Sept 21: My record holds

Thanks to all for their comments. My happiness and excitement was not for the validation as praise, but in taking what I learned during my difficult experiences and turning it into something positive for someone else. Also that you never know when a few words from you will make an indelible impact on someone else's life. As Carol says, you never know if just smiling at someone will be the highlight of their day.

And having an ER doc who will give a permission to go or stay: way cool. It is so wonderful the health care profession is opening up more in the recognition that not everything occurs to a patient can be monitored on a screen.

I'm watching something on the DVR from several months ago: Michael Fox's documentary on optimism. He has some wonderful viewpoints, is very funny, has a lot of great things to say in a very down-to-earth manner. It occurs to me, however, that it's a lot easier to stay consistently positive when you don't have to worry about finances, which he doesn't.

The last week has been filled with life's typical dramas. My ex-tenant has been officially evicted, is still a resident of the county jail. His arraignment has been delayed for another two plus weeks, which really drags the agony out for GF. I'm afraid that since it was a non-violent crime he won't serve much time. In any case, she has made great strides in cleaning out the apartment, although some large things remain. The excellent news from my standpoint is that things are moving along very well with the gal who wanted to move in before, now coping with the inevitable county red tape since that is where her housing allowance comes from. Best case scenario would be her moving in October 15, but November 1 is still going to be great.

My back door is still nailed shut, but a replacement is now in my garage having been found at a salvage place. It's going to need a lot of refinishing, but hoping to get it up this weekend.

Still finding myself a little jumpy about security, not lessened by finding a few women on my yard yesterday morning looking down at a purse with it's contents spilled all over. Turns out there has been a rash of car burglaries recently and last night was my street's turn. Probably teens, they just go up a street finding who has left their car doors open and then take money, electronics, etc. When the police arrived they said it was the third call from my street. I'm glad to have a garage.

No lead in my pipes! No lead in my blood!

Still awaiting the window guy to come back so these things can be replaced before it gets colder.

Major drama in the office on Thursday. A 78 yr old man, not in great health, was sent over from a routine office visit to have a routine echo. During the echo he went into arrest. I was just finishing a rare, late afternoon cup of coffee when the wife burst out of the room yelling "Help! Help! Something's wrong with my husband!" The echo tech, always unflappable but now clearly stunned, looked up at me and said "He's not breathing...." He didn't have a pulse, either, she had been thrown briefly by the ECG continuing to show his pacemaker making his heart beat--it just wasn't perfusing. (We suspect a saddle pulmonary embolus, despite his being theraputically anticoagulated, as he arrested from one after hip surgery just last December.)

So, the usual: docs came, I intubated and defibrillated. For those of you in EMS this isn't a big deal, but in an office setting it just doesn't happen. I've been accused of being to blame, since this is now the third code in the office, and even more responsible after my post saying that the office was 'boring'. The ALS unit was wonderful--unfortunately that has not been the norm from that station--but these guys were fabulous. As I had positioned myself at the head and the code continued, I heard myself volunteer to start an EJ (IV in the neck). In my head a voice was screaming 'You haven't done that in at least 10 years--shut up!' While slightly messy and only using a 16g it was successful. Much to our collective surprise the patient has survived, although he has multiple major issues. He's still on a ventilator, needs drugs to keep his blood pressure up, heart function looks bad, coagulopathy, fever.... My initial reaction was that it would give his family a chance to say goodbye, maybe what he needs now is the permission to let go.

My bosses have stood by me through a lot, it feels good to justify their keeping me around. But my overwhelming emotion has been that of gratitude. We've all heard older people talk about when they were young, what they accomplished. It's their way of telling us that they weren't always helpless, dependent on other people for even basic daily needs. When I was faced with my physical deterioration at an earlier age than most I found that it was also my way of reminding myself of life before my helplessness and dependency. This has been part of the struggle: adjusting to a body that controls what I can and can't do, giving up things I had so enjoyed, learning to change expectations for the rest of my life. As I've mentioned many times, what hurt the most was having to stop running as a paramedic. It was always something that felt like my true calling, where I felt the most comfortable. But in those 15-20 minutes of running the code, especially an initially successful one, it gave me a chance to rewind time, to travel back to my 'glory days'. How many people get a chance to do that? The last six and a half years were--temporarily--erased. It was the most fabulous high; I was giddy for hours. And very, very grateful for the flashback experience.

Regarding the post title: Patients come in all the time worried about dying during their stress test. Someone has told them that their neighbor's dogwalker's hairdresser's cousin's brother died during their test. Despite the statistics of stress tests safety (1 in 5,000 MI, 1 in 10,000 death) they remain unconvinced that we aren't going to cause their demise. So my reassurance has been to tell them that in the 18,000+ stress tests I've performed (seriously--it's been 15 years) that all my patients have left with a pulse. Not mentioned is that some leave on stretchers and a couple have left not breathing. While this patient was not a stress test patient, my record holds for all patients leaving my office with a pulse and blood pressure. The explanation for which is the immediate treatment given, as opposed to an arrest at home, and not addressing at all any Diety or master plan.

Thanks for checking in, Laurie