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.



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.