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.