termination

Tomorrow will be my last day working as a Paramedic at the Tri-Valley Fire Department. With fall colors in full display and temperatures dipping precipitously towards freezing, the last of the hearty tourists are filtering to points south. In a few weeks, Denali National Park will all but close down for the season. The last four months have seen my first real, paying, full-time work as a Paramedic. Despite a rocky start, I found my stride and can hardly believe I will pack up my uniforms & trauma shears and head off to the next bizarre adventure tomorrow afternoon. (And yes, this sleepy small town fire department proved itself perfectly capable of producing the bizarre.)

I took this job because a mentor-of-sorts told me that working a summer at Tri-Valley is what inspired her to become a Paramedic, and was where she returned to cut her teeth as a new medic as soon as she earned her badge. It was also the only opportunity I had been offered, after hounding after every opportunity I could find for a year, where I could work in Alaska, cut my own teeth on an ambulance as lead, and not have to run into burning buildings as a side-line. I gave up working as a Wildland Fire Medic to spend my summer indoors at a fire station, and although I missed the smoke, safety-naps, bears, cubbie baths, fresh-food box steak-nights, campfire coffee (ok, maybe not) & endless blister mitigation, I don't regret spending my summer on the road system in a real bed (well, maybe a little bit ... but you get my point.)
The lessons learned here in the mountains have been various and have as much to do with life (and especially Very Small Town Life) as with medicine. Any delusions I had about living in the idyllic world of a tiny rural community have been thoroughly and permanently debunked. Working alongside the PAs at the Canyon Clinic has been the best part of the summer, and has solidified my resolve to pursue that end ... eventually. The confidence I have gained in my abilities as a medic and as a fledgling lead are already invaluable, and will hopefully soften my landing on Monday.

Next up is temporary remote-site medic work in Western Alaska. I have already compiled a two-foot-tall stack of reading material to keep me from imploding, and in light of redoubled warnings regarding unprecedented boredom I am considering an attempt to redeem the debacle I made of knitting back in '05. In the mean time, I'm watching termination dust work its way down the mountains around Healy and trying not to think about the future encroaching from just beyond this season's snow.

siren

Outside, the glow of the late northern sunset is inching towards unaccustomed night. Up here in the cradle of the mountains, the fierce winds of the last week have faded into a fluttering, almost-warm breeze that has just a kiss of the stinging autumn nearly upon us. I want to strip this stiff uniform into a heap, pull on my own familiar clothes and walk up the valleys away from this little outpost of roads and houses and people. Away from anxiety about what the next months will bring or won't. I want to walk into the woods and valleys and sleep under the newly lit stars in a bed of alpine tundra, I want to wake to the almost-frost of late summer on my cheeks.

That is why we go to the woods, go out on the water, across the desert, isn't it? So we can just walk for awhile? Just focus on picking a line across a valley, or a dry footstep in the rocky creek? So we can get the weary rest our bodies can never quite capture in our real, our necessary lives? So our minds can reset themselves with the monotony and physical demands of travel under our own slow power. Is this why the dream of the journey cannot be shaken?
I have debunked so many of the fantasies that brought me here, but this one remains. On a warm, darkening night like this I just want to walk away into the mountains.

3.0

So what now? I took a seasonal Paramedic job with the Tri-Valley Fire Department, resigning from my clinic job after eight months of blood pressures, flu shots & nebulizers for a chance to get more solid Paramedic experience, if only temporarily. I’ve been here nearly a month, working every other week. As the spring semester was wrapping up, The Plan was for Peter to finish up school in the fall, after which we would move to Texas to establish residency as he applied to Texas med schools. I was going to get a real, full-time Paramedic job. Finally.

I turned thirty a few weeks ago. I was hoping it would pass like every other birthday … just a blip on the radar and on to another year. I refused to believe it would bother me. But apparently a self-reflective freak-out was inevitably right on the heels of the margarita & hot-wing celebration. Since I finished my B.A., I’ve never held a job for more than nine months. I’ve applied to and been rejected from MFA programs, started applications for and abandoned the pursuit of an MSW, and dropped out of a Master’s in Education one semester from finishing. I’ve tried eight year’s worth of different jobs on different tracks. I’ve made lots of roads into what I don’t want to do and backed out a little wiser each time, but until I started into the medical field last year I hadn’t found anything that stuck.

Turning thirty and Peter’s trajectory into the next eight (plus) years of medical school & residency have made me give my life a longer look. I love pre-hospital medicine, at least in the limited capacity I’ve experienced it so far. But a life of being underpaid and working twenty-four hour shifts isn’t exactly where I want to be when I’m turning 40.

With encouragement from the PA & ANP I was working with at the clinic, I’ve been looking into what it would take to apply to PA school. It’s a little intimidating, going back to school … again … on so many levels. But the life & possibilities presented by being a PA are so much more along the lines of what I want for my life. I think. Even though I won’t be on the front lines anymore, my Paramedic license and out-of-hospital work isn’t going away. I do love what I’m doing right now, now that I’m working as a Paramedic. I just need to start looking ahead as well.
I worry a little that by jumping with both feet onto a career path that heads directly into science and medicine and several more solid and very full years of school with a R.E.A.L. J.O.B. at the end, that somehow I'm giving up on writing, on running dogs, on playing guitar on stage and raising goats & chickens & a greenhouse full of tomatoes & peppers & spinach. I'm trying to remember, more, to believe that all these things are mutually possible. But looking at the specter of hard sciences on the horizon it's a little hard to see how its all going to fit.

We'll see how I feel about all this in six weeks.

nippy

The White Cloud continues to hang over me. I turned my pager off last night for the first time all week, and there were two calls - major hemorrhage & an MVA - within two hours. I could have walked to the MVA before the ambulance arrived. Paranoia only grows.

I made a milk run to Freddie's tonight and caught Steve Wariner on Prairie Home Companion playing a guitar piece that tore my heart in a way I haven't felt in a long time. I sat in the parking lot until he was done, although I left the engine running since the temps had dropped from a balmy -25 to -35. This morning, when I drove by on my way to proctor an EMT-I test, the temperature reading was nothing short of brutal at -41. I hope things warm up like they are predicting for Turkey Day.

My LPN supervisor shocked me on Friday by sitting down and telling me that if I left the clinic for an EMS job, she wouldn't hold it against me. After my interview last September, which I characterized afterward as hostile, I didn't think they were going to hire me at all. Apparently those with an EMS background have a proclivity to get "bored" with clinical work. Clinical work is not boring. I hardly know where the days go. My primary complaint is that it is not what I have been trained (and want to) do. I am still learning a lot, and I'm glad for a full-time gig, but it is a huge relief to know I won't be burning bridges if something more in line with my training surfaces. Unlikely, but hope springs eternal.

In the mean time, the dark is bothering me but the cold is not. The Subaru's engine block heater shorted out, and her check engine light has been on since the first cold snap in October, so we're biting the bullet (after a huge repair job on the Ford two months ago) and taking her into the dealership Monday. I think the cold is bothering her a lot more. I just hope she starts in the morning.

Peter made tacos for me tonight, as well as mixing some amazing new Vodka & Lemon drink he's created which is perfectly slushy after sitting out on the porch for fifteen minutes at thirty five below.
In light of the vodka, the pager is off. Goldstream, you are on your own tonight.

counting

Discontent is growing. As I've settled into my job, I've realized that 80% of it consists of making phone calls. And even though they are a minority, the Crazy People make up a very loud and demanding percentage of that task. Week days are so busy that I don't notice too much, but as soon as I report to the fire station for training - especially EMS training - or watch an ambulance fly by as I'm leaving work, it gets a little harder to go back and take auto-cuff blood pressures and refill Lisinopril scripts for another day.

Fire station hours are not helping. I have been pulling my required 60 hours worth of shifts a month, not to mention having my pager on whenever I am home. However since earning my Paramedic License, I have run on Zero calls. If I'm at the station, the tones are dead all night. If I'm at home, anything that we get paged out for is on the other side of the district. This weekend, I had my radio on from Friday night through Monday morning. The only tone-out we got was for a chimney fire on Sunday night. The tone came out five minutes after I left the house, without my pager, to buy some printer paper in town. By the time I got back to the cabin 45 minutes later, all units were pulling back into the station. My white cloud status followed me all through Paramedic Academy & my internship, but this is getting a little ridiculous. If I ever had an edge, I can feel it slipping away now.

I love prehospital medicine, and I have a knack for the book-learning part of it at least. I got 100% on my recent advanced medic standing orders test at the station, and didn't do too badly on the scenario testing (besides some major and yet-un-resolved ACLS conflict-of-opinion with my proctor.) But without the dirt under my fingernails, the nagging feeling that a year of my life and thousands of dollars was flushed away keeps growing. I'm frustrated and even a little angry, all the while telling myself that this job, this life in a black hole of EMS, will pass. Most days, though, it doesn't feel like I will ever get to where I want to be.

As if I ever knew where that was.

In the mean time, I grit my teeth for eight hours and count my blessings for the rest. Three of them are in bed with me now:

nose

Despite my lifelong obsession with animals and my genetic predilection for random trivia I have found a piece of dog minutia that had somehow escaped my radar. Although this is my fifth year in Alaska and my obsession with northern working breeds has only grown with our time here, the addition of Pico and a peculiar change he has undergone in the last month had Peter and I puzzled. Some quick google research brought us up to speed.

Northern breeds (and to some extent, Labradors as well) undergo a depigmentation of the nose in the winter, colloquially referred to as snow-nose. Nobody knows why. As the dog ages the pink nose becomes permanent, but during early adulthood a husky's nose will change between black and pink from summer to winter.

Figure I : Pico Puppy Nose, May 2009











Figure II: Pico Adolescent Nose, August trip to Deadhorse.











Figure III: Pico Adolescent Nose, early October. Just prior to first sticking snow.















Figures IV & V: Pico Adolescent Nose, November, three weeks after first sticking snow.





















Figure VI: (Experiment Control) Nyssa, 6 1/2 years old. No northern bloodlines. No changes in nose pigment noted despite years of cruelly enforced winter-weathering.














The investigation continues ... in the mean time, we went over to the Goldstream Store on Friday night for some last minute eggs (farm-fresh! horrah!) When we pulled up in the parking lot, there was a dog-team tethered in the snow between the store & Ivory Jack's. As we got out of the car, the musher loaded his purchases, kicked the snow hook out and took off towards woods & trails behind the buildings. I love it here.

costs

[update below]

With all the health care reform debate going on, I feel a little apprehensive about throwing my largely uninformed two cents in. But here they are anyway.

I have been paying for "disaster insurance" for the last four years. This insurance initially cost me $130 a month, and would cover my ass if my yearly medical bills were over $2000. As of this summer, this insurance costs me $250 a month and will cover medical bills over $5000 a year. I am fully responsible to pay out of pocket for all annual exams, incidental doctor's visits, emergency costs & medications up to that limit. Despite the apparent absurdity of paying $3000 a year in case I am hit by a car or perhaps by lighting, stories of people having freak accidents and ending up hundreds of thousands in debt had me scared enough to keep paying up.

This is a story in two parts, with no conclusion. Just so you know.

Part One: Ankle
In July, I was attempting to bikejor with Pico when he went after a whitetail deer and the bike rolled over my ankle. I did the usual Rest, Ice, Compression, Elevation for the first 48 hours, but still could barely bear weight by day three. On day eight I decided to eat the cost of an Urgent Care clinic and an X-ray, since the stability of the injured limb seemed to be deteriorating. I was told it wasn't broken and sent on my merry way, with a bill for $300 showing up in the mail in Alaska a month later followed by another for something like $80 in unexplained administrative fees. Two months later, it was still slightly swollen, painful & unstable. Because I was trying to complete the Firefighter I class at the time, I went to an Orthopedic PA clinic and ate the cost of another X-ray and exam hoping for a definitive answer and maybe some physical therapy exercises to do at home. Instead I was told that there was an old break and calcification which was probably impeding the healing, and that the Firefighter class would have to wait. That was it. That was two months ago. It is still a little swollen, still a little too sensitive to lateral movement, and I am now over $700 in the hole.

Part II: Fever
I started a job at a community health clinic a month ago. Inevitably, all the germy air caught up with my immune system and I came down with a nasty sore throat & fever on Wednesday night. Certain I'd gotten a flu of some kind, I was bracing myself for a week or more of feeling like a bug on a windshield. My supervisor told me to come in and be seen by one of the clinic docs, primarily because she doesn't yet know that I only skip work when I can literally barely walk. I called the human resources department, only to find out that my insurance at work doesn't kick in for 60 more days. SOL is the appropriate acronym here, I think. This morning I checked myself in and screened myself before anyone else arrived, to avoid spreading my gunk even further. The internist I work for came in and decided I had bronchitis, not the flu, due to an already broken fever & junky lungs, and prescribed me a Z-pack and a second day not further infecting his patients by staying in bed. I went home sick from my full time with benefits job at a sliding scale health clinic, and by 10AM my little cough had eaten up $200 more dollars in medical fees and pharmacy costs as well as all of the sick-time and vacation-time I have managed to accrue over the last six weeks.

I know that compared to most of the health-care stories, mine is a minor one. I am a healthy young person without any chronic medical conditions, and full-and-part time jobs that cover my tail for all the little medical issues & expenses I've sunk into over the last few years.
At the same time, I have paid nearly a grand for a sprained ankle and a one-day fever over the last six months. (I somehow neglected to mention my $700 visit to the Urgent Care clinic two winters ago, for six stitches and fifteen minutes of the good doctor's time. Or when Peter was told to go to the ER by a triage nurse because of body-fluids exposure [see previous post] and was charged over $1000 for the doctor to tell him not to worry about it.)

Now I work in a clinic where the majority of patients we see are either uninsured and paying out of pocket or on medicare/medicaid. Some work part-time, some are self-employed, and others can't or don't work. All of them are dealing with much higher bills and much more dire consequences if they don't seek and get the medical care and medication they need. Sometimes they get it, sometimes they don't, and the difference between the two is almost universally measured in money.

update: as of 11/06, add another $104 to the ortho bill. apparently they forgot to bill me for the 10 minute follow up appointment two weeks after the x-ray.