The Final Day

Bring it...

And so it begins....

0340 - I'm up, turning off my alarm for what probably will the last time at this unGodly hour for a while... I've always been a morning person... I prefer sunrises to sunsets... maybe I will enjoy living on the east coast for a while... watching the sun rise on each new day.... hmm....

0505 - "If you're not 10 minutes early, you're 15 minutes late..." So today I was a bit late... distracted at home... futzed around for a while... plus I collected a bag of pens to bring back to the ED... so, yeah, I'm the reason you can't find a pen in this place... btw - Temp 97.3, still good...

0544 - My scribe just sneezed next to me, and after having her wash her hands and her sleeve with hand sanitizer, I realized we were not maintaining social distancing, and I immediately reached for my thermometer... it's like my talisman against the evil humors... maybe I should make her take her temperature... and spray Lysol around her and me...

0555 - The first ambulance comes in with what was described as a "chair throwing, hallucinating, psychotic patient that might be going through alcohol withdrawal..." ok, so let's see how well those blood draws and medication administrations are going to go... the patient seems calm... for the moment...

0630 - This I will not miss... breakfast at the hospital. The most excited I can get about breakfast are the days they have a country fried (I think it's) chicken patty... of course, the last time they had that, it was on a Friday... during lent... yeah

0645 -  The calm psychotic patient no longer is calm... here's to hoping they don't go psychotic

0710 - Called to the ICU to intubate a patient that's not breathing very well. Medications drawn, RT's in order, tube goes in, and it's back down to the ED where...

0727 - The psychotic patient has gone totally psychotic in my absence... so now they're being put in restraints and given medications to put them to sleep...

0730 - I take a bite of my now-cold breakfast and am told that I patient with a chainsaw injury that I spent almost an hour sewing back together has come back. The wound looks like it's starting to heal as expected. I am pleased with the result, as hopefully is the patient...

0800 - I'm trying to eat breakfast again

0810 - Complete pandemonium has commenced and all of the psych patients are now in 4 points and receiving medications... hoping the din in the ED diminishes... someone's going out for coffee... we're girding our loins people...

0830 - I attempted to eat my completely cold breakfast. That did not go as planned as I was being constantly interrupted for psychotic patients, triaging who gets tested for COVID based on symptoms and travel history, signing EKG's... the usual ED work stuff...

0850 - Temp 97.8 - still good

0916 - Have completely given up the idea of eating my icy cold breakfast and am instead going to test the limits of my diabetes medication by feasting on some of the apple fritters and donuts one of the PA's brought in honor of my last day... and the coffee finally arrived!

0935 - Finally got a patient out of here after reassuring them that there was nothing wrong within their belly... buh bye....

1002 - The sugar high is starting to kick in... either that or the caffeine in the Dutch Brothers coffee has gone straight to my head because I am buzzing around a department where I really don't have a lot of patients at the moment.... so I keep circling, and talking fast, and taking way too long to explain things...

blood sugar rising...

1035 - I'm discharging a very sweet senior who fell two days ago and is still having pain. They feel much better after the pain medications I gave them. They asked my name and if I was a traveler. When I said I wasn't, they told me "It's great that we have a fantastic doctor in the area" I almost choked up. "Well there are lots of us. Thank you."

1056 - One of our local police officers just brought us a dozen donuts... adding to the six boxes of donuts we already have... Thanks for thinking of us! Hmm... sugar rising according to my CGM... but maybe I need another one....

1130 - Where did the time go...? Temp is 97.8 and I just had to go back into the tent... full precautions... another person screened... so far no positive tests but we'll be getting results over the next several days. I think it's time for another half a donut...

1225 - "I just used a little bit" Yeah... that's why your blood sugar is over 500, you have ketones in your blood, I'm giving you tons of fluid and insulin... and it's not like it's your first time... #MethBeBad

1245 - The nurses are frantically texting and making phone calls to make my every EMS photo dream come true... they secured a fire truck, maybe an ambulance, some police contacts, and one of them, seriously girl, called to see if we could get a helicopter... would have honestly open mouthed French kissed all of them if that had happened...

1302 - Fire truck came and had to leave on a call almost as soon as it got to the back entrance... ambulance crew showed up and we shot a photo with them...

1325 - I checked out all my patients to the oncoming doc... I emptied out my mailbox and packed up my lab coat... Thank you, all, it has been my honor to work with all of you all of these years.

Dr. Bonales, signing off, Humboldt... stay safe out there...

Day 27 - Giving Thanks

Remember those who work to keep your family safe.

Remember those who work to keep your loved one healthy.

Remember those who work so that your

emergency doesn't turn into a tragedy.

Thankful for my colleagues, law enforcement officers

and first responders who shared this holiday

with me, doing what they do best.

#1596 - On Triage

 I know I've written about this before, but I want to make sure that you really get the concept.  And, since I am preparing for a mass casualty exercise for my EMS group tomorrow, I thought I would share some of what I've been doing today.... plus have a good excuse for the short post...

Triage is the system used to determine in what order patients are seen in the emergency department.  So someone having a heart attack or a stroke will be seen before someone with a toothache.  And, while you may be worried about that fact that your kid fell and hit his head on the coffee table, we're more worried about the kid whose parents continue to smoke and who is on their third nebulized breathing treatment because they're still wheezing.

Now, I know you've been waiting for three hours, but I can't control what comes in the "back door;"  you know, the big one labeled "Ambulance Entrance."  Sometimes, people who are having actual emergencies come in on the ambulance.  I can't determine that until I go in and see them.  Then, when I have determined that their month long bought of abdominal pain which is suddenly worse today, isn't life threatening, I can get to you.  For your drug refill, or your migraine headache that magically appears every Friday night that needs that "dilaudid" stuff, but please be quick about it because "my ride is waiting."

And, not to sound callous, but you have to remember that we have seen the worst that can happen to someone.  So when we reassure you that the finger you almost cut off with a table saw because that "pesky plastic shield just kept getting in the way" is going to be ok, it's because we've dealt with this kind of emergency before.  You're not going to bleed to death, but that finger's going to be just a little bit shorter than the others.

2013 A to Z Challenge Post:

T is for Time

A New Place to Begin Anew

I don't have to post a blog today for the challenge, but since I promised one last week and I didn't deliver, I thought I would write one today.

When I first started blogging, it was on a platform run by AOL called Journals at AOL or something like that.  Suddenly AOL pulled its platform, and we (my fellow J-landers and I) were left floundering as we tried out other platforms.  I ended up on Blogger.

Since I had long answered the question that "yes, there are squirrels in Buffalo," I thought I would name my new blog "Buffalo Squirrels Won't You Come Out Tonight?"  Partially, this was to pay homage to my new temporary home, and partially, it was a tongue-in-cheek reference to the clientele I was meeting in the emergency department.

As I transitioned from a first to second year, I could see changes in my attitude toward dealing with patients.  I think I also became more reflective of some of the patients and cases I witnessed.  I gained a lot of experience dealing with emergency situations, some medical and some traumatic.   I also wrote a lot more about my patient experiences than I had before.

We had a plane crash that year with 52 souls lost.

I celebrated my one year anniversary with my DH.

I learned a little about a LOT of orthopedic surgery, mostly during call when the "Black Cloud" of the ortho service was my resident.

I ate my body weight in New Orleans while on a conference.

I spent a month with the county medical examiner and had a great rotation... hard to believe when you're dealing with death, but some of it is so fascinating.

I started off my senior residency year and had the worst case of my residency which still haunts me to this day.

I continued my love for all things fire truck related, and became assistant medical director of the Buffalo Niagara International Airport Airport Rescue Fire Fighters.

Hubby and I traveled the Interview Trail to find our new home in the Pacific Northwest.

I was sued.  The upside was returning to Boston and really enjoying the city and colleagues.

I crewed on a racing sailboat during that last summer in Buffalo and thoroughly enjoyed it!  Which led to my first posting on You Tube as I filled a video full of the hundres of pics I took that summer....




And, finally, graduation came, and I planned the cross-country move along with the end of that blog and the beginning of this one.

Thank you for joining me on this journey through memory lane... enjoy the rest of the challenge!  And, please, I hope you continue to enjoy this little blog of mine...!

#538 - M is for Mass Casualty Incident

My training is in Emergency Medicine.

My subspecialty is EMS (Emergency Medical Services.)

My interests are in Mass Casualty Incidents

and Disaster Medicine.

Days like today are what we train for.

One of my colleagues from residency was at the race today.

She also was in my subspecialty group,

and her interest is in mass gathering medical services.

I don't know if you realize that when you have a sporting event

you have to have x amount of emergency medical services per x amount of people.

The more people, the more extensive the list of 

emergency medical personnel you have to have on hand.

She was working the medical tent at the race.

Usually she deals with sports-related injuries.

Today turned out to be a little different.

When you watch the video of the explosion,

and you start to see people running away,

pay close attention to those who run toward the danger,

those who started pulling down the barriers even as the second bomb exploded,

who immediately went into Mass Casualty Mode 

and started helping.

That's EMS.

That's my friend,

who ran back to help start up triage

to help the injured.

This is what we train for,

and she did what I would have done/would do

in the same situation.

I loved Boston the year I lived there training at BWH.

We watched the marathon from the Common as the first racers came into view

the year I lived there on one of my random days off.

I pray for those affected by this incident.

No Rest for the Wicked

If you can imagine, today was crazier than yesterday even though we  saw less patients.  But let's not dwell on that too much...

So, even though I don't have to have a post today for the A to Z Challenge, I thought it would be fun to share some of my favorite posts for those of you new to my blog site.

I have been blogging since 08/06/2007 when I was heading east from Minnesota to Buffalo.  My first blog was entitled "Do They Have Squirrels in Buffalo?" because I had developed quite the squirrel army on the property of our rental near White Bear Lake, and I was going to miss the daily goings-on of my little furry extended family.

That blog chronicled the first year of my Emergency Medicine residency and the adjustments I had to go through switching from a surgically-trained mind to an emergency medicine trained mind.  I finally got married to the man of my dreams in that year, and we went on a belated honeymoon.  I wrote about the different rotations I was having to do, and how some could be more painful than others.  Having a chance to cut... in surgery the theme was: a chance to cut is a chance to heal, and I do enjoy doing things more than talking about doing things.

The year went by, and I started gaining more responsibility as I started my second year.  Also, I started getting more snarky in my commentary, especially while working the children's hospital.  I started doing shifts with the Mercy Flight crew and wrote about my first helicopter ride.

I ended with a final post on 10/26/2008.

Next week, I'll post my favorites from my second blog: Buffalo Squirrels Won't You Come Out Tonight?

Birthday Shuffle a Deux #16

I Hate Everyone - Get Set Go



I love Grey's Anatomy.  Or, I should say, I used to love Grey's Anatomy.  Mostly it was the medicine and remembering how it was to be a surgery resident.  A lot of competition, a lot of late nights and hard work, and a lot of camaraderie.  The drama and romances... well, at least not in my residency program.

This song is sometimes the theme music for my day.  I work in an Emergency Department, and there are days when I do hate everyone.  The physician's desk is near the triage window, so I get a "preview of coming attractions" throughout the day.  Sometimes, the presenting complaints just make me cringe and wish I'd gone into something else... back to surgery perhaps...?

Patients that drive me the most crazy:
 - multiple medical problem patients that don't stop smoking, don't stop drinking, forget to fill their medications on time and come in because they're on the verge of collapse.  They get admitted, all of their medical problems readjusted, sent out with scripts and follow-ups and then come back several weeks later to do it all over again.
 - dental pain.  Your teeth are bad, you continue to smoke, you'd rather spend money on meth than a toothbrush and a dentist.  And, they always seem to come in on Friday or Saturday nights or at six in the morning... funny about that...
 - as seen on WebMD.  Stop looking up differentials on your smart phone and arguing with me about diagnosis and treatment.
 - repeat customers.  I know you're a drunk, everyone in town knows you're a drunk.  Sit in the middle of your room away from stairs, porches, your cat, chairs, ladders, and car doors and maybe you won't fall down three nights in a row needing to call 911 and getting so much radiation you glow.  If the liver cirrhosis doesn't get you, cancer from all of the scans and films we've had to do just might.
 - rashes... I just don't like them...

Life Moves Pretty Fast

 I can't believe how much time has passed since the last time I posted... Let's get you caught up on "life on the farm" shall we...?

Why, yes, this is a baby goat... Her name is Boot Scootin' Boogie aka Bootsie. She is a bit of a surprise. When we got our goats about a month ago, the breeder said that Josie was sterile. That she'd been with a male goat for a while and hadn't gotten pregnant. So, last week Monday after the goats were put in for the night, I told my DH that something was wrong with Josie. She kept calling out from the barn and seemed very restless. He argued that she was just being annoying as always, and we went to bed. The next morning while I was in the shower, DH went out to let out the goats and chickens for the day. He came back in and said, "Something's wrong with Josie." I asked what, and he said he didn't know but that "something's falling out of her behind." I quickly got dressed and ran outside. And, that's how Bootsie came into the world. It's been an amazing week of watching this tiny little shaky blob slowly find her legs.  She now scampers around the yard with her Momma.

I did medical control for the Tour of the Unknown Coast bike ride again. It's a fabulous 100 mile bike ride along the coastline here going from redwood forests to the coast and then up an impossibly steep series of hills before the scary downhill run home. No major traumas, just some dog bites that had to be attended to.

Dixie is a week away from being 6 months' old. It's been awesome seeing her grow up and develop. She went through an impertinent teenage stage which she is slowly getting over, and she's really turning into a wonderful dog.

As for our "mutant chickens" that I wrote about in the last post... well, 3 have disappeared. One for sure died, as we found it near the barn. The other two, we're not sure, but I hope there isn't another wild cat around. We have seen foxes around, so maybe they got eaten by one of those. Nonetheless, DH thinks we should stick with bigger breed chickens. They seem to do better.  In fact, tomorrow I'm supposed to get 2 more large hens and a new rooster.

Work continues about the same, and I know we're starting to head into the trauma season, so it's going to get even more busy. I was chosen as an instructor for a new program on patient safety so that has kept me busy with training and meetings. I also am the new pre-hospital care medical director, so that is going to take up a little more of my time.

With new babies, a new puppy coming soon, and living in this wonderful place, I know I am going to have to get a better handle on my time... I don't want to miss anything...

An Extraordinary Life

Most people remember the TV show in the early 70's called "Emergency!"  It's where paramedic firefighters were showcased for the first time.  What I didn't know is that the character of Johnny Gage was based on a real-life firefighter named James O. Page.  Not only is he recognized as one of the forefathers of EMS, he is generally considered a gifted writer, teacher, and historian.

Today at our NAEMSP conference, the Memorial lecture was dedicated to him, and the speaker talked about his life.  Wow.  It got me to thinking about how you learn about these amazing people and hear about the extraordinary things they do and wonder how they did it.  How does someone live the extraordinary life?

It made me start thinking about the movie "Dead Poet's Society" and how influential that movie was to me at the time... about to start college... thinking of challenging what I felt to be my parents' ideas of what my life should be like.... wondering how I was going to lead my own extraordinary life.  This scene is my favorite:





The lecture ended with a quote which was found in the wallet of James O. Page when he died suddenly. Given that it's a brand new year, I felt it appropriate to think of this as a mantra for the upcoming year... what will you do to make your life extraordinary?

‎"I want to appreciate the time when moments were made into memories. I want to embrace them, cherish them, and never forget that they come so few and far between. I know that wherever life takes me, these memories will always follow. They remind me of what's truly important. It's not just life, but living. It's the journey, the destination, and all the little points in between. And I must admit, I like what I see." - author unknown

NaBloPoMo Day 12

Today I occupied part of my time listening to our EMS scanner.  I live in a small town with a volunteer fire department.  Every day at noon, the alarm siren goes off.  It also goes on whenever there's an emergency call.  If I'm near the scanner, I can turn it on and listen to what the run is.  I have an interest in EMS, in case that wasn't obvious....

Today's drama was courtesy of a motorcyclist who went over an embankment by the river without his motorcycle and ended up needing to be rescued via helicopter since it was near impossible to get him out by any other means.  The story unfolded through several rescuers and dispatch.  The patient ended up going to Eureka, and a paramedic got to fly along with him, leaving a member of the flight crew to have to hitch a ride with CHP back to his flight base.... oh and someone's personal vehicle got stuck in the mud, twice.

Just another exciting day of small town life...