We must take a moment to wave at Mal (*waves* Hi Mal!) who is down at College currently on his Techy course. Mal is a friend of FlatMateBam and he came over for dinner some months ago to discuss the job and whether or not he fancied it.

We congratulate him on getting a place at College and are confident he’ll do just fine, he was wandering around Station the other day while I was eating my porridge and looked very official in his training blues.

Bam reports that he has found himself in that charming frame of mind where he is Just. So. Excited. about learning new things and wants to share his new found knowledge with EVERYONE.

This week, apparently, Bam and Mal were at a party and Mal was complaining that, while they got to practice intramuscular injections on oranges, he was concerned that he didn’t get a chance to stick a real person before he did it in anger.

The conversation turned to the limitations of practicing on one’s colleagues and Bam mentioned that while I was on my paramedic course, she’d offered her arms up for me to practice IV access.

What she meant to say was:

“While Kal was doing his para course? I said he could practice putting cannulas in me.”

Bam, however, was a little pissed.

And said.

“While Kal was doing his para course? I said he could practice putting catheters in me.”

We’re close.

But not that close.

Today I sat in the office of a consultant anaesthetist with whom I’d butted heads on my placement. He signed my chitty and shook my hand.

“Congratulations…d’you feel ready to go out and intubate people?”

I laughed.

“I feel ready to go out and have a go.”

“That’s good enough for me. You’ve done well…and if you need anything? Anything at all. You just give us a phone. I’d rather you didn’t call me with ethical questions at three in the morning, but clinical issues are fine. Don’t forget, we trained you, we signed you off, you’re out there on our name. You’re one of us and you’re always welcome to come back if there’s anything we can do.”

I shook his hand again, dropped my box of chocolates and card off into the staff room (because an ODP had complained that “The paramedics always promise us chocolate and then forget about us once they leave”) and stepped back down to my car.

Tomorrow I’ll have Boss or Guv write me a reference, I’ll speak to the training department and figure out what I’m meant to do with all the rest of my training paperwork and then I’ll shove it in an envelope with a very painful cheque and send it off to these folk.

And then they’ll give me a number.

And that number gives me licence to practice.

And that WILL be good.

Can’t be fucked redoing the design, it takes a lot of time, of which I have precious little currently.

But, since I’ve finished my placement, I am now (with the small matter of being unregistered and still unable to practice) a fully qualified paramedic.

So, to celebrate, I made a new mast-head.

Festive, no?

Mad props to Beattie for the quote - thankyou!

She strolls onto the ward, a bundle of notes under her arm, her uniform looking closer to pyjamas than work-wear. I’m sat at the desk in mufti, slacks and a shirt, confusion over whether I should wear my Greens has pervaded my placement between two hospitals.

She sticks her hand out.

“Hi! I’m Fanny the Pharmacist! You must be new, how you doing?”

A friendly face is always welcome, I take her hand and shake it.

“Hi Fanny the Pharmacist, I’m Kal and I skin puppies with my teeth before wrapping their lifeless skins around my genitals and camply dancing around geriatric wards yelling “I am Kal the spaniel-skin-willy-warmer-wearer…hear me mince!”

No, wait, that’s not right.

That’s not what I said.

I said:

“Hi Fanny the Pharmacist, I’m Kal and I’ve been setting my hand on fire, then extinguishing the flames by fisting corpses in the mortuary…it’s a simply capital affair - won’t you join me?”

Again….a second…this is tricky to remember and I want to make sure I get the details right.

It must have been something awful because she dragged her hand from mine at light speed, looked me up and down with her lips curled and stalked off, snarling over her shoulder.

Oh wait, I’ve got it.

“Hi Fanny the Pharmacist, I’m Kal the Paramedic.”

She wasn’t pleased, apparently, because as she left she said, in a voice filled with betrayal and disappointment.

“I thought you were a doctor.”

Yeah, well, I thought you weren’t an asshole…guess we’re both disappointed.

My toast is cooking, tea is brewing, I’m leaving in 9 minutes.

But justhave time to tell you of the most recent danger to paramedics out there.

I stuck my tourniquet in my back pocket this morning then sat on the edge of the bed to put my shoes on. The hard lump of plastic on the tourniquet’s valve fitted perfectly against my left “sit bone” and knocked me clear off balance. This, coupled with the wobbly mattress, couped me off and onto the floor, where I laughed at myself for some time.

This is why Trauma Queen exists, to give you guys further opportunity to rip the piss

There’s an expression the patients in CCU get. It’s an expression that I’m not accustomed to. I’m used to seeing “Thank Christ, the ambulance is here.” or “Oh God, I’m scared, but the ambulance has arrived.” or “Who’s this cunt in the green?”

The patients on the ward have a beaten, defeated look. Their skin hangs down between their clavicles, their shoulders sink to the mattress, but their muscles are tense, anxious, scared. I follow the doctors on their ward rounds, the patient look up at them from their pillows, not bothering to lift their heads. There is no “Thank God you’re here, Doctor.”

Their acute distress has been and gone, their faces now an image of long, sleepless hours thinking about how their heart is slowly packing in.

“We’re getting there!” the medical staff say, cheerily, and the patients sometimes smile back, but it feels like charity.

Mostly they look at the doctors coming into their cubicle and ask if they’ll be home for Christmas? Or maybe New Year?

And then, in small voices, like folk who really don’t want to know the answer but can’t help but asking, they enquire as to what’s going to happen next. Will you test me for something else? Give me more drugs I don’t understand? Stop me eating? Make me eat? Drive another line into my neck?

Everything hurts and we sit behind our ranks of monitor screens, watching the patients as a series of numbers, it all feels terrifyingly machinistic.

One old guy knows my name. He says good morning when I arrive each day. He’s a nice old man, but has some scary problems. I can’t fix him, I can’t even take him “to see the doctor.” I’m not his nurse, I don’t understand his treatment regime, I’m insufficiently au fait with the ward’s procedures to really do much for him, but say hello back.

He moved to another ward the other day. I should go and say goodbye before I leave tomorrow. He’s wheedled through my shell.

This is why I couldn’t be a nurse. Not a ward nurse. An A&E nurse I could handle, maybe. But this whole “getting to know people” stuff?

No thanks. It scares me cold.

Fuck this maudlin shit…

I’m in the Coronary Care Unit at hospital; my last week of placement. I was really nervous about this part of things; the unit is so specialised…JUST cardiac stuff?

Well, yeah.

But there’s SO MUCH CARDIAC stuff. Really, honestly, there is stuff about hearts that I didn’t even know I didn’t know it existed. And I knew that I didn’t know a lot of stuff existed.

I’ve fallen into a nice system. 0730 I meet the nurses for handover, giving me an overview of the patients on the unit. 0830 I join the doctors for ward rounds, where I fail to understand everything they say, but diligently write it all down anyway. Then, for the next hour or so I research the stuff I’ve written down. I teach myself about drugs, about cardiac rhythms I’ve never heard of and the intricate interplay between the heart and the blood and all the myriad chemicals and amazing biochemical gubbinery that floats around in it.

Then for the rest of the day I float about the ward, doing minor nursey stuff and waiting for crazy shit to happen.

Lots of crazy shit happens. Yesterday? I went and watched a woman get an echo-cardiogram, we sat, myself, the patient and the echo-techo while one of us had gooey gel rubbed all over her boobs by another of us and the third stared at the screen, his mouth wide open while images of THAT WOMAN’S HEART were displayed. Like, not a movie, or a picture. But that valve, right there? The fucked up one? That isn’t working well and is all flobberly instead of perfect? That’s why she’s sick!

Then I watched someone get an angiogram and, again, stared at the screen while we saw the arteries of THAT GUY’S HEART get pumped full of contrast. And that little wiggly bit there? Where it stops looking like a big pipe and instead looks like a little pinchy bit? That’s why he’s sick! That’ll be why he gets crushing chest pain when he does anything. It’s because one of his coronary arteries is all full of shit and the blood isn’t flowing to his heart muscle.

The main problem with all these epiphanies is that I start saying stuff like “Cor! That’s his heart! That’s it! Right there! You can totally see it!” and teh staff look at me with a “What a fucking retard” sort of expression on their faces.

But seriously, isn’t that mental?

THAT’S THAT GUY’S HEART!

A&E is crowded, I’m less of a student than an extra pair of hands; I take blood and change sheets, roll a commode down the corridor to and from cubicles. I ask questions where I can, but ultimately settle for being as independent as possible, discussing treatment and investigations for my patients with staff.

I’m labelling blood samples when a doctor grabs my arm.

“Osteogenesis imperfecta! In Minors! Have you seen it before?”

“Ummm…nope.”

“He’s got blue sclera. You should go and have a look.”

So I do, tucking my badge into my scrubs, strolling into his cubicle, making small talk while staring at his eyes.

Astonishing.

A subdued yet vibrant blue, like shining robin’s eggs, with dark brown irises and widened pupils, dilated from the pain of his injuries.

It’s a sign I’ve read about in textbooks, but would probably miss if I hadn’t seen it alongside a definitive diagnosis.

Valuable knowledge.

I’m struggling to write here while I’m on placement, largely because so many of my posts feature individual cases or staff - easy enough while I’m on the road with staff who know me, harder with colleagues who aren’t aware of TQ.

This week I learned that cat bites are a higher infection risk than dog bites, but human bites are the worst and that certain finned fish can cause a condition called scromboid, where massive levels of histamin develop in their tissues, which you then merrily chow down on. You’re not allergic to the fish itself, but because you’re ingesting histamine, you present as anaphylaxis. I’m almost certain I’ve seen this before.

Because I’ve been a good boy, tubed every mother fucker from here to way-over-there, I got to pick a “specialty day” and, because I’m a sucker, I said merrily “Why, I’d like to go the paeds ward, please.”

So last night? I did.

I’ve always maintained that someone should produce a course for medical staff called “Managing the moderately ill child”, because I can SEE the kids that are just fine and I can also SEE the ones that are just alive. But the ones in the middle are tricky little buggers.

But, turns out? Bridge Hospital has a sister hospital. And IN that sister hospital, is a paeds medical receiving unit where kids get sent by their GPs when they “should PROBABLY be in hospital…maybe”

Moderately ill kids, right there.

I only spent eight hours in there, but learned a huge amount (mainly about bronchiolitis, a condition that we see a lot of) and it was fantastic to see the non-emergent, but still acute treatment of it. I ended up with one wee girl, just a few months old, whose parents headed home for the night. I took obs, helped with a couple of NG tubes and generally monitored her for the shift. I saw her temperature spike and her breathing increase to compensate, I saw her dump her SpO2 when we passed her NG and talked at length about her risk factors with the staff.

One of the statements on our True/False exam questions was always “Babies are obligate nasal breathers.” and we diligently circled “True” for that extra 1%, but last night I really saw the impact of that. Tiny airways clog with snot rapidly and if your method of eating inolves sealing your mouth and sucking, a closed nose will lead to hypoxia and apnea. As one doctor said last night “They’re just not old enough to learn that they need to back off from the breast and take a breath.”

Death during dinner.

Sucks.

So by the end of last week I had my twentyfive intubations under my belt. On Friday morning I went into Theatres with two bags straining at the seams with cream cakes. They seemed to be well received, I’m a creepy little creep, but the staff at hospital have been amazing in getting me the procedures that I needed. I even managed to tube a “Grade 3″ patient (only epiglottis visible, bloody difficult) just for shits and giggles.

I’ve spent today and yesterday in A&E, floating about, taking obs, chatting to people and while it’s all great, I’m starting to yearn to get back into an ambulance. I’m pretty confident in my newly developed intubation/cannulation skills. Take one small tube, put it in a slightly bigger tube, try not to smash it through the bigger tube’s walls. Easy.

But now I want to put these skills into practice in *my* environment. It’s all very well taking obs for people and helping out in the Emergency Department while nothing’s going on, but I feel a fanny scrabbling with monitors that I don’t understand, staring bemusedly at blood filters and vacuum cylinders (neither of which we use on the road, but bizarrely both of which I have to prove my competence with).

I want to get back where I understand the rules, where I’m in charge of the patient, where I really, really have to be paying attention because it really, really counts. Placement’s brilliant, but I need the holes in the safety net to get a bit bigger now, thanks.

(further - I have to pass 6 LMAs, 25 ET tubes, 25 IV cannulae, draw up 10 infusions and be seen to be competent in a host of other skills. I think there should be an extra sheet on the paperwork called “Finding a parking space in Bridge Hospital at any time other than dawn and midnight.”
Because that’s FAR fucking harder than any of this medical business.)