divide

After nearly three hundred clinical hours in the local hospital, I finally had my first two shifts riding along with the Paramedics at the city Fire Department. They were not particularly busy nights, but the handful of patients we had left me feeling both assured that learning paramedicine is exactly where I want to be and overwhelmed by how far I have to go. In class, I'm keeping up with the material and doing well on tests. In the hospital, my patient assessment skills are solid and I'm learning to develop differential diagnoses before looking at the charts or talking to nurses. With over thirty IVs under my belt, I'm feeling better about wielding needles around unwary veins. But ultimately bedrooms, kitchens, sidewalks and street corners are where I'm going to be assessing patients, and the back of an ambulance will be my clinic. And after 48 hours responding to "Fairbanks Fire Department, Ambulance Request, D - Delta response to ...," I am acutely aware of the vast divide between these two settings, and how much better my knowledge and skills need to be before I can use them efficently and effectivly for both routine and emergent patients out in the world.

Today, I was back in the hospital assessing ICU patients and tearing through back hallways to the lobby with the rapid response nurse, racing the respiratory therapist to a page. But my heart was not in it.

My paternal grandmother, who has been spiralling rapidly into advanced dementia, fell and broke her hip in the middle of the night. She was in surgery for most of yesterday, and due to the nature of the break and her general state of frailty probably won't walk again. Although she is stable and has no idea who her children are or where she is or why, I want to be with her. Today in a hospital three thousand miles from the hospital my grandmother is in, every patient I moved, every occluded IV I flushed, every blood pressure I took, I was hyper-aware that I was doing these things for strangers, and not for her. Their families were there in the hallway talking to the nurse, in the room reading quietly by their resting loved one. And I was there, bringing warm blankets to other people's grandmothers and grandfathers and not my own.

Ever since I left home for college, I have chosen to live far from my family. And I have been content with this decision, and I still am. But right now, that distance stings and that contentment has sharp edges on every side.

irregularities

Yesterday, I was driving past the most popular campaign-picketing intersection in town. On one corner, a white-haired man in a bright orange jacket was holding a campaign sign in the cold, smiling and waving at passing cars. Being that I support this particular candidate, I rolled down my window and let out a whoop. He turned and beamed in my direction, guffawing so loud I could hear him in my car. And then I realized that the white-haired man was none other than Karl Kassel himself, out in the cold with his supporters. I hollered "Good Luck" as the light turned green, and headed home.

Today, driving past the same intersection Mr. Kassel was again out with his supporters in the early morning Fairbanks cold. I have so much respect for that. At the next intersection, there were a handful of high school kids mixed in with the Republican supporters, waving hand-made black-and-pink signs supporting "Paris 4 Prez!" with much more enthusiasm than their adult counterparts.

After listening to stories of hour longs lines, rain-soaked voters and machine malfunctions on the radio all day, hearing to stories of city-residents waiting in line for two hours to cast early ballots and tales Alaska Natives flying in from the villages to cast their ballots in Fairbanks and Anchorage to be sure their votes were counted, Peter and I headed up to the fire station to take part. There were a handful of cars in the parking lot, but as we walked in it was clear that they belonged to the seven voting officials and one voting observer sitting inside knitting and having an animated discussion about which cell phone carrier has the best coverage on the Slope. Peter and I had the entire polling place to ourselves. I love this state.

spook

Nyssa walked out this morning to our creation on the porch ... she jumped two feet in the air and landed in crouch, hackles raised and growling. It took a few sniffs before she identified it as vegetable, not animal and then it was off without a care for her morning pee. I nearly fell off the porch laughing.

glance

I have two things in the works for this space, but nothing ready yet. In the mean time, I want to share tonight's sky:Peace, folks.

unintentional

We always put off turning on the heat. As September rolled towards Equinox, with fuel prices still hanging impossibly high, we put it off over and over again.

"I'm cold."

"We could turn on the heater."

"Um, well. I guess ... never mind. I'll find the wool socks."

or ... "Nyssa is crying."

"Cover her up."

"She is covered up."

"Oh ... maybe we should turn on the heat."

"Well ... I'll just give her another blanket."

Mornings are brisk, but we are out the door quickly. Nights aren't bad, with quilts and down comforters and wool blankets. We probably have enough to survive a nuclear winter - which isn't far from what we have up here for nine months anyway. But when you are reading in bed under eight layers of insulation and your hands get too numb to hold the book, it is time to give in.

Last week, after Peter harvested the rest of our carrots and parsnips, I brought an outside thermometer into the cabin. When I saw that it was still reading below fifty in the middle of the afternoon, I went out to start our stove up for the season. We almost managed to make it to Equinox with no heat, but not quite. Maybe next year.

After much wrangling with our landlord, we did manage to get our windows, eaves and floor-edges re-sealed, and an arctic entry installed around our drafty front door. When she came by to take a look in May and realized that no, we weren't exaggerating when we said we could see daylight around all four sides of the door and around the purlins on the ceiling, she agreed to do some work. I wish we'd had this conversation a year ago, but suffice to say we won't be using quite as much heating oil this winter.

[Arctic Entry - and empty garden boxes ...
above - door hinge, inside, mid-winter]

Last weekend, I worked as an EMT for the Equinox Marathon that runs from the University up Ester Dome (a Dome, in Alaska, is a Really Big Hill ... it is not an easy Marathon.) I was hoping for pretty views of Denali and the Tanana Valley as we watched runners struggle by, but instead we parked the ambulance in a cloud and spent the marathon warming up runner after runner with numb hands and mild hypothermia. It was a nippy morning down at the start, but nobody was dressed for the cloud of sleet at the top of the long climb. Although I felt pretty lazy watching seven hundred people limp past shivering and soaked, sitting in my warm ambulance studying RSI drug dosages and downing bowls of chili our fire chief's wife brought up for us, I was just as happy to put off my own attempt for yet another year. Especially when we started getting runner after runner with a dozen bee stings from running through a nest on the trail.

[Denali from Ester Dome ... on a clear day]

That evening, I managed to pass this year's Medic agility test with a minute and a half to spare -completing it at all being miracle in itself given my current state of endurance. Then Sunday night, I showed up at the University Rec Center for a league indoor-soccer game. Only five Paramedic students showed up, and we played against a team of sixteen undergraduates - eight of them on the court at a time against our five. Given the odds, and the fact that the other team actually knew how to PLAY soccer, I thought our 5-2 loss was pretty impressive. Especially since one goal was a header off a perfect corner kick by yours truly that didn't go where I intended but ended up perfectly placed for another teammate anyway and the other was a fluke I managed to tap past the goalie as I attempted to keep myself from tripping over the ball and doing a nose-dive. Apparently everyone on the other team thought I did it on purpose and were thoroughly impressed. I am not going to relieve them of that impression. The short of it is that as the oldest player on the court by seven years, I was feeling my oats for the first time and wishing I still had an inhaler, but I managed to show the Impertinent Youths how things are done regardless of my inability to breathe for most of the game. I have been limping ever since.

Paramedic clinicals have started in earnest, and true to form I am already behind on paperwork. I spent last week in L&D watching babies get born in various ways and with various complications, and I feel like I learned more in those three days than I have in the five weeks of eight-to-five note-scribbling classroom frenzy preceding them. This week I had the Colonoscopy Special all day Monday in Outpatient procedures, where I learned the ins and outs of conscious sedation. Then last night and this evening I'm scheduled to skulk around the ER like a true trauma junkie.

Last night, while trying - and failing - to get an IV on an abdominal patient, I missed two ... count them TWO ... gunshot wounds. Truth is, though, I learned a lot more from hanging with the abdominal through his eventual admission than I would have from a couple of lucky-as-hell boys who both got an expensive lesson in very, very basic gun safety along with their discharge instructions.

progressing

We have two days of respite while we go through orientation for our clinical rotations at the army hospital on post. After the first day of sitting through hours of mind-numbing powerpoint slides and military jargon, I'd rather be in class. But the food is good.

The lack of class does not translate to a lack of work. Or a lack of procrastination. I spent an hour and a half of my precious study time tonight watching Once. It was possibly one of the most beautiful films I have ever seen, and my stomach still hurts from the closing shot.

So I'll leave you with this while I hit the books again:

[sugar snap peas]

[zucchini]

blink

The last two weeks have felt like just a few days, and several months at the same time. The sheer amount of information we've been getting is hard to fathom, even though I've been sitting through it, trying to take at least some of it in. When I got home from class on Friday at five thirty, I fed Nyssa, kicked off my shoes and laid down. I woke up at eight this morning a little startled, but feeling calmer and more focused than I have in two weeks. It is amazing what fourteen hours of sleep can do. It's amazing that I needed that much to catch up.

I spent my shift at the station today burrowed in a corner of the training room catching up on last week's work and reading. I will spend tomorrow at the laundromat doing the same thing. We've covered basic chemistry, cell biology, pathophysiology, pharmacology, nervous, endocrine, respiratory and circulatory systems, related emergency medications, medication calculations, shock, fluid balance and resuscitation and advanced airway management. We've learned to start IVs and intubate unconscious patients, and started the process of learning to knock out and intubate conscious ones. After several days of being repeatedly stuck with needles (of varying size) by classmates, we all look like heroin addicts with bruises and trackmarks all over our arms. Those of us that weren't shy of needles before are becoming so now. Those of use who were terrified of needles don't mind them quite so much anymore.


But the bottom line is that I love this. After so many abortive attempts at finding something that will work for me, this just feels right like nothing else has. I love the crazy academic pace, the kinesthetics of skills. I love watching all the disparate pieces of information start to fall together in a patient. I love suddenly understanding even more of what I've been seeing in the ambulance, being able to think critically about calls and start to answer some of my own questions. I can't wait for clinicals to start in a few months, as nervous as I am for that step up.

[this is only a few ... ]

Not that there haven't been a few hiccups along the way. The Paramedic program is experimenting with a new class & clinical schedule this year, working with new instructors and simultaneously integrating online components that have never been used before. The balance is far from perfect, and things have been a little on the chaos side at times. But with two weeks behind us, I think we are starting to find the sweet spot.

On the MRSA front, I'm almost through my round of antibiotics. Although the worst is over, the infection is hanging in there with every last bit of energy it has. I am going to be watching that spot very carefully in the days after the pills are gone. I won't make the same mistake twice. (At least not this year ...) I'm also starting to feel all the negative gastrointestinal effects that go along with a heavy course of these types of meds (perhaps the root of some of my denial.) There is lots of yogurt and probiotics on my horizon.

Peter is off on the east coast this week, visiting some good friends and helping his dad get their old Harrisburg home ready for sale. He'll be back Thursday, just in time for the fall colors. The marsh-tundra at the bottom of Goldstream valley is crimson, and the aspen have started to turn.