge to load up my pack, drive to the middle of Nowhere Backcountry, USA and spend some time out alone in the wilderness. That wanderlust. It's nagging. Is it my age? My SAR instincts tell me that this is a terrible idea, though.

Life is all there for the taking, it's a matter of taking the plunge.

The simple, overwhelming joy of existing.

Today I was driving home, listening to a good song (Windmills, by Toad the Wet Sprocket, if you must know) when the sky seemed to suddenly explode into this beautiful sunset. The Rockies, craggy and defined by snow, were dripped in this ethereal orange haze. I had to consciously refocus my attention on the road. I gripped the leather of the steering wheel and forgot about everything. I have a lot to be thankful for in my life, but at that moment I let it all go and just existed in the moment. It felt so overwhelmingly miraculous to just exist. God knows what it all may mean, or how it came to be, but the simple act of living is beautiful.

My 2 seconds of "fame"

Here's the aforementioned news clip. I'm pretty much the only person not wearing a black and gray jacket, with the sexy blue/green gloves.

And no, for those who are newish to my blog, I am not in high school. I recently "graduated" the team but continue to volunteer in the field and act as an instructor. I was a lieutenant during my tenure as a regular, high school student member, but officer positions are filled by youth only (except for the chief staff) and they are completely in charge in the field. So officers automatically lose their rank the fall after graduating high school. It's pretty crazy, but it works well. The leadership is continually refreshed and it brings new blood in command constantly, which can be difficult but has definite advantages. Anyways. It's pretty cool. Kudos to our Chief - he deserves that award. Kudos to his wife as well - who you can see playing patient in the clip.

When the world is watching

Our Chief was honored with some "heroes" award by a major local TV news station. They wanted to film a segment of us running through a quick training, so we staged a search and carryout for them.

I was the primary medical - just treating a simple isolated tibfib fx. I felt like I did a good job, but it was only after the fact that it really hit me. This segment is going to run 6 times on a major network. Hundreds of thousands of people are going to see me. It's not the laypeople that make me nervous, it's the idea of hundreds of EMTs, medics, nurses, etc watching me. Scrutinizing my every move. What if I made some small f-up and didn't even realize it, or they edit it in a way that makes me look bad?

It airs in 3 hours. I'm glad they aren't using my name.