The calls that knock you down and teach you

The call came in like any other, "68 y.o. Male feeling ill". As we arrived on the truck, there was no hint of the chaos that was about to unleash itself in the house on a quite street. The Paramedic on the ambulance, is often known for his ability to be calm under pressure, this night he looked panicked as he met us at the door and said," we need to go right now!" the man was pale,cool and diaphoretic. When we attached him to the four lead, he had tombstone t-waves. It looked like he was having a heart attack in the bottom part of his heart. When we placed the 12-lead on him, the ectopy had cleared and he was in normal sinus tachycardia. We where puzzled. Then things got worse. He began to complain of not being able to breath. His lungs where demonstrating pulmonary edema. One of the other medics on scene began to reach for a nebulizer mask, when the patients pupils dilated shifted to the left and he vomitted. now we where thinking neurological cause. As we sped towards the stroke center, he began to drop his Herat rate from about 160bpm to 40bpm rapidly. I remember asking, "do we have a pulse?" No pulse. "Ok gentleman, here we go." As we pulled into the ER, we got a pulse back, then lost it. We worked him in the ER for another 20 minutes before we got a pulse back, just as the attending physician was about to call it. During that 20 minutes, the ER attending took a portable ultrasound, and discovered a 7cm dissecting aortic aneurysm. They patient maintained a pulse into the OR where he died on the table. Many lessons where learned, but I often am left to wonder if my seeing all of this knowledge was worth the death of a father on the eve of fathers day? I have faith that one day, be it today or 30 years from now, that what we saw last night will effect the life of a patient and their family.

Location:S 25th St,Bellevue,United States

Changes and Challenges

Frances and I, despite a fair amount of jet-lag found a great place at a fair price and began to determine what we need to bring with us in the fall. I have included picture below. I still cannot help but shout from the rooftops that I am going to be a doctor!!!!
I had a hard time returning to work and dealing with all the normal everyday crap knowing that I am moving on in less than three months. I began to think that nothing I had to experience in that time would teach me, and then the call came in for a GSW following a pursuit. I expected to find the normal small caliber injuries that I have often dealt with in my career in EMS. Instead, I found high powered armor piercing round injuries. It was unreal, I had never actually seen a real pericardial syntesis until that afternoon when the Helo crew performed one on this patient. It was one of the most devastating calls that I have been involved with to date, but it taught me once again that in the face of the worst, I can be calm, cool, and collected. Additionally, in the midst of chaos, I could teach and simplify the most complex of concepts. While it is difficult to see these traumatic things, I can move forward in the knowledge that given the worst, I will be fine. All that I need to overcome now is the academic challenges of the first two years.
Enough of the depressing. Frances and I found a one bedroom apartment with all the amenities to make it comfortable for a newly married couple. It has a great view, a nice bathroom, and a kitchen that many a chef would be jealous of. It even has a wine-cooler! Here is to the adventure this fall, and any still waiting for me at work. Enjoy the photos below:

Things are happening fast...

A mere two weeks ago, I received a phone call that has utter changed my plans for this fall. The day before my graduation from graduate school I was planning on starting another masters in the fall. At approximately 3:30 that afternoon, I received the call that I have been working toward for the better part of a decade. "Noah, we are pleased to inform you that you have been accepted to our medical school for the class starting this fall!" In an instant my entire system of contingency plans became useless. No more studying for the MCAT, working as a Paramedic while at school full time, no more disheartening letters from medical schools informing me that they didn't want to admit me or I had been placed on the waitlist. The paperwork that has ensued has been enormous. If that did not make this opportunity a reality fast enough, I am leaving tomorrow to look at housing prospects for Frances and I this fall. This experience has taught me that the journey thus far may have been long and difficult, it has been worth every step. I am under no delusions as to the task that lies ahead of me, but I appreciate this chance more than any other person I know. I am just thrilled for the opportunity before me!

Location:Bellevue, NE

The Night the Codes Kept Coming......

In emergency medicine there are certain patients who are rare. In the field this is especially true of cardiac arrest. One Sunday night not long ago, I ran two in the space of 4 hours, at the slow station.
The first was dispatched as difficulty breathing. When we got up to the apartment I found a patient lying on the bed obviously not breathing. I immediately transmitted a working code. The patient's roommate stated that she had begun having difficulty breathing approximately 10 minutes prior to calling 911. As the only paramedic on scene it was officially, cowboy-up time. The initial rhythm was Asystole. With IO, ET tube, Vaso, and Bicarb on board we achieved ROSC at a rate of 48 and a BP of 82/P. I started the first epi-drip for the department (the protocol had been added the week previous) and maintained a pulse into the ER. The patient made it up to the ICU.
The second came just as we cleared the hospital from an ETOH call. It was surreal. Unlike the first this was declared code-99 at the time of dispatch. We I arrived the engine crew was already doing CPR and had dropped a King tube. This gentleman had been up talking to his wife when he collapsed. Just like the previous code the rhythm was Asystole.  It took Vaso, 2 Epis, D50, Calcium Gluconate (also a first time push for the department) to achieve ROSC. As before, the patient's pulse came back slow with a low BP and so an Epi-drip was started. The patient made in the doors of the ER and coded again. We again got a pulse back with an Epi dose. Just after achieving ROSC for the second time, A nurse yelled across the ER that a patient had just coded. The ER doc left me in charge of my patient and took off with several of the engine crew to work the code on the other side of the ER. Unfortunately neither my patient nor the one on the other side of the ER survived.
As, I was talking to the ER physician a short time later, he told me that they had 6 codes (including my 2) in the last 12 hours. It was a night that I will not soon forget. Although neither of my codes survived to discharge, the night taught me an important lesson, rule out H&Ts early and aggressively (just don't push sodium bicarb and calcium gluconate too soon after each other as happened with the ER code).
The adventures continue to give me insight and I know one day they will make a difference, first in the field and eventually as a physician. Until next time.....