The MacMedic

Unlike my last hospital which did annual reviews on the anniversary of your hire with raises effective immediately, this hospital reviews all employees in August with raises effective at the beginning of the new fiscal year in October. This morning was my turn to go in and spend some time with my manager for my review.

I went in not knowing exactly how it was going to go. While I have tried to give my all to my job while I am there it has been clearly evident, to me at least, that I am not 100% bought into the program and still feel like an outsider. I have not developed the attachment and dedication to this job that I had had in my previous one and I thought, and still think, that it shows.

Surprisingly enough my manager did not see it that way and my review was actually quite good. If I had to review myself on the same points I can’t say as I would have given myself the high marks that I received from him and the ED management team. I guess I will just have to try harder to be as good at my job as my review made me look.

So far I have always approached the day shift portion of my twenty-fours with some trepidation. These 12 hours usually consisted of being an “IV and lab draw” slave to the day staff and really having no time to keep up with the work that we need to do for the EMS portion of the job. Today was different. It wasn’t different because the nursing staff had changed their views on how to treat the paramedics, it was different because the volume in the ED was about 60% of what it had been for the past six months. I, for one, am certainly not going to complain.

Even the out of hospital volume was down with the first 12 hours of the shift consisting of three cancelled calls. After we were released to our quarters for the second half of the shift we only did two more calls, both before midnight and both cancellations as well. From about 0030 on I did something that, up to this point, had not been my normal. From about 0030 until 0630 I slept deeply and relatively well waking up much more refreshed than usual for shift change and the drive home. I don’t know if this is a sign that I might be beginning to have the ability to sleep well at work or not.

Yet another night in triage. I wish I could say that I was challenged at some point during the night but aside from the challenge of not falling asleep and whacking my face on the desk when the 4am drowsies hit it was a boring night. As much as I want to feel like a member of the team and want to do my part spending 10-12 hours a night in triage is doing nothing to make me feel that way and, if anything, making me feel a bit abused.

Another Thursday twenty-four hour shift with the same partner. We seem to be working every other Thursday together and I am starting to get used to his mannerisms and affect. I still don’t know for sure that he likes working with me but at least we do seem to be tolerating each other well.

For the day we had one of the new orienting paramedics working with us. Although my partner was senior to me I seemed to be doing most of the orienting which was both frightening and good for me all at the same time. Frightening because I am still trying to figure out what I am doing here and how things need to be done, good for me because it is forcing me to get the answers to the questions that I don’t know.

For a twenty-four hour shift is was surprisingly light even during the day. Three calls during the day, 1 ALS, 1 cancelled enroute, and one downgraded to BLS.

The ALS call was interesting and I actually found myself wishing that I had a student riding with me instead of a paramedic with a couple of years in the field. We were called to a building supply store for a possible stroke. We arrived just after the ambulance and were escorted into one of the back offices by store personnel. Seated in an office chair was a male who appeared to be in his late fifties with no apparent deficits. His employees related that he had experienced a sudden onset of slurred speech. The patient himself only complained of a burning sensation in his right eye. As suddenly as the slurred speech came on it rapidly went away prior to our arrival. A good story for a TIA (Transient Ischemic Attack).

As the orienting paramedic did her assessment I copied down some information about the patient and then took a good look at his face. I wasn’t sure but I thought he had just the slightest hint of a facial droop when he wasn’t smiling. When he smiled his face was symmetric and without deficit. I mentioned it to the paramedic who was doing the assessment but she said she didn’t see it. I figured it could very well be my imagination.

While the ambulance loaded him onto the stretcher the patient began to rapidly develop slurred speech again with the same burning sensation in the right eye. No, the droop was not my imagination. By the time we arrived at the ambulance his speech had cleared up again. The rest of his exam was unremarkable except for some borderline hypertension. Not exceedingly high, just higher than I would have liked to have seem.

The patient had return of his symptoms a couple of times more during the 15 minute transport and was delivered to the ED staff with no appreciable deficit, for the moment.

I was think that it would be a good teaching case just because it demonstrated the value of constantly reassessing your patient and looking for the subtle and somewhat unexpected signs and symptoms. Most of us had always been taught to have the patient smile when looking for facial droop, in this case it was when he wasn’t smiling when the sign was exhibited.

From our end it was a somewhat routine call. IV, labs, glucose check, 12 lead, oxygen, monitor and transport. With no “stroke center” in the area we had transported to the nearest facility. I certainly would have preferred a specialty center if one had been available considering the patients age and good health up to this point but that was not an option.

The patient would eventually be admitted for recurrent TIA but his CT Scan wasn’t showing anything acute and aside from some oral antihypertensive and IV anticoagulant medications he was admitted for observation to the telemetry unit presumably for an overnight stay.

Only one more call during the night part of the shift and that one was my partners turn. Not much of an ALS call but he felt compelled to go since the patient had been given anEpi-pen prior to our arrival for an allergic reaction. Not anaphylaxis, just a milder allergic reaction. This patient would be given steroids and Benadryl by mouth and observed for a while and discharged after a couple of hours.

We went back to sleep. I didn’t sleep all that well after we returned. It was my second night in a row with not much going on and I kept feeling like the other shoe was going to drop. Just a general uneasiness, nothing specific, and just enough to make it difficult for me to sleep. The shift ended with nothing else happening other than me still being quite tired. I was happy to hand of to the oncoming crew and head for home and some sleep.