8.27.2008

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]

8.23.2008

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.

8.12.2008

misdiagnosis

Peter says I go a little crazy when I'm sick. If something is wrong, I sink into an irrational state of denial and declare that I am fine, that I will get better on my own, no doctor visit is needed. I have ultimate faith that my body will heal itself without intervention.

Two days ago, I woke up with a spider-bite looking wound just above my left knee. There was a tiny, pinpoint dark spot and a raised red area the size of my pinky finger. I have a bad history of reacting poorly to spider bites. I gritted my teeth, tried not to itch, got dressed, and headed into town for the first day of Paramedic Academy.

On examining my leg at lunch, I was startled to find the red area was now as big as all four of my fingers. When I got home, I could barely cover it with my hand. It was hot and stiff and significantly raised. I was sure it would be fine in the morning. Peter was sure I should go to the Urgent Care clinic. After a quick phone consult, so was my mother. I studied and went to bed instead. In the morning, it was worse and I was still convinced it would take care of itself.

I debated myself through eight hours of class today, as the heat spread and the swelling nearly doubled. After yet another conversation with Peter about how I should go to Urgent Care immediately after class, I was still undecided. It is just a spider bite, I told myself, while trying not to scratch through my jeans. My body will figure it out and be fine.

When they let us out of lecture half an hour early, I decided to drive over to the clinic. I would go in, hit the restroom and take another look before deciding. Besides, I needed to get another TB test and titers for varicella and measles for clinical rotations next month.

I muttered under my breath to the receptionist about why I was there. "I was bitten a couple of years ago, and it kind of blew up on me. My arm ended up all swollen and I got a nasty fever. And now I've got this new one ... it's just making me a little nervous. And also, I need a TB test."

After weight (ack!) and height check and blood pressure (110/60, hallelujah!) the doctor walked into the room saying, "You have a spider bite? There aren't any biting spiders in Alaska."

I explained while I hopped up on the table and let her take a look. She poked the spot and asked me again how fast it had gotten like this.

"I noticed it yesterday morning."

"You have an aggressive staph infection. In fact, it looks to me like MRSA."

(For the non-health care crowd, MRSA is a very nasty antibiotic resistant strain of staph that is endemic in many health care facilities and starting to show up in the general population.)

She went on to prescribe me a round of double-strength antibiotics to be started as soon as I picked them up, a prescription ointment and instructions to heat-pack it every two hours and stay off my feet. She then told me to go home and mark the red margins with a sharpie.

"If the red is past your margins tomorrow night, come back in immediately. You'll have to go on IV antibiotics. If you had waited two more days, you'd probably have ended up in the hospital."

Oops. I guess my medical education has begun in earnest.

8.11.2008

chapter

At eight o'clock this morning, I will sit down in a classroom with sixteen other students. Four are from my fire department. One is from the Fire Medic program. The rest are strangers. We are this year's Paramedic Academy class. We won't be strangers for long.

Early this week, faced with a stack of books best measured in feet and every Paramedic school horror story I've been told and re-told over the last four months echoing in my head I was having second thoughts. Lots of them. On Thursday, I responded to three very different calls that restored my confidence and resolve. This morning, I'm as ready as I'll ever be ...

8.10.2008

wildfire - ad nausium

I was restored to the fire line on the seventh day, and worked on the Cub Complex for a total fifteen. I was hoping to stay out for thirty - the maximum - and am only a little ashamed to admit I actually cried when I found out I had not been reassigned or extended at the end of my first fourteen (things in California were cooling off by then) and had to pack up and head north.

Highlights included watching a burn-out operation (where hand crews light a forest fire to burn an area ahead of the wildfire to create a line it cannot cross) blow up one afternoon from a ridge above the action. Radio traffic was heavy and helicopters were ferrying and dropping water to contain the burn.
[pre-burnout]
[three hours into the burnout]
Another day, I was posted at the "top of the world lookout" at about seven thousand feet, where I had a smoky view of Mt. Lassen and an incredible 360 view of the whole Cub complex. It was like having a front-row seat for a day as crews were moved around, trees torched, spots were discovered and put out. My partner that day was a more experienced medic who used to work on the fireline, and he was doing double-duty as a lookout for our division supervisor. It was quite the education.
[steve: medic & lookout on top of the world]
I got to know the faller team from my second day rather well, and ended up sharing several meals with them over the next two weeks. One day they took me with them as they cut down trees along the highway that the fire had closed down. They were looking for trees whose roots or lower trunks had burnt in such a way that they were likely to fall on the road, posing a major hazard to unwary cars. There's nothing quite like having a massive fir tree fall straight towards where you are standing and explode as it hits the pavement a few feet away. My stomach was not the same for the rest of the day. (I know it is sideways ... I can't fix it.)


I was also posted with a crew of young Pueblo men from a reservation in New Mexico. For several days they were the only hand-crew on my division and I followed them around and hung out with them on their breaks. I got to know several of the squad bosses pretty well, and on the last day they ambushed me, painted my face and put me through the same 'initiation' that their rookies go through after their first fire.
[bottom row, far left, shamefully clean shirt]
[war paint]
On the second-to-last day of my tenure on the Cub, my partner and I left the line late and ended up heading down the mountain on logging roads we hadn't driven before. We were well behind the crews and well ahead of the division supervisors who were waiting for night-shift to arrive. That day, crews had lit a huge burn-out which was still flaming hard even in the cooler, damp night-weather. They wanted the arriving shift to know exactly what was going on. My partner and I took a wrong turn at an unlabeled T-intersection. A mile later, we came around a corner and found ourselves in the middle of the burn with no way to turn around. The road was narrow with steep banks on both sides, boulders loosed by the fire scattered across the gravel and flaming trees all around in the dark. It was surreal, as was the quickly rising temperature in the vehicle and the crackling I could hear through the closed windows. When we came to a flaming tree that had just fallen across the road, we made a quick decision to risk a 150-point-turn and high-tailed it back to our wrong turn.
(NOTE: I did not take these pictures, but they are from the Cub Complex. I spent that entire episode trying to get out alive and not pee my pants.)
[photo credit: scott linn]
Thankfully, there were no major incidents or accidents on my fire. I saw a few decent burns and lacerations, and got more experience with the many and varied presentations of dehydration but for the most part the medical issues I saw were relegated to the blisters-and-sniffles I had been told to expect. When I got back to Alaska, I heard some wild stories about other medics who had some major trauma on their lines. As confidant as I am that I have the skills and perspective to deal with such eventualities, I'm just as glad my first fire was a mellow affair. It let me figure out how things work, what to expect and how to navigate the particular landscape of a long-term ICS operation.

I loved working as a fire medic, and can't wait for next season. Being paid to hang out in the woods all day and patch up a kaleidescope of wounds is just the ticket for my little soul.

8.07.2008

wildfire - days three through six

Day Three

I went to the same spot today with another medic. Rick, the division supervisor, took me around the division with him for a few hours in the morning. I saw a little more flame, and he explained what I was seeing - from how well things were burning and why based on terrain and vegetation to areas of major concern they were aggressively protecting. There was a huge area a quarter mile from where things were currently smoldering where the timber had been harvested. There was tons of down, dry trees and brush that had been left behind by the loggers, all of it on a hot, south-facing slope. It was a tinderbox waiting for a spark, and there were no natural barriers for miles beyond the slash.

It was good to see all of the things I'd learned about in my Red Card class last may coming together, from where the fire was burning, how weather and humidity affect the burn activity and how different equipment is used to fight the fire, either by attacking it directly or moving ahead of it and cutting breaks in the fuel.

I am not a big fan of the medic I was paired with for the day, but the Medical Unit Leader has promised to pair me up with a different (and equally partner-dissatisfied medic) tomorrow. For today I am paired with a career city firefighter who has the emotional maturity of a thirteen year-old. He complains about everything from the vehicles we have to the hours we are working to the food to the management team assigned to this incident. Although I agree with him on the last point (those I have encountered, with the exception of the division supervisor we're with today, tend to lead by force, pushing and shoving rather than leading by example from ahead) but still, it is difficult to listen to him whine and complain for thirteen hours. It is one thing to not get along with a coworker you share and office with, another to not get along with a coworker you are expected to sit in a car with. All. Day. Long. Thankfully, he snored in the driver's seat for 90% of the day, leaving me free to read and think and incrementally turn down the nauseating pop station he left on full blast before he nodded off.

I also had my first on-the-line patient today. Two loggers (they are called Fallers, and work independently, as opposed to Sawyers who are part of a 20-man line-crew) came by our rig, one with a burnt foot (he had stepped in an ash-pit and the heat had seared through is boot, blistering the arch) and one with blood all over the side of his face. The other medic took the blistered faller, and I started over to take care of the bloody-headed one. I realized he wasn't badly hurt when I was waved away as he gave a big, loud piece of his mind to the faller-boss which I thought for a minute might end in blows. When it didn't, I got him away and started cleaning all the blood away.

Elder Faller was a rough-looking man, towering over me with with his thick logger's broad shoulders and massive arms. I had to get him to lean down quite a bit to work on his face without reaching. His bloody, grizzled head was still glaring around with leftover rage at whatever the conflict with the faller-boss had been about. When I saw the boss had dodged safely out of sight, I teased him a little about his mortal head wound and my attempts to make him yelp - or at least flinch- while searching through the blood for its source. Eventually I found it: a tiny superficial scrape less than two inches long. There was no good way to bandage it so I had him hold some 2x2s on it for a few minutes to stop the blood seep, then slathered it with tribiotic and called it good. I kept on goading and teasing him through the ordeal - he was obviously mortified to be treated by a medic for such a tiny scrape - and by the time he headed back to his chainsaws and axes he was chuckling and relaxed. I hop the faller-boss stayed away for awhile.

Day Four

I was on the line with a girl-medic today. What a relief. We stopped for Mochas on the way out to the line, and talked about EMS, kayaking and backpacking on the way out to the line. She is my age, but married early and has four kids whose initials and birth dates are tattooed on her arm (her "four consecutive life-sentences.") Her ex-husband has custody of the kids in the summer, allowing her to work wildfire season and bank up on the cash. We parked in a dust-bowl on a new (for me) division of the fire to the north-east. An army truck with a load of electronic equipment parked just down the hill from us, and we were told they were flying a reconnaissance plane overhead doing detailed heat-imaging of the fire and relaying it in real-time to the truck. It is some kind of prototype program (at least we were told) and they were fine-tuning it on our incident.

Girl-Medic had a US Weekly and a Cosmo, which I read out of desparation - you can only read Dune sequels for so long before your brain needs a break. I was reminded many times over why I never pick those things up. I need to remember to bring more and varied reading material on my next fire. A couple of Dune books does not cut it. I started hand-writing letters, though, something I love to do but hardly ever have the patience for.

One thing is for sure - it is a lot easier to find a spot to pee in the woods when you're posted with a girl.

Days Five & Six

I was stuck in camp at the aid station with the Medical Unit leader for two days. There are only a couple of EMTs she can stand to have hanging around in the unit all day, and apparently I am on of the 'lucky' few. Although it was nice to get a shower and run into town to get stamps at the post office, I'd rather be on the line.

Both mornings, my Faller Boys came in to have burns and various other flesh wounds dressed along with the usual crowd looking for congestion relief and moleskin for blisters. Once the crews left for the fire, things were quiet. The hardest thing was sitting in those metal chairs and trying to stay awake. We had someone come in from the fire with reduced lung sounds who ended up going to the clinic in town, but that was the only real patient in two days. There was a trickle of camp-based CCC kids who came in for band-aids or to have turned ankles iced and wrapped ... or to get a minute of rest from cleaning up after eight hundred odd firefighters. They were usually quickly found and chased out again by their supervisors.

For the most part, these last two days have been slow and frustrating. I don't like sitting in here with the management, having hollow conversations while trying to ignore the constant bad-mouthing and bitching. I'd take being posted on the fireline with a shitty partner who snores to bad music for thirteen straight hours that sit under these fluorescent lights being polite, even if it means losing a hot shower during my lunch break.


::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
(in real time)
I am at the fire station tonight, eating my shift-captain's frozen blueberries while I blog. I've spent most of the evening trying to make sense of the Paramedic Academy schedule that came with my acceptance letter and prepare myself for the insanity that will start Monday at 0800.

I responded from home to a tone-out for an MVA this morning just up the street from our cabin. I found the crumpled car but no patient or bystanders and drove around for fifteen minutes trying to figure it out when the ambulance passed me and pulled into a driveway a quarter mile down the road. Apparently the patient had walked home and then called 911 from there. Some days, I wish somebody would issue me a radio.

Our garden is giving her first harvest despite the cold, overcast weather that has plagued us all summer. We have had a salad and a tiny northern zucchini, and Peter made pumpkin-seed pesto with his basil crop. I saw my first sugar-snap pea yesterday, stil flat but long and bulging with pods. Some garden pictures are posted on Solar Aperture, and more (as well as more in-context fire pictures) will be forthcoming when I'm not blogging from the station.

::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

8.02.2008

interlude

:: to report on disasters a little closer to home ::

On my tours, I talk about how dry the interior of Alaska is. A combination of permafrost and tundra keep the little precipitation we do get (between 12 and 15 inches, on average) available to vegetation, and allows this region to green up rather spectacularly in the summer. For the most part we don't get a lot of rain, which makes for nice warm summer days.

This summer has been an exception. Especially this week. Unusually wet weather, and recent heavy rain has flooded the Tanana, Salcha and Chena rivers that run through Fairbanks and her surrounding communities.

The water came up fast. On Wednesday morning at about two thirty, my fire department pager went off requesting assistance evacuating a neighborhood in our district that sits along the Chena where it runs into the already flooded Tanana. I listened to the chatter over the pager for a few minutes and determined, a little guiltily, that there was quickly more manpower than vehicles and decided to forego the twenty minute drive to the station.

Thursday night, I showed up for my shift and was immediately requisitioned along with three other volunteers and two canoes to do a door-to-door paddle and determine what residents had decided to wait out the flood, see if they wanted out or needed anything. We loaded our gear and headed down to the borough's incident command post (incidentally, in the Paramedic Academy building that will be my life in ten days) to get instructions, hip waders and heavy rubber gloves.

We were out canoing down streets and up to flooded houses until one in the morning. The water wasn't moving very fast, but it was nasty. Fumes from diesel and heating oil slicks made me dizzy, but that wasn't as bad as the ooze from flooded septic systems and outhouses. I was very, very thankful for hip-waders and gloves. I didn't get many good pictures - I only took the small digital camera, and what with the rain-cloud gloom and our continuing distance from solstice, they didn't come out very well. Besides, I was spending most of my energy trying to avoid downed trees and submerged cars with canoes, and determine which gaps in the trees were driveways that needed to be explored.

For the most part, the raised foundations made to avoid melting permafrost kept houses from being ruined. Power was still on, and in most of the houses that were still occupied folks were watching cable TV and seemed unconcerned about the water inches below their floorboards. Yards told a different story, however, as we navigated submerged cars, flooded workshops and floating freezers full of a summer's catch of salmon heading out towards the Yukon.

[lt. gelvin attempting contact from our canoe]


[flooded rv & cars]

We found a few elderly folks who had survived the great flood of '67 and were pretty nonchalant about ruined gardens and yards full of river silt. Almost everyone had a canoe tied up to their porch railings, plenty of fresh water and food. Some had even managed to get cars out to higher ground before the water came up, and had been canoing out to work every day. It was, over all, a pretty mellow disaster.

I'm headed down to Valdez to help a friend move. I'll be back to post more journals from the fire on Wednesday.