It seems like a yearly (or less) tradition for me to stumble again on this blog for some reason or another and post an update on work-related things. Which is fine (at least for me)! I seem to have spread myself, butter-on-bread-like, between various media and social networking sites. Each one I use as an expression for one aspect or another of my life. I think I originally intended this blog to be focused on my career. However, I figure there's enough medical blogs out there (most of them much more entertaining and consistent than mine). I may as well mix and match.
On the medical side of things, I'm continuing to work as an emergency room technician. Our ER has been expanding, and construction is - finally - underway. The talented engineers are bursting through old rooms and halls to create an entirely new, hugenormous place. Of course, with the expansion it seems as though we're leaking employees. We've lost about half of our technicians, and replaced most of them. Several nurses left, and are slowly being replaced as well. Short-staffing led to an evening tech and I competing to see who could pick up more hours. I think I won by a whisker, but we were both doing around 60+ hour workweeks for about a month. Rough stuff, I'm glad we're not salaried! I'm awaiting news of my application to PA school; supposedly I'll be getting word back within the next three months or so. Here's hoping.
In terms of other stuff, I found out it's pretty hard to find a good striking school in this city. All the dojos/dojangs are either tip-tappy Tae Kwon Do (no offense to any practitioner out there, but the ones we have here are pretty slaphappy) or roleplaying in the guise of a no-sparring dojo (hold my wrist. No, not like that). The MMA gym here has some decent kickboxing that I've seen so far, so I figure I'll keep it up until I can find a good hard-hitting karate dojo. I've had to take it easy on the judo side of things due to a rib injury, but I think crosstraining in both would be beneficial. Either way, once I'm healed up I plan on hitting the next judo tournament available (I've missed three ack).
Monday, October 28, 2013
Friday, April 13, 2012
Of Late..
I suppose since it's been around two years since my last posting it may be time for another one. In that gap between this and the last, I've almost completed an associates of science. I've applied for summer undergraduate research in chemistry, and now the waiting game for word back begins. Within a year or so I'll be a junior at the (relatively) nearby university; my major will be either in biochemistry or molecular biology. Progress is slow but steady, and I expect to be unleashing my schooling woes here over the span of the next several years.
In the meantime the semi-rural hospital I work at is chugging right along. The planned expansion of the ER was put off for at least another year, I helped train three (or maybe five - I think it's a prime number) new technicians, and otherwise noodled around as primarily a floor technician. In my copious amounts of free time I homework'd. I also have a longbow en route to help me get outside more often, though all the trails and state lands literally outside my backyard is already drawing me out the door much more often than I used to.
Thursday, October 1, 2009
On moving forward
As of today, I've been working in the ER as a tech for a year and four months. I've been in the hospital setting in general for two years. In the tech position, I feel as though I'm a professional part of a team. The ER is a tight-knit group, where one person can make a huge difference in the work atmosphere, patient flow, and overall dynamics. In this exclusive group, I'm the employee with the least required education. I have no license, or registered title, or even certification (unless registered nurse aide counts). Yet, I am responsible for making sure everything flows smoothly. I order and coordinate labs, radiography, and respiratory therapy. I clean and lay down fresh linens, and stock each of the nine rooms. I track down and page doctors for the ER doctor. I gather records, send records, and otherwise obtain information if a situation demands it. I perform all EKGs in the department, and all "Stat" EKGs in the hospital itself (and my EKG interpretation skills are better than some of the nurses). I help nurses as directed, and, if I'm finished with my current tasks, I check in patients and run vital signs. I perform compressions when a patient is in cardiac arrest, and run to calls to help subdue aggressive patients. I irrigate lacerations in preparation of suturing, and I dress wounds as required.
This paragraph wasn't to brag (well, maybe a little), but to illustrate the training and experience I get from this job alone. As I get more in depth in the medical field, I am drawn towards expanding my scope of practice. To that aim, I've begun the first few steps. I'll be starting prerequisite classes this winter for Physician Assistant school. The schools I'm looking at require a certain number of experience hours. By the time I finish the classes, I should be a fairly competitive applicant, assuming I keep my GPA up. It's good to have a goal again, and it's strange how quickly two years have passed.
This paragraph wasn't to brag (well, maybe a little), but to illustrate the training and experience I get from this job alone. As I get more in depth in the medical field, I am drawn towards expanding my scope of practice. To that aim, I've begun the first few steps. I'll be starting prerequisite classes this winter for Physician Assistant school. The schools I'm looking at require a certain number of experience hours. By the time I finish the classes, I should be a fairly competitive applicant, assuming I keep my GPA up. It's good to have a goal again, and it's strange how quickly two years have passed.
Thursday, July 16, 2009
On Behalf of the ER
I've decided that today would be a good day to hopefully explain some mysterious going-ons that patients and families of patients have asked about. It's meant to be a not-very-comprehensive but also-not-sarcastic little list.
1. The ambulance came to pick up my mother, but then sat in the road while they fiddled around in the back putting in an IV. Why weren't they rushing to the ER?
- A lot of times, the medics will perform interventions that they feel is needed immediately before transporting the patient. For many of these interventions, having an access point to the vascular system is important. This is especially true if a patient is unstable - it's best to put an IV in while it's still possible (i.e., there is still enough blood pressurizing the veins to allow a peripheral IV attempt) rather than having to resort to more invasive methods (needle that goes into bone marrow, needles that go into your jugular, etc). Keep in mind that IVs are the gateway through which fluids and many medications can be administered.
2. The nurses are all just milling around outside. Why am I just sitting in this room, what am I waiting for?
- Unfortunately, this question occurs due to a lack of communication. Once the initial barrage of assessments, x-rays, and blood draws is over, we have to wait to have the results back. Our lab can take around an hour or two to return the more common tests, while some uncommon ones may take longer. X-rays are usually available for the ER doc to see within a few minutes, while CT scans and ultrasounds have to be digitally sent to a radiologist off who-knows-where. The radiologist types up a report of his/her findings and then faxes it to us in about an hour and a half.
- The reason the nurses may be milling around is because he or she has done everything for the moment, and is now waiting for results or more doctor's orders. The ER personifies the "hurry up and wait" mindset. Also unfortunately, the nurse cannot always stay in a room with a patient while waiting - he/she needs to be available to take care of the other 1-4 patients he/she may be responsible for.
3. Why was that person brought back before me? I was here first.
- During registration, a nurse will triage each patient that checks in. The patient is marked 'non-urgent', 'urgent', or 'emergent'. These are based many variable such as why the patient is checking in, initial impression, past medical history, etc. That man sitting in the chair may be complaining of back pain after lifting heavy furniture, but if he is also pale as a sheet, has a blood pressure of 90/50, and has a history of an aortic aneurism, he is going to go ahead of someone with an abscessed tooth. The entire system is centered around priority. Nobody comes into the ER for fun, and it is understandable to be frustrated by the wait and the feeling of being bypassed by other patients, but critical patients always come first.
4. Why do I have to get all these procedures done again? I had all the same ones on my last recent visit.
- While the previous test results may be good to set a 'baseline' (what your lungs usually look like in x-ray, what your ekg usually shows, etc), we need to see why you feel or look the way you do now. We're trying to figure out what changed, and in doing that we need to look at all the potential causes. You may have had an ekg done last week, but today you're having chest pain, and another ekg may show that parts of your heart are dead. Things like that are very very important to catch.
I may or may not add more questions here as they arise. If anyone reading has any, go ahead and comment and I'll try my best to answer it!
1. The ambulance came to pick up my mother, but then sat in the road while they fiddled around in the back putting in an IV. Why weren't they rushing to the ER?
- A lot of times, the medics will perform interventions that they feel is needed immediately before transporting the patient. For many of these interventions, having an access point to the vascular system is important. This is especially true if a patient is unstable - it's best to put an IV in while it's still possible (i.e., there is still enough blood pressurizing the veins to allow a peripheral IV attempt) rather than having to resort to more invasive methods (needle that goes into bone marrow, needles that go into your jugular, etc). Keep in mind that IVs are the gateway through which fluids and many medications can be administered.
2. The nurses are all just milling around outside. Why am I just sitting in this room, what am I waiting for?
- Unfortunately, this question occurs due to a lack of communication. Once the initial barrage of assessments, x-rays, and blood draws is over, we have to wait to have the results back. Our lab can take around an hour or two to return the more common tests, while some uncommon ones may take longer. X-rays are usually available for the ER doc to see within a few minutes, while CT scans and ultrasounds have to be digitally sent to a radiologist off who-knows-where. The radiologist types up a report of his/her findings and then faxes it to us in about an hour and a half.
- The reason the nurses may be milling around is because he or she has done everything for the moment, and is now waiting for results or more doctor's orders. The ER personifies the "hurry up and wait" mindset. Also unfortunately, the nurse cannot always stay in a room with a patient while waiting - he/she needs to be available to take care of the other 1-4 patients he/she may be responsible for.
3. Why was that person brought back before me? I was here first.
- During registration, a nurse will triage each patient that checks in. The patient is marked 'non-urgent', 'urgent', or 'emergent'. These are based many variable such as why the patient is checking in, initial impression, past medical history, etc. That man sitting in the chair may be complaining of back pain after lifting heavy furniture, but if he is also pale as a sheet, has a blood pressure of 90/50, and has a history of an aortic aneurism, he is going to go ahead of someone with an abscessed tooth. The entire system is centered around priority. Nobody comes into the ER for fun, and it is understandable to be frustrated by the wait and the feeling of being bypassed by other patients, but critical patients always come first.
4. Why do I have to get all these procedures done again? I had all the same ones on my last recent visit.
- While the previous test results may be good to set a 'baseline' (what your lungs usually look like in x-ray, what your ekg usually shows, etc), we need to see why you feel or look the way you do now. We're trying to figure out what changed, and in doing that we need to look at all the potential causes. You may have had an ekg done last week, but today you're having chest pain, and another ekg may show that parts of your heart are dead. Things like that are very very important to catch.
I may or may not add more questions here as they arise. If anyone reading has any, go ahead and comment and I'll try my best to answer it!
Monday, June 8, 2009
I'm almost through with another week-long stretch at work, and I'm feeling pretty good. I'm slowly becoming accustomed to the odd sleep schedule, and I'm starting to understand exactly how much sleep I need as a minimum. Night shift is the fine art of arranging your lifestyle around sleep, which I admit makes one appreciate sleep quite a bit. Not too much noteworthy has happened recently in the sleepy little ER. A handful of true emergencies, a parcel of urgent issues, and a whole truckload of mostly unnecessary visits. I signed in a patient yesterday who had a chief complaint of "sunburned face". He had a little bit of reddening around his eyes and cheeks - he rated his pain as an 8 out of 10. This would sound completely ridiculous but for the fact that he's a known drug seeker, so I suppose any excuse would do. Because of the sunlight, we have had several patients check in with sunburns, which doesn't make much sense to me. I can understand how it can be painful, but I'm curious as to what mentality would make someone think of the ER as a place to go for it. I suppose I can blame popular culture and commercialism, where everything and everyone should be medicated (at least according to the pharmaceutical companies).
In other news, with the fiance applying for (and likely to be accepted to) a radiology technologist program, things are up in the air. The school is a three-hour commute from where we currently live, so we're going to have to figure out whether we need to move or if we're going to keep our home base here. There are many arguments for both, so crunch time will be later this week when we get word back on acceptance. I will either keep this job, or apply for another ER position at a hospital in that other town. Either way, I'll work while she gets edumacated, and then we'll switch off once she graduates.
In even other news, I recently attended an in-house tournament at my judo club and attained yonkyu rank (blue belt). Now I need to start really training my butt off so I can get to brown belt! With no schooling to distract me, I can focus on work, the kiddos, and physical training. It's pretty nice. When I'm not working I'm either playing with the kids (we made some cool little bonfires last weekend!), sleeping, or training. Five days a week of lifting/cardio/judo/jiu-jitsu is pretty good, it tends to balance out well with the rest of my schedule.
In other news, with the fiance applying for (and likely to be accepted to) a radiology technologist program, things are up in the air. The school is a three-hour commute from where we currently live, so we're going to have to figure out whether we need to move or if we're going to keep our home base here. There are many arguments for both, so crunch time will be later this week when we get word back on acceptance. I will either keep this job, or apply for another ER position at a hospital in that other town. Either way, I'll work while she gets edumacated, and then we'll switch off once she graduates.
In even other news, I recently attended an in-house tournament at my judo club and attained yonkyu rank (blue belt). Now I need to start really training my butt off so I can get to brown belt! With no schooling to distract me, I can focus on work, the kiddos, and physical training. It's pretty nice. When I'm not working I'm either playing with the kids (we made some cool little bonfires last weekend!), sleeping, or training. Five days a week of lifting/cardio/judo/jiu-jitsu is pretty good, it tends to balance out well with the rest of my schedule.
Tuesday, September 23, 2008
Alternative Beliefs and the ER
Since starting my job, I've very often encountered dualities that challenged my methods of thought. The protocols surrounding procedures creates a grounded and solid lens through which to view anything out of the ordinary (which tends to include everything in the ER). It's insidious enough that I don't even notice until I mentally review the day. Checklists that I unthinkingly tick off form a very rigid structure to view the oddities that pass through, especially the psychiatric patients. I've wondered time and again - how would I (or the nurses or physician) view a Therianthropic patient in a deep mental shift? Similarly, how would we appreciate a metaphysical causality for conditions such as possession or psychic attack? The usage of sedation and restraint in a monitored room is very clumsy-handed, and I'm not sure whether this is because I work in a rural hospital with limited resources, or if it's a standard by which most work off of.
On a different note, it's interesting when we have actual emergencies come rolling through the door. The feel of the department changes from tolerant calmness for minor complaints to a sense of excitement and urgency - this is what everyone has been trained for. Everybody works closely as a team, and the already sharp focus of the nurses and physicians becomes almost razor-like. The most recent and notable occurred at midnight, and involved a patient who fell from a height (about 30 feet) onto his side. He was responsive but confused when the medics picked him up, but was completely unresponsive when he arrived at the ER. A quick chest X-ray revealed a tension hemo-pneumothorax (he had both air and blood in the pleural space, and it was worsening with each ventilation). The ER physician attempted to relieve some of the worsening pressure via an IV needle between the ribs, but it didn't do much - the viscosity of the blood was probably clogging it. The surgeon on call decided to place a chest tube. He prepped the area and then used hemostats to open up an area between the ribs, and was subsequently exploded upon.
The blood and air was at such a pressure and volume that it managed to get the surgeon and cover much of the floor and side of the gurney. Units of blood were hung to replace the volume, and many meds were pushed, but the patient's body was overwhelmed and decided enough was enough. I heard the very distinctive and jarring "code blue" bell from the room (it's the alarm that signifies a cardiac arrest, which means a mass influx of nurses and physicians to the indicated room) some time later, and we spent about half an hour performing CPR. Since someone started the chest compressions before me, I didn't break any ribs when I took over. If anyone tells you that CPR isn't hard work, call them a liar. The ER physician eventually called the time of death, and we kept the patient in a room for the family to visit later. They had to drive three hours to get here, I don't want to imagine what kind of drive that must have been.
I'll see if I can update this more, but I'm about to start night shift in earnest next month. I'm about to work a seven day stretch, we'll see how much energy I have!
On a different note, it's interesting when we have actual emergencies come rolling through the door. The feel of the department changes from tolerant calmness for minor complaints to a sense of excitement and urgency - this is what everyone has been trained for. Everybody works closely as a team, and the already sharp focus of the nurses and physicians becomes almost razor-like. The most recent and notable occurred at midnight, and involved a patient who fell from a height (about 30 feet) onto his side. He was responsive but confused when the medics picked him up, but was completely unresponsive when he arrived at the ER. A quick chest X-ray revealed a tension hemo-pneumothorax (he had both air and blood in the pleural space, and it was worsening with each ventilation). The ER physician attempted to relieve some of the worsening pressure via an IV needle between the ribs, but it didn't do much - the viscosity of the blood was probably clogging it. The surgeon on call decided to place a chest tube. He prepped the area and then used hemostats to open up an area between the ribs, and was subsequently exploded upon.
The blood and air was at such a pressure and volume that it managed to get the surgeon and cover much of the floor and side of the gurney. Units of blood were hung to replace the volume, and many meds were pushed, but the patient's body was overwhelmed and decided enough was enough. I heard the very distinctive and jarring "code blue" bell from the room (it's the alarm that signifies a cardiac arrest, which means a mass influx of nurses and physicians to the indicated room) some time later, and we spent about half an hour performing CPR. Since someone started the chest compressions before me, I didn't break any ribs when I took over. If anyone tells you that CPR isn't hard work, call them a liar. The ER physician eventually called the time of death, and we kept the patient in a room for the family to visit later. They had to drive three hours to get here, I don't want to imagine what kind of drive that must have been.
I'll see if I can update this more, but I'm about to start night shift in earnest next month. I'm about to work a seven day stretch, we'll see how much energy I have!
Thursday, August 21, 2008
Experiences in Washington, and Thoughts
Well folks, it's been a while since I've posted anything of substance. So here goes nothing!
I have a tendency to let my occupation define my existence - which may or may not be beneficial towards growing as a person. I've gained a lot from my foray into the medical field, and I feel as though this is the right path to be taking, at least for the time being. There are lots of interesting stories, patients, and occurrences to be had in an ER, as well as complete chaos. I work in a small (14-bed) emergency department. We keep track of which patients are in which rooms via little paper cards in slots on a wooden board. Some days, I am the only emergency room technician. Our EKG tech doesn't work nights, so I have to perform all stat EKGs in the hospital during night shift. We only have one physician in the department, and sometimes we get a midlevel (physician assistant or nurse practitioner) or two. All in all, it's a small and cozy environment. We get anywhere from 50-100 patients a day.
Like all ERs, we have our frequent fliers. Some of them, in a bid to get the narcotics they're looking for, will collaborate with a friend. One even called me today, posing as a private-practice psychiatrist calling ahead for his "patient".
"She's totally not going there to get drugs. I swear." was basically the gist of his conversation. I have to admit he was pretty smooth; must have run into questioning ERs before. I told the "psychiatrist" that the patient he was talking about had quite a lengthy history in the ER. A few hours later, he called again, this time pretending to be working at another ER.
In other news, I'm going to get some sleep now. I'll try to post a bit more often to this journal.
I have a tendency to let my occupation define my existence - which may or may not be beneficial towards growing as a person. I've gained a lot from my foray into the medical field, and I feel as though this is the right path to be taking, at least for the time being. There are lots of interesting stories, patients, and occurrences to be had in an ER, as well as complete chaos. I work in a small (14-bed) emergency department. We keep track of which patients are in which rooms via little paper cards in slots on a wooden board. Some days, I am the only emergency room technician. Our EKG tech doesn't work nights, so I have to perform all stat EKGs in the hospital during night shift. We only have one physician in the department, and sometimes we get a midlevel (physician assistant or nurse practitioner) or two. All in all, it's a small and cozy environment. We get anywhere from 50-100 patients a day.
Like all ERs, we have our frequent fliers. Some of them, in a bid to get the narcotics they're looking for, will collaborate with a friend. One even called me today, posing as a private-practice psychiatrist calling ahead for his "patient".
"She's totally not going there to get drugs. I swear." was basically the gist of his conversation. I have to admit he was pretty smooth; must have run into questioning ERs before. I told the "psychiatrist" that the patient he was talking about had quite a lengthy history in the ER. A few hours later, he called again, this time pretending to be working at another ER.
In other news, I'm going to get some sleep now. I'll try to post a bit more often to this journal.
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