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.

watershed

Two years ago today, everything changed for me.

Two years ago this week, I had just dropped out of graduate school. I had spent the first weeks of fall cooped up in a classroom with twenty eight fifth graders and an increasing sense of panic. I had spent the last year and a half taking graduate courses in education, but was realizing with growing certainty that the US educational system was not where I wanted to spend my life.

The first Saturday of October, Peter arrived home from a shift at the mental health group home where he worked. We went for a walk around our little neighborhood of cabins, relishing the fresh snow - first of the season - and crisp mid-20's weather. There were two puppies at the pound we were considering adopting - two little husky-mutt sisters that I was fantasizing about turning into pulling dogs and the start of a small recreational team. Instead of heading indoors at the end of our walk, we stood in the driveway chatting about fencing and pacing out a possible layout for an outdoor dog run.

A blue truck drove by at top speed, and a few seconds later I heard yelling.

"Somebody call 911. There's a car flipped over in the pond."

I ran out to the road and looked in the direction of the truck. There was a children's party going on two doors down, with cars parked all up and down the street and people milling the yard and porch. Two men were walking quickly towards the driver of the truck, one whipping out a cell phone.

I thought, "If the car is in the water, there isn't much time."

I was pretty sure I knew where the car was. There is a little drainage pond about a hundred yards down the road from our cabin, right where another street Ts into ours. It was frozen over when we had walked past it just a few minutes before.

I yelled for Peter to call 911 and then bring the car, not thinking in that moment that he hadn't heard anything and had no idea why I was suddenly running down the road. As I was running, my mind was spinning through the Wilderness First Responder course I had taken in 2005, and the refresher I'd finished in June. Scene Safety. BSI. Airway, Breathing, Circulation. Spinal Precautions. In that first course, we did a simulation of a Jeep rollover in a creek. All the fake victims had been thrown, one ending up in a tree, one in the shallow water, the other two in the deep grass on the bank. It had been deep winter in Texas, sixty degrees and sunny with green grass and college students playing Frisbee on the other side of the road. I had dealt with a few minor emergencies working for Wilderness Quest in Utah, but most of my in-the-woods training had been in blister care and forced hydration. I was thinking, "This is it. Now I'll find out how I handle something serious."

I heard screaming before I got to the little drainage pond. Although it had snowed, the weeds and brush growth from the summer obscured my view. The screaming continued, followed by a hollow banging. I finally cleared the weeds. In the pond was the underbelly of a large sedan, sunk to its axles. Serving-plate sized chunks of ice bobbed on the wakes of black tannin water. A girl was on the other side of the car, screaming and slamming the undercarriage with her fists. She was up to her shoulders, soaking wet and clearly hysterical.

When she took a breath, I heard pounding from the inside of the car, more muffled screaming and the sound of water pouring into the space. I looked around. The street was empty, and the sun had dipped below the trees.

Scene Safety. Keep yourself safe, first. This is the first lesson of every CPR, first aid & EMT class. I tried to ignore the screaming from the car and coax the girl in the water towards me. At first she wouldn't even look at me. I looked around. The street was still empty. I was not about to get in the water, or get close enough to the girl to get pulled in, at this point. I told the girl that help was on the way and she needed to get away from the car and onto the road. Still screaming, she started to wade towards me, chunks of ice bumping away from her as she made her way around the exposed tail pipe. I coaxed her on as she repeatedly turned back towards the screaming victims still in the car. Out of the corner of my eye, I saw Peter pull up in our little Ford wagon. He got out and helped me pull the girl up the steep bank. In the process, I slid down past my knees into the water. Peter bundled the soaking, crying girl into the back seat of our car with the heaters on full blast. I asked how many people were in the car.

“Four."

“Shit.”

I saw three men come around the bend in the road towards us, one of them carrying a crow bar. Already sliding down the steep side into the pond, I decided with Pete & a warm car in the road, three more big men headed our way and 911 called, it was as safe as it was going to get. I slid the rest of the way in and struggled past chunks of ice towards the far side of the car. The screaming and banging was louder, and I could still hear water pouring in. Yelling when the screaming stopped for breath, I asked if they could open or unlock the doors. The screaming continued, and I groped under water with quickly numbing fingers to find the handle. It clicked back easily, clearly locked from the inside. Suddenly Pete and the three men from the party were next to me in the water. We tried to break the windows, but deep under water the crowbar and the hammer Pete dug out of the back of our car couldn’t get enough momentum to crack the glass. We tried to rock the car onto its side, feet groping for purchase on the slippery sludge at the bottom of the pond, but the vehicle was wedged into the bank on the road side and heavy with water and wouldn’t budge more than a foot or so.

The sound of water pouring into the car had long since stopped, and the banging from the inside was weaker although the screaming continued. We were all getting cold, and didn’t know what else to do. I remember slamming my fists on the undercarriage in frustration, screaming “Jesus” as a curse and not a prayer for the first time. I knew if we could get the windows broken, we might be able to go from there. Things were getting fuzzy with cold. I looked up and there was a crowd on the street, some holding blankets, watching us flounder, listening to the now faint cries from the car.

We went for the windows again, and suddenly a back side window gave. I had gotten Pete to bring a heavy winter glove with the hammer, thinking of glass, and it was still sitting dry and warm on the frame of the car. I reached for it, but my hands were too stiff and cold to slide it on. I threw it into the water and took a breath, sinking under and groping through the window for the lock. I couldn’t find the back lock, so I went further until I felt the front door and threw the catch. I never felt the glass slicing my fingers.

The five of us rolled the car back up a few inches and popped the front door open. When the car rolled back down to rest on the open door, I reached in and pulled out a little boy, probably ten or eleven, blue with cold and eyes wide with terror but breathing and looking at me. I passed him to the man behind me, and he was handed off to the shore.

I reached back into the black recess of the car as a McDonald’s cup and French fries floated out through the now-open front door. I saw a pale arm in the gloom. I pulled it and met no resistance at first. Then the body it was attached to wedged between the two front seats and stayed there. Back passenger. I struggled to free her and yelled to nobody and everybody on the street, “this one’s unconscious” hoping for direction. From someone. With a little gentle prodding, she floated free and came face down through the door. I rolled her gently onto her back. Blue. Not breathing. I said this out loud, hoping for some help. There was still no ambulance in sight. I slid my arms under hers and started walking backwards towards the road. Somehow we got her up the steep edge and onto the gravel. I looked up, and Peter was kneeling on her other side. I looked down and saw her tennis shoes, the wet laces forming ice crystals. I tilted her head, looked in her mouth. Black water and dirt. Still no breath. I felt for a pulse, but my hands were totally numb and now, alarmingly, I saw that they were also bleeding. I think I remember screaming for someone with warm hands to feel for a pulse. Nobody came forward. I wasn’t prepared for this eventuality. What do you do when you can’t assess for a pulse because your hands are too cold? They didn’t go over this in class. I looked up and saw the crowd watching us, saw Peter looking at me, saw the other rescuers coming out of the water into the waiting blankets of those on the shore. I tried to rip her shirt, to get to her skin. CPR has to be skin-to-skin, I remembered. I looked up at Peter.

“Are you sure you’re OK with doing breaths?”

“Yes.”

“I love you.”

And we started doing CPR on a real person for the first time in our lives. I felt her ribs cracking like sticks under my frozen hands, felt her chest destabilize as I pushed down. I had read that this meant you were doing good compressions, but what skin I could still feel was crawling with the feeling of it. After several cycles of compressions, I looked up while Peter gave her breaths, and realized that there was still yelling and banging coming from the inside of the car. I looked up, and saw a trooper and another bystanders struggling to break open the door wedged into the mud on the road-side of the pond. I looked behind me at the group of people watching. The other rescuers from the water were gone.

“Does anyone know CPR?”

A raven haired high-school girl looked left and right, and then stepped forward. “I do.”

“Can you do this?” She came and knelt beside me and I placed her hands where they needed to go.

“Right here, OK?” Her hands were warm.

I walked back to the pond, and slid into the water. “There’s a door open already,” I yelled to the trooper.

“He won’t come out that way.”

I waded back into the water and yelled into the open door.

“Hey, what’s your name?”

He told me.

“Can you get the door unlocked on that side.”

“No.”

“Can you come towards my voice?”

“... no.”

“Are you trapped? Tangle up in something in there?”

“I don’t ... know...” His voice trailed off.

“Can you reach towards me? Just reach towards my voice so I can get ahold of you.” I groped in the dark water bracing against the side of the car in case he made a grab for me. I didn’t want my head to go under again. Finally I felt, through my numb clubs of hands, the seam of his jacket. I grabbed it tight and pulled. I felt him brace against me.

“You need to come out of the car.”

He didn’t answer.

“Are you still with me?”

“Yeah. I’m cold.”

“I know you’re cold. We’re trying to get you out. The ambulance is on the way. I’m just going to hold your jacket for now, OK?”

I struggled to keep my grip and keep him talking. His voice was fading, leaving the ends of sentences off. I looked up and suddenly there was an ambulance and a fire truck and a swarm of people in uniforms hovering around the unconscious woman on the road and a woman in a red dive-suit looking thing jumping into the water and moving in next to me.

I introduced the person in the car, and told her he wouldn’t come out but I didn’t think he was trapped – just cold and scared. She reached along my arm and gripped his jacket. I let go and backed away. Suddenly I was very, very cold. She coaxed him through ducking into the water to get to our side of the car, and then suddenly he was free and she was guiding him towards the shore. There was a blanket waiting, and he was bundled off to another ambulance. I stumbled out of the water, and there were hands pulling me up the slope onto the road. Now I could barely move. I knew I needed to get my wet clothes off, but my arms and elbows wouldn’t bend. Someone passed me towards an empty ambulance, and I struggled to step up and inside and nearly fell when I dropped to sit on the cot. I heard someone say “we need this for the code” and after a few long seconds my mind processed that I needed to get out. I started to get up, but found my legs weren’t responding. I looked at the medic in the rig and said “I’m really sorry, but my legs won’t work. Can you help me get up?” She hauled me to a standing position and I waddled back out onto the nearly-dark street. I was hustled towards another ambulance, but when I stuck my head inside there was the little boy being passed into the back, and the older boy on the cot and three firefighters filling up the extra space and I backed out.

Then I saw Peter in our car, backing towards me. I stumbled to the other side and carefully folded my stiff limbs into the seat. The heater was on full-blast. I could barely feel it. I lifted my hand up. It was still bleeding. We drove around the block and into our driveway, shuffled up the stairs and into the house, stripped off our stiff, wet clothes and turned on the heater as high as it would go. We huddled there, shivering violently, for an hour, wrapped in sleeping bags and blankets, unable to think of anything except how cold we were and how the heat wasn’t blowing out hot enough or fast enough to make up the difference.

But eventually, it did. Later that night we went across the street to return the coat someone had thrown over my shoulders between the ambulances. It was a neighbor I had only met once before. She invited us in and drew a steaming bath that I lay in while Peter drank hot tea and chatted with her.

We found out later that the unconscious woman had died on impact, and the two boys and girl had gotten away with only a few scratches. Nobody knows how the girl got out of the car, or if anyone would have noticed the dark undercarriage in the tannin-black water of a drainage pond after dark on a quite rural road on a Saturday night in October if it weren’t for her being there in the water screaming loud enough for a passing truck to hear and look.

Peter took a beer down and split it with Georgina’s spirit at the pond a week after the accident. I went to her pot-latch, held at a local bar down the road, and stood against the back wall as adults cried and children played and slipped out after half an hour. I did not stop to look at the pictures of her life, posted on a table by the door. My neighbor made a cross of flowers and hung it in the branches of the willow tree on the other side of the pond once it froze back over.

I had nightmares for a year, seeing her face or the face of the little boy gasping for breath next to my bed in the half-way place between dreams and waking. Within a month, I was enrolled in an EMT course at the volunteer fire department for the area where we live. By January I was riding the ambulance, learning to take blood pressures and pulses and cut people out of cars with the jaws of life. By the first anniversary of the accident, I was enrolled in the local Paramedic Academy with not nearly enough experience but more sure than I’ve ever been that I was finally on the right path.

It has been two years since that cold October dusk, and I still never drive past that little drainage pond without thinking of Georgina and the three kids whose names I never learned.

job

A week down, and work looks to be palatable and possibly something to look forward to. My coworkers are down-to-earth and happy, but not in the high-pitched sappy way I was worried I would find with so many women occupying not much desk space. The actual tasks are going to be a little repetitive ("Hello, your prescription is ready ... hello, you can't have more vicoden, atavan, percocet, methadone, _fillinnarcotichere__ you just refilled a month's worth two days ago ... hello, you missed your appointment ... hello, I can't diagnose over the phone you'll have to come in and see one of our clinicians") although checking in patients should break it up nicely. They, at least, are a varied and interesting crowd.

There are several providers, as different from one another as the patients, from the fast-moving-fast-talking PA who finishes charting on the way to the next room to the slow-talking southern Physician who is an hour behind by ten am, to the thorough Internist who arrives two hours before anyone else to review the day's charts, scribbling handwritten notes to himself and his assistant to make sure no test or question or possibility falls through the cracks of a busy city clinic serving the un-and-under-insured.

I am home now. Peter is cooking tacos and the dogs have gathered at his heels hoping for scraps. We are going to watch Toy Story, a welcome relief after this season of endless John Carpenter movies on Friday and Saturday nights. Two days in a weekend, and there is a lot of laundry to find time for.

sticking

Snow has been coming down all day, but it doesn't want to stick. I keep looking out the window at thick, heavy flakes pouring out of the sky. But the yard is still green. It doesn't want to let go of summer, not quite so soon.

I start my new job on Monday. It is the first time since 2003 I will have worked a real full-time schedule at a real place of employment with W-2s & pay-stubs & no lay-offs when the tourists head south with the geese. It is making me antsy. I keep eyeing the truck, wondering how much it would cost to get running & outfitted with an old cabover. I did have a couple of decent road trips this summer. The last and most superb was up the haul road to the north coast of the continent. It whetted my appetite to live mobile again.


It was a perfect trip despite our late start and midnight arrival at the dusky arctic circle. The next morning Pico and I went on a long ramble along the pipeline while Pete & Jon slept in, and we arrived in Coldfoot in time for a late lunch and gas. As we drove north, the colors changed from green to yellow and red and orange. Trees disappeared just before Atigun pass. I was reminded by the constant snapping of Jon's camera just how lucky we are to live in this place. We plunged into Atigun valley with snow chasing us down from the pass. Heading out onto the coastal plain, we ran into caribou by the hundreds & two herds of muskoxen wandering across the one road in their vast northern territory. I was spellbound by these prehistoric beasts, wandering endlessly over the northern foothills of the Brooks Range, utterly unconcerned by our roads, trucks, pipelines and passage through their ancestral land.




We slid into Deadhorse well after dark, the sun setting an hour before midnight at this late point in the season. With the few maps I had seen, I was expecting a small gravel pad plunked down on the tundra with two motels, a gas station & a dump station for RVs. In my mind's eye, vast oil development would lay far beyond the locked gate at the end of the highway. Even in the dark, I could see how wrong my assumptions had been. We drove into a complex of gravel pads that went on endlessly in the dark. Giant trucks, mining equipment, tanks, storage containers & warehouses loomed up in the gloom. Fire-light flickered above oil wells across the marshy wilderness in all directions. We drove in circles, trying to pinpoint the motel, trying to find a place to pull over and sleep. There was nothing. Parking lots were full of dumptrucks and semis, driveways were roped off. Ominous photographs of grizzlies ripping open dumpsters papered the doorway of the hotel we finally found. Grizzlies, I thought angrily, that would not even be here in such threatening numbers were it not for this installation of humans and their waste. Grizzlies or no, we had to sleep. It was two AM. We pulled into what we hoped was an inconspicuous spot in their lot and curled up in our seats to wait for dawn and our promised guided tour past locked gates to the Arctic Ocean.

I was in a foul mood when I woke. The vast wild beauty of the arctic coastal plain in her best fall colors at sunset had been replaced by a gray, greasy industrial wasteland. The ocean was out of sight beyond miles of towering oil installations, housing & recreational complexes and mile on mile of road built up high and slicing the tundra marsh and ponds into neat quadrants of well-contained green. We rolled out of the car, stiff and sore, and made our way into the tour office for our morning ride past the guarded gate to the ocean. We sat through a dated piece of propaganda reminding us of the glorious uses of indispensable oil and the spectacular care taken to protect the arctic wildlife in and around the oil fields. Smiling biologists took soil and water samples, happy caribou babies frolicked with no gravel or oil field in sight. We walked out to the bus, and were shuttled through even more dregs of discarded detritus of our biggest and grandest industry, and stored equipment waiting to go out on the frozen tundra in a few months and find more to drill and take. We were warned not to take pictures of the security area (or IDs had been run, to ensure clean backgrounds before entering this national security risk.) We passed a few tundra swans and a fox, slinking through one of the gridded green areas. We drove up to the ocean and saw it stretching grey and white-capped and cold north to the top of the world.


Heartened, we hopped out into the cold wind and walked to the point of the headland. As we reached the shore, we saw half-buried barrels rusting in the cold salt spray, scraps of metal jutting from the beach, steel poles at crazy angles in the water, Styrofoam chunks in various stages of eternal decay tangled in the driftwood. The whole shoreline was choked with trucks and buildings and pipes and powerlines. I wanted to scream. We took off our shoes and waded knee deep in the icy water, daggers of cold ripping through flesh with every second. The cold was so relentless that it would not numb my skin, only increase the pain with every wave and splash.


We waded back, dried our feet and legs, and shuffled to the waiting bus. The driver assured us of the happy wildlife coexisting with development all through the National Petroleum Reserve across the northern coast of the state. I gritted my teeth and hoped he would drive faster than my anger could rise.

I have been against opening ANWAR to oil development from the beginning (the rest of the northern Alaska coast is already open to drilling, both on land and out at sea ... why open a critical wildlife habitat in the corner of the state for a trickle of oil that won't touch our needs, or last as long as it took to develop?) but I wanted to believe that Prudhoe Bay would prove just a little spot of destruction on an otherwise untouched coast. It may be just a spot in the grand scheme of things, but as far as I could see the country was decimated. And according to the maps, what has been done to the land goes far beyond what my eyes could pry into across the horizon.

The drive back was fast, eating up all five hundred miles in one shot, most of it in the rain.The drive home was made longer when we passed a wreck south of the Yukon River, still hours gravel-and-fog driving north of town. A man rolled his truck off an embankment and into the woods. We don't know how long he lay unconscious in the cold rain, but when we found him he was a hundred yards off the road and making steady progress putting as much distance as he could between himself and civilization in a haze of ethanol and hypothermia. With four hundred miles of wilderness ahead of him and colder rain coming fast with the dark, that direction didn't seem prudent, so we turned him around. Soaked to the bone with no shoes, it took twenty minutes to guide him back up to the road. We stripped him down and shoved him into layers of sleeping bags, made a tent out of a tarp on the gravel berm and heated it with a propane furnace - all provided by the hunter & his two young sons (with fresh caribou and racks stacked in the back of their truck) who had first noticed the headlights in the trees well below the road. If karma is real, that man has a trophy bear and a couple of big moose coming his way. After several attempts to communicate with dispatch in Fairbanks via satellite phone, we gave up and hoped they had heard most of what we said. An hour later an Ambulance appeared from the Pipeline Pump Station up the road and, relieved of our duties, we kept driving south into the fog. I gave up driving when we hit pavement at Livengood, and slept til we rolled into the driveway at four am.

Winter and work are blowing in even if I don't want to let them stick quite yet. But temperatures will settle down below freezing and routine will settle on my bones like a heavy pack a few days into a long slog up to a spectacular view. I certainly won't miss the mud.

early

After the warmest September on record in years, it is equinox and it is snowing. The stairs have iced over and the muddy ground is turning white. Welcome, winter. We didn't expect you quite so soon, but the snowboots are by the door all the same.

fall

It is equinox eve, and they are forecasting snow. I knew fall was over yesterday morning when, with a crisp 33 degrees on the car thermometer, I drove past a dog-team pulling a four-wheeler over the washboarded dirt road to our house. The dogs were hot and panting with the unaccustomed work in the relative heat of a late fall dawn, but they were pulling hard with tails wagging, happy to be at it again after a long summer of smoke and rain and mud, sprawled on top of their dog-houses in the awful sub-arctic summer haze.

Dar Williams is coming to the Blue Loon on Friday, an unexpected and delightful treat to end my little hiatus between interviewing for and starting a job. In August, I saw Tim Easton there with Michelle and it was a perfect show even though I didn't know his music enough to shout the choruses with the rest of the packed house. I hope Dar gets as good a reception, although Tim gathers what amounts to a hometown crowd after so many years passing through in the near-dead of winter.

With no viable paramedic opportunities on the horizon, I'm going to be working as a medical assistant at a local community clinic. I'm a little weirded out about working a regular five-day-a-week full time job for the first time in a very, very long time but I am glad to have work of any type even if it's not in an Ambulance. I was entirely surprised by the job offer, since the Nurse Manager who interviewed me seemed rather hostile towards EMS-trained applicants. I guess what it probably came down to is that I can give shots and draw blood and obtain EKGs, and they needed more than a vitals-and-history taker. And I must have managed to come across a lot more confidant than I actually feel.

After facing my fears in Fire class for two weeks, I had to pull out. My ankle, badly sprained this summer but nearly healed, deteriorated rapidly with all the hauling and climbing and jumping and pulling and turning and had me limping as if I was fresh off crutches. An orthopedist took more x-rays last week, and determined that the calcification around an old fracture on the lateral malleolus may be irritating the injury and making the healing slow and a little tricky. Wrapped tight and laced in 10 inch wildland boots, with no tall fire engines to climb around and tons of hose to haul across parking lots, the twinges of pain are fading into a general soreness. I am home tonight and not hauling hose and climbing ladders and there is a great deal of relief, although this only means it will have to go through it all again next fall. The upside to being down for the count, however, is the ability to hold a camera.

dread

After nineteen days of smoke, anaphylaxis, tribal politics, atrial fibrillation, morning briefings, sinus infections, medivacs & blisters, I returned home to a full house. Peter's friend Jon was up from Buffalo for ten days of Alaska which thus far had translated into lots of porch-grilled brats and enough beer to wash them down and then some. Immediately on my return, despite the pressing need for me to get a real job with all this newly verified Paramedical Education, we packed the car and the puppy (Nyssa, recovering from an infection and a notoriously bad road-trip companion to boot, stayed at the kennel) and started driving North. Despite the fact that I have "operated" tour "coaches" up to and beyond mile 175 of the newly famous Dalton Highway, I had never been beyond Toolik Lake research station up to the actual oil fields & arctic ocean. The trip was spectacular. More on this later. (More includes lots of drama after a vehicle rolled down a 80 ft ravine about half an hour ahead of us on the mostly deserted highway in a cold fall rain.)

On our return to Fairbanks, after a long shower and a lot of laundry, I started on two new projects; looking for a Paramedic job in a town with no Paramedic job and starting (a week late) the Firefighter I class at the Volunteer Fire Department.

I will tell you, and tell anyone, with no qualms, that I have no interest in fighting fires. I hate structure fires, and I hate burn injuries. Of all the possible ways to die, burning to death is at the very, very bottom on my list. And burning to death seems to be the number one subject of every fire class I have attended. The textbook starts each new, mostly inane chapter with stories of Firefighters who didn't pay enough attention and got burnt or asphyxiated (not quite as bad a way to go, but still full of terror.) I am taking this fire class, because for better or worse, EMS is still bound up rather hard and fast with fire departments country wide. I may need this basic fire-cert to get a job in the future, when we leave this town and move back to civilization. Also, the VFD that I've been affiliated with for the past few years has helped and supported me to no end, and I feel I owe it to them to take the class so that I can help out on fire scenes even if it's just by driving the Big Shiny Trucks, hauling hose, or changing air tanks. (I will reiterate again, here, my absolute terror at the thought of actually entering a burning building.)

I started out a week behind, but I was heartened when on the first bunker drill I only got a slap on the wrist for not getting my neck flap fastened correctly. On the second evening, however, all my ill-gotten confidence was shot down when we did an actual hose drill. For some reason, I was put in front of my company (two other women taking the class.) We were in full fire gear, including self-contained breathing apparatus (SCBA) which all told weighs in at nearly 50lbs. We were blindfolded, and instructed to follow a hose line strung across the ambulance bay, around tires and equipment and under one of the rigs. I did fine leading the group through several obstacles, hose knots and double-backs until we got to the place where the hose went underneath the rear of the ambulance. I was boiling hot inside my gear, and my adrenaline was pumping from yelling through the SCBA and continually running helmet first into the tanker, the tool-rack, scattered gear. I realized with dread that I had to flatten myself out and belly crawl under the chassis to lead my company through. I got as far as my hips and stopped. I felt my SCBA mask & helmet strap pressing into my throat. Even though I knew, way back in the corner of my mind, that I was in a lighted ambulance bay with several instructors standing around, no live fire anywhere to be seen, plenty of air in my tank & two more experienced team members mere feet behind me, it did no good. I felt my throat closing. I knew I was going to suffocate and die under the axle of the ambulance. I was sure this breath would be the last one I could get past my constricted throat. I took a deep breath and tried to center myself in reality. I closed my eyes under the blindfold and focused on what I new to be true, as I have on so many occasions when events have spun out of control. I could not find that center. I backed out, kicking my company out of the way as I did so. I took a few deep breaths and tried again. I got as far as my belly under the ambulance, and felt my chest and neck crushing in. I couldn't breathe. I couldn't think. I had to get out. Before I knew what was going on, an instructor had flipped my purge valve and had pulled back my blindfold and was demanding that I keep breathing through the mask and not rip it off. I realized my hands were on the mask and she was physically restraining me from doing just that. If I did that in a fire, I would be dead with my first breath.

I have never failed so spectacularly at a task. My company went on without me, as I sucked air out of my tank and tried to believe I wasn't suffocating and watched them finish the course in the happy light of the safe, dry, hazard-free bay. I wanted to rip the whole of the gear off and storm out of the class forever, but instead I followed meekly as they wove around the ambulance and found the end of the hose without me. I would not cry with failure in front of them. I wanted to scream at the condescending looks of the other firefighters and the insincere "it's OK, it happens to all of us" from the 19 year old "Company Captain" who has been with the VFD for all of two months. I wanted to hit her.

I spent the next two days in a sea of dread. I considered every possible way of quietly dropping out of the course. I thought of every reasonable, thought-out explanation of why, with job interviews pending and Peter in school and other part-time gigs starting soon and the other demands of the fire station for shifts and training I couldn't continue with the class. None of them had to do with my under-the-ambulance terror of Day II.

This morning, I woke up after a fitful night of terror dreams. I dragged myself through coffee and breakfast and to the fire station an hour early to study for the paltry multiple-choice quiz and try to focus on things other than my own imminent asphyxiation. The lecture on ways to burn to death due to improperly understood building construction did not last nearly long enough. After lunch, we were hauling ourselves into bunkers and masks and off to perform various tasks under the perfect indian summer sky.

After securing and hoisting various sharp & heavy tools to the roof of the three-story bay, our second task was an entanglement course. We were instructed to blindfold ourselves over our air masks, then follow a twisting hose line through a maze of tight spaces, wires & cords, dead-end & impossible squeezes. They didn't let me go first, given my paltry track record, so I stood blindfolded, listening to two of my team members struggle through, cursing and kicking as their gear was caught up in a thick spider's web of garden hose and their air ran out, alarms shrieking. I kept breathing into my foggy mask, sucking dank air from the blindfold over the air space. It was my turn. I found my center, that cold, dark place where I can think. That place too far out of reach on Wednesday night. I knelt down, took hold of the hose, and gripped my determination to keep breathing and keep moving.

And somehow, I did. Granted, I have not attempted to shimmy my way under the ambulance yet. That fear, I will face later. But I did keep on moving, swimming over wires and squeezing through enclosed spaces and breathing and breathing and breathing. I came home exhausted far beyond my shaking legs and sore shoulders. Three beers and three chicken mole tacos later, I can still taste the dread of the last few days in the back of my throat. This was the first time I wasn't sure I would come through the other side. And I'm still not sure ... the ambulance still sits in wait. But I am closer, and I think I may yet make it through that space.

drought

There has been next to no rain in the Texas hill country for two years. I spent three months of my summer walking the dry grass and rocky creek beds around my parent's home. My new pound mutt was with me, chasing white tail dear at filling his coat with sticker-burrs at every turn. We would walk to the river where I learned to swim and see dry shoreline never exposed to the air in my lifetime. I would nap in the thin air-conditioning of my parent's home, unable to stop sweating after four years of sub-arctic winters. Dreams of the torrential rainstorms and dancing lighting of my early childhood came and went in the night.

I arrived in May to ride with the Paramedics of Hays County and finish the requirements of my program so I could test and return to Alaska for the wildfire season. I intended to stay for six weeks, eight at the most, but when my grandmother fell and broke her hip for the third and last time everything was put on hold while she slipped from this world into the next. I can still hear her breathing of those last few comatose days, six times a minute, a gasp between pursed, cracked lips. Holding my own breath unwittingly to the scarce rhythm of hers, I held her hand and felt her pulse strong then thready, retreating towards her heart over the course of days and breaths. We turned her, we sang to her. Her children sat vigil at night, counting each ragged grasp for air. A fish with no water.

When I began riding the ambulance again after a month's hiatus, no rain had come and the heat was breaking records of longevity. The last few shifts were busy with asthma attacks and heart attacks and anxiety attacks and an odd car crash on the hazy tarmac of the interstate. Two tests passed, and I was done after a year of too little sleep and too much rushing and not enough reading or writing or play. A few days ago, I packed my two bags and the mutt and boarded an airplane home. I arrived to a perfect arctic sunset at midnight, the sky lined with blue and grey and red and orange, the air a perfect balance of breeze and warmth. Peter and I sat with the runway to our backs in the eternal dusk, watching the sky and the trees. The husky pup, knowing he was back where he belongs, flopped down in a heap at our feet and watch the sky along with us.

Now I am packed again, off to tend firefighters in the Crazy Mountain Complex where 18,000 acres are burning near a village on the Yukon river. But this time, there is a peace and a feeling of home that I did not take with me into the drought and heat of Texas. I am going just up the road for a few days or weeks to do the thing that I love to do - to bring relief to wounded & tired firefighters and to sleep in a tent under the stubby black spruce and the midnight sun. The smoke from the seventy-odd fires burning around the state is already in the air around our cabin, hazing the trees across the road and soaking into the walls and into our coats so we will breathe it like a campfire into the winter.

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.