1 slice or 2?

people of central ohio, please be more careful with sharp objects and your fingers...
i like to sew but with 4 people all with meat slicer injuries makes me think there's an angry meatslicer runnin a muck in town, so beware with your next subway sandwich or taco from the bell - you might get two slices of something even if you only wanted one.

PEAs, carrots and rebar

PEAs, carrots and rebar = good night for Jenni. Recap of these and others.
1. lady mowing her lawn feel a stick hit her in her leg, looks down it's apiece of rebar in her leg - naturally she pulls it out only to realize hmmm it went all the way through and hit her other ankle-she pulled harder and called the squad. Soft tissue only, nothing chipped or broken - she's actually very lucky it didn't go to her chest or head - doubt she could have pulled it out then. Closed the entrance and exit holes.
2.70ish guy slumped over cold at home, wife pumps on chest, calls 911. Squad comes, starts running code - all the hospital he's asystolic we're 6minutes out. 2-3 minutes later, pulse of 45, with a pressure, as they are pulling up - he's starting to wake up. He's tubed already *darn* rate of 150, trying to pull tube, put him down with vec and versed. can't find a femoral for the ABG, maybe because he doesn't have a pressure - oh and now no carotid - multi focal PVCs and a bradycardia - PEA... atropine and bicarb and some more epi - now we have a pulse.... back and forth - PEA and then a perfusing rhythm - for like 2 hrs. Call life flight - codes, they arrive, he's back, pressure too crappy to take him even with his max dose of levafed, dopamine, 3 atropines. numerous epis. Time to let him go.
3. lady slicing carrots - oops that's not carrot that's my finger - needs four stitches.
4. Oh look stairs I think I'll forget how to walk - rip open my knee (and I steal the suture job from the med student - right under her nose) 9 mattress
5. young guy: my legs hurts and is all red - had a spider bite there so I dug around with a safety pin and it drained... not a spider bite - abscess with cellulitis - I&D and packing
6. 18yr girl - I can feel a string coming out of my girl parts, it must be an emergency - it's 11pm on Sat night... oh wait that's my IUD, I forgot.
And this is my short night - I love the ER.

the fabric whore and airplanes

Bob took Mary and me to Lancaster today - about 30miles away to buy fabric (I love to buy fabric!! I take after my mother who too is a fabric whore) for a project I will be completing here hopefully). I am super excited for it! I would venture to say most people in my shoes would be hard core studying for boards or this or that but not me, I want to do something fun in my spare time - at least for now.

Shawn has an "interview" with his medical director as his lead training comes to a close. I am so proud of him! He is going to make an awesome lead. We talked for a very long time last night about our fears of being on our own in our professions and how much we don't know and were so quick to remind the other that - you do know more than you think and what you don't know today or for one patient today - you will when you see it again next time. Shawn is one of those humble smart people -really he's quite a genius. I secretly hope that his book smarts ill rub off on me - he's book, street and people smart - the triple threat - AMAZING!

I have been postponing purchasing my ticket for Ecuador. I hate making big purchases that have set dates. What day do I arrive - or leave or do I have Shawn come down. Do I go a week early etc. And with clinical project happening before it - I could have gone early but I waited and waited... I hate spending a big chunk of money like that... so knowing my window to buy my ticket is getting smaller and smaller - I continued to put it off. This usually is bad thing because I miss the cheap price and end up paying more. suck. So just the other day Shawn told me he was taking me to see RENT one of my favorite musicals EVER and it's the week before I leave for Ecuador - so good thing I didn't buy my ticket. Secondly, Brian Regan is coming on the 26th of June the day I had planned to fly out - but having not booked my ticket yet - we're going to that too! Thirdly when I looked today to see about tickets - they are now about 1/2 the price they were when I was originally going to book. So for once, waiting paid off three fold!

that which wasn't is not

So the vulture landed today in Circleville - 4 hrs later than anticipated. No lunch or box of bagels to share but the real kicker is that the vulture didn't watch me (prey on me) actually see any patients. By the time the vulture arrived we were so far behind the docs had told me not to see any more patients. So she watched me watch the docs, stand around and tell some toe amputee guy we were going to redress his nub and back to the nursing home he would go. After an hour she said she saw all she needed to see and I was doing a good job (I want to know I am providing good patient care - Dr. Pedemonte and Prof Geitzen always made a point in clinical skills class to point out good things and what to work on - we always have room to grow and I loved that). She also informed me, when I asked if there was anything I could do better or needed to work on - "well I don't know you that well, except that one conversation on the phone, but everyone says you need to stop crying about things." Interesting I said, I've never cried at a rotation - well my first one I was brought to tears because 1. I passed out on day 1 and 2. he yelled at me to the point I finally cried in the OR. so WTF! So now I feel like a) i got the shaft on my site visit - isn't the whole point to do a LAP on me and tell me how to improve? Not just show face and b) so the program faculty and staff think I am a crybaby? yeah, I feel really comfortable asking any faculty to write me a rec now - well, she's a fairly intelligent girl, with brown hair and she cries a lot. Now I know I am quick to shed tears - it's part of me, it's who I am, so get over it - I'm one of those raw emotion kind of people. I cry when I am frustrated with myself - when I think I could have done better but didn't even though I probably couldn't have done any better because I was already doing my best, I cry when I am hurt emotionally or physically (sometimes), or when my integrity is questioned, I cry when I am sad. I cry when I feel like I have done all that I can do and it's still not enough.And sometimes there are just tears because it's the only way my body responds. It's me - it's one of my faults and maybe one of my strengths - i think raw emotion isn't seen all that often. In fact when asked in my Pacific Univ. interview if I show my emotions I sad - yes I do, my tears free flow- it's a part of me. So if it was ok in my interview or it's been a problem somewhere in my academic career - why has someone not brought it to my attention as a concern? Instead I am known as the Pacific Univ. PA program crybaby. What a title.

Now I'll be honest, when I first tried to get into PA school, I knew my academic grades may not show me in the best light - and some schools didn't take a second look at me - they wanted that person who had an outstanding grade in chemistry - or someone who didn't retake Orgo chem, but I knew that any school who interviewed me and accepted me would eventually see where I think I really shine - hands on patient care, so I hoped at each interview that a school would see my long term potential, not my short comings as a chemist. Patient care is my area and my comfort zone. PacU has a PA award for outstanding clinical student and not that many of my classmates are equally great at clinicals and equally deserving but I have been hoping all year that I would be outstanding enough to be recognized for that with that award almost to say see Pacific you made a good choice when you let me in. That small amount of hope all went up in smoke today. Awards are stupid I think - ultimately someone will feel left out or not good enough all because of someone elses objectivity. And really it's not about me - it's about the patients. Am I doing everything I can for them? If my frustrations and and hard work don't translate into better patient care then it doesn't really matter at all.

Silly I know to feel like I am working for an award but I feel like I need it to prove that I am good enough to be a PA, to get a job to justify my hard work. Although I know no award actual does that. Knowing I will be a great PA one day comes from the inside and Shawn tells me daily how great I'm doing just from the stories I tell. I've never won or been voted to hold any office for anything (ok 2 exceptions - I won a big award in KC for a science fair project in 4th grade when I quick froze thousands of red wigglers in my attempt at understanding cryogenics and I was class president in 3rd grade - but everyone hated me and tried to overthrow me). Every office I ran for in college and PA school (and even HS) I lost - which frustrates me *hence I cry* why don't people think I will be a good leader? Why am I not in a position to be a leader? I don't care if anyone actually likes me (after all most of the time it comes down to a popularity contest in my opinion) and I don't care if people want to be friends with me, I just want the opportunity to potentially do something great - save the world one person at a time. I almost feel guilty that I am presenting Pedemonte's award at our graduation party because I wanted to do it but not because anyone actually thought I would be a good choice to do it (in fact when I brought it up that I was interested in presenting that award, I think that person thought I was joking).
My CV is pathetic. I've never won any awards, been recognized for outstanding anything, never held an office (not that I haven't tried desperately), never been published. So I am just an average girl from the midwest who will graduate from a PA school in the NW - a blur in the background. unfortunately people look at the CV to determine your potential - and once again I feel like I look bad on paper, someone just has to give me a shot. Thank the Lord Shawn tells me how wonderful talented, gifted and loved I am daily! (and really in the end it's him and only him that matters but I feel like I need to show him I am deserving of those praises although I know that's not the case since he knows me better than anyone).
So with that being said, the average midwestern crybaby girl is glad she has 2 days off and so grateful that Shawn doesn't care about anything but me and loves me for who I am - tears and awardlessness and everything else. Shawn's my lobster, penguin and polar bear all in one.

The Vulture

So, tomorrow the vulture lands in Circleville and is then apparently off to mass. I am hoping the vulture doesn't come over for dinner. So for now she is circling, hovering, waiting until the fresh meat of tomorrow. Oh boy I can't wait - as the pit in my stomach grows larger. I'm not sure who frightens me more - the vulture or old-ex pageant karma lady at the hospital. And lucky me I get both of the tomorrow.

Pt crumped this morning - after cardioversion (back into sinus) - I couldn't get the tube - he was still gasping for breaths and fighting me but I didn't feel badly because the doc couldn't either and then he started breathing on his own, then he lost a pulse, then the breathing and back and forth and so on. With an EJ fraction of 25% (normal is 55-60%) it was bound to happen, 4 months ago he was given 6months - and today was his day. Afib with RVR, BP in the 50's and 60's. He looked like hell. I'm just glad it was the cardiologist who just happen to be in the ER decided to cardiovert. After 50 different family members passed through and lingered and lingered (I'm all for goodbyes - but seriously one of the creepiest dead ones I've seen - eyes still open and fixed and mouth open like he was gasping for air) he was taken by the men in black.

Closed a great eyebrow lac in an older guy who popped himself in the glasses with some sort of power wrench and had to tell a sweet older lady that her rib pain was due to a giant mass found on CT in her lung with a little pneumonitis behind it. What a day.

"Reed between the lines"

Reeds our boy - and no that's not some euphamis to something else. Reed Johnson is a Cubby. last year he was seen making clutch plays, pinch hits and 110% each time he stepped on the field. He didn't get a ton of playing time - (but I know a good one when I see them - just look at Shawn). So last year after a couple amazing plays and saves at the series we were at in Chi town I just had to have a shirt with his name and number. Shawn got a Derek Lee jersey - which is cool - because he's like a Chicago Cubs staple. It's like Shawn's jersey is the ice cream and I am the cherry on the sundae. But last year Reed was really a nobody - and even this year but.... But today - he made yet another clutch play in the outfield! It goes a little something like this: bases loaded in Milwaukee, Prince Fielder (and his fat ass and super baggy pants) steps up to the plate. Here's the pitch and crack! it's up there - it's going, going, and Reed Johnson pushes up off the outfield wall and snags the ball as it goes over the wall!! As Fielder walks to the dug out - grand slam and tragedy averted - he tips his batting cap at Reed - a classy gesture. You should check the catch out - it's freakin' amazing!!! So this year when I wear my Reed Johnson shirt i know I believed in him before he was big - and now I subscribe to his blog. Only in a fantastic Cubby-love driven marriage can a women sport another man's name on her shirt.

On less fun work news - it was drug seeking Monday. seriously folk - do you think we are that stupid? We can look up all your narcotic prescriptions in a database up until a month ago, we do call pharmacies. And if you just filled 140 percocet 6days ago, I'll be damned if you're out - should've made them last ladies and gents cuz you aint gettin none here. Well, we did give one percocet to a patient - there was a least a little pathology there but had an appointment with the specialist tomorrow - so they can fill your narcs. Why do we even give narcotics in the ER if someone is going home. What did we do before all the Vicodins, Lortabs, Percocets? We sucked it up. And the crabby head of emergency got after me again today - this time for eating at the nurses station - while the other docs were eating. Apparently I need to either eat in the Dr. lounge or staff lounge, but everyone else is exempt. She has pristine white hair - she probably uses that dog whitening stuff and looks like a mean southerner and ex beauty queen. Karma is a b---- lady. If she has to talk to me again she'll have to write me up she told me.

I bonded with the host fam tonight - Mary convinced me in my down time I should sew with her. So Thursday morning Bob is going to take us to Lancaster to JoAnn fabrics. I call it a little motivation to do Typhon and homework on time! I mean who needs to study for boards or finish my CV. Naw...I'd rather do something I probably won't do at home!

Oh my gosh how can I forget - the most wonderful thing happened today. My Easter basket arrived!! Shawn sent me the most sweet Easter box - full of all my favorite sweets my favorite coffee cake mix and the most adorable shawnee smelling card with a poem. His poem read:
did you honestly think I would share his poem? Not so much. Needless to say it was really sweet and brought tears of joys to my eyes! I LOVE THAT GUY!

Easter blues

It's Easter Sunday and I am 2200 miles away from home - enough to bring me to tears today when one of the docs said - oh and you're away from home on Easter - bummer. I excused myself and dried my eyes. Today was insanely busy - and for a holiday! Everyone decided to do one of 3 things today: 1. respiratory failure, 2. MI, 3. Stroke, there were a few non emergent visits today too but really all emergencies ( my favorite - whom I didn't actually see myself: severe sepsis, possibly having an MI and nearing respiratory failure. The doc wasn't all that sure what else to do and what drugs to use - so I printed her off the 6hr bundle to make sure all those things had been ordered which was great because she totally told the RN on the floor that if she *the RN* wouldn't start dopamine when his pressure was dropping to 54/22 that it would be her fault if he died or sent him into septic shock.).

Squads from all over were bringing in the sickies. That made me miss my Shawnee more. He works his tail off at work. Being a paramedic is really a thankless job for the most part. He does all the dirty work- he's the first chance at saving someone outside a hospital and yet there is no recognition for the hard work, quick thinking and life saving he does. If there was ever an emergency - it's him I would want to come to my rescue. In fact if I ever have an emergency I would request him. But even though his job is thankless most days, I appreciate all that he does and I am so proud of him. I wish he would jump on here and write but maybe he doesn't need an outlet or maybe he forgot the password. This blog was intended to tell our story - but I have really clogged it up with all about me. I guess it's how I vent and recap the day so when I talk to Shawn our conversations don't totally revolve around it. My life feels like it is consumed by school already, the last thing I want to do is chit chat about my boring day - it all seems so uneventful and mundane. It's been nice to go back though and read my stories from the beginning of this journey until now. Although not much has changed - I seem to complain a lot about everything and don't spend nearly enough time about my family - whom I have spent 80% of my time away from this year.
So after a very very long 10hrs - my butt didn't hit the chair once today (doesn't help that the two docs on today are totally chatting Cathy's), I hiked home just in time for grilled burgers with the host fam and their son's family. They were good but no match for Shawn's burgers - he is the grill master! So I am off to rest, I am too sad to do homework or hang out watching religious TV(or the actual name is God TV) so resting sounds good, with my smelly hippo.

Random

Random post while I am anxiously awaiting my computer date with Shawn. I took today off, I am working tomorrow to avoid any awkwardness of celebrating Easter with my host family. They're nice people and all but just felt awkward thinking about trying to fit into their Easter celebration plus they had fmaily come into town. Easter is my favorite holiday - everything is new and refreshed.
I walked to work for the time yesterday - nice easy walk and when I got off this morning I even felt like jogging - so I did - with my bookbag and a ginormous - not exaggerating - umbrella that Bob dropped off at the hospital for me since the forecast suggested rain. Very nice - I guess I could have really clobbered someone or thing that tried to get near me on my walk home. The walk is well lit I can't decide just how far it is, but it was very refreshing this morning walking home with the birds chirping and the very beginnings of light began to shine from the horizon with the full moon not having set.
Halfway on my walk to work I realized I forgot my hair tie. damn. No worries I had an extra in my bag. I realize today that my hair tie is probably 3 or 4 times as stretchy as my last hair tie from the same batch. It may sound trivial but there is a precisely calculated amount of stretch needed to make a good ponytail. Too little stretch and you can actually disconnect the actual rubber band inside the covering - it's a strange phenomena if you've never needed a hair tie - but trust me it happens and if you have too much stretch like before mentioned hair tie it doesn't really hold that great of a pony tail without many many twists - so like a I said a fine balance. I may have to find my hold hair tie before my shift in the morning.
I met my host family's son, daughter in law (whose name is Bradley - long but interesting story for another time) and their son who has aspergers. He leads a very sheltered life and is apparently hypersensitive to red dye called lake -41 or something like that. He looked at me like a very big 7yr old, but I was feeling homesick and not in the mood to play dog pile on the rabbit or pillow whomp - but I did settle to play Chinese checkers (I tried ot lose but really beat both the kid nad his mom quite badly). He has no concept of personal space - but that's the aspergers and introduced to me all 9 of the mini stuffed animals - most of them beanie babies and told me what animal, their name (which 7/9 were the actual animal name, the white tiger's name was tiger - go figure) then he demonstrated their behavior, the sounds they make and then went on a long diatribe asking what percent of their behavior was wild as he demonstrated how they played together.
Well it's about that time. Off to work tomorrow - but only 10 hrs - not too shabby of a day!

railings up

"The little gal was trying to roll me to my left side and she just kept pushing until she pushed me out of bed"
Looking at this seventy something stroked out lady (previous CVA not because she fell out of bed) I had a small chuckle - inside of course. I can see this lady with her left hand contractured up to her shoulder, completely flaccid leg thumping to floor as the aid tried to reposition her in the bed and oops rolled her too far and oops again with a thud and a shreek- apparently the aid - a tiny toothpick gal was trying to log roll a tree trunk - who knew the toothpick was so mighty.
First thing the patient actually said to me: "you aren't gonna push me out of bed too are you?"

5% and 95%

Actual ER emergencies last night versus the percent of urgent care/family practice visit last night. The guy who almost whacked his finger off last night that I sewed back together after squishing all the sub q fat back in - that was an emergency. Gal with a 104 temp and super crappy lungs sounds - major raging pneumonia - emergency. 60yr old something guy with COPD, CHF in resp failure - lungs full on the CXR looks super dusky - brought in by squad - um yes, emergency (I was secretly hoping in my dark dark world that he would crump and I could tube him, but in retrospect he was a bigger guy, with a small airway - might not have been a fun tube, so I guess I'm glad he didn't crump and need intubated - and because that would obviously be bad for the patient). Ummm, otitis media in an 11yr at 4m - not an emergency. 1st yr college freshman who wrote on twitter she was suicidal, police check on her, she denied denied denied then called them back 10min later and says "the answer to your last question is yes" she needs medicated and 30days inpatient - not so much an emergency. Oh my back has been hurting for 2 weeks or my ear started hurting 20min ago, or i bumped my knee getting out of the car dropping my friend off - not emergencies. Perhaps tonight will be better. Maybe I should stir up some ruckus before I go in tonight so we can turn those percentages around a little.

All in a day

Quick run down in no particular order - maybe just the interesting ones
-GLF - subarachnoid bleed - and that's an underestatement - 3 ruptured brain aneurysms lead to the GLF
-2 RLQ pains - nada
-B/L Lower abd pain -noncontributory hx --> trich+ oh look at the swimmers
-31M army fellow with sinusitis and pneumonia
-20M - hx of HPV ("damn that girl I knocked up" he says) wants STD testing so he can engage in extracurricular activities... so I did the swab - too bad if he wanted anything else he has to go to the health dept...and what part of this was an emergency? - yeah that's what I thought -
-8F - mom is sure her daughter is just ready to crump over and die - wanted her admitted because she vomited and was sick last week..."what? she's not going to die?" that's an eerie question to be asked... here - have some amoxicillin I guess - wasn't my call, thank God for preceptors, possible Munch. by proxy
56M attempted suicide - OD of EtOH and vicodin... yummy - didn't even budge when I nailed his IV and foley
And to round out the day - 4 or 5 narc seekers all back to back... oh and a strep throat.
And it's only day 1
-

It's the great pumpkin

I arrived in OH last evening and after taking it up the backside from the car rental company at the airport I somehow made my way into Circleville through the tornado watch, thunderclaps and flashes of lightening. I did manage to get lost - but manged to be lost within the city limits - and only blocks away from my host family. I'm staying with a retired military couple named Bob and Mary. A devout Roman Catholic couple who were/are LPNs - he works at the VA in Chilicothe part time. Wonderful people and have some amazing personal medical stories they've shared with me! I am super lucky! A warm comfy bed, my own little bathroom with the most lovely shower head. There's a clock that chimes hourly with Christmas tunes, and one that just chimes, there's their dog that barks and growls every time I look at it or enter the same room - but Molly means no harm - she did the same to the two sisters (nuns) that stayed here not too long ago - she really hated their long grey habits. There's a crucifix in every room, and a picture of Jesus or Mary or both including the Pope in every room. There are 2 stoves and two ranges - one that works and one that doesn't. The house is immaculate. There's a cat that lives in the basement for allergy sake - Herbert P Ninninger is his name(their autistic grandson named him). But everyone calls the cat baby boy or sherbert. It's going to be a great 6weeks!

I went to work this morning at 8am, only to be told come back tomorrow somewhere between 7 and 10ish to start work. The big questions from everyone this morning - is there another student? Where is she? Do you know when she'll be here? I wanted to say - damnit I'm not her babysitter - I don't know. But I didn't, I just said - we're not staying at the same place, I'm not sure of her current whereabouts. (End of story.) So I came "home" and ate a banana drank some juice then took a 3 hr nap. Talk about a lazy day! Then Bob took me for a tour of the Round Town (circleville)and pointed out the places to eat if I was interested and places to avoid and some of the history of the town. He also showed me the 4block walk to get to the hospital - so needless to say I will be returning my car and not renting another. So very excited about this!! I also got to see the giant pumpkin water tower and am sad I wasn't here in Oct for the great Pumpkin show.

The cute thing about this couple - he calls his wife gorgeous an she calls him babes. lovely. Bob likes to watch the Bachelorette and he calls stop lights: stop and go lights.

One other quick story - Bob called me Sat to make sure I was still coming. It was just before 8am west coast time. Half awake I said: "Oh I'm glad you called, I was going to give you a ring today."
"Give me ring today?" he asked puzzled. "Why would you give me ring?" he continued.
"well I was going to ring you up later today" doing my best to clarify what I thought was the obvious meaning.
"What do you mean ring me up?" he replied
Finally, after wiping the sleep from my eye I said "call you, I was going to call you later today."
"Oh." was the only response.
I later realized that if you are going to clarify something - don't use the same word which was confusing in the first place.