Triage comments

Oddest comment from the triage nurse today:

"I've got 5 patients in 4 beds!"


Guess it's better than 4 patients in 5 beds... >.<

Messy

The medical orderly and I open the back doors.

Blood covered the walls, the stretcher, over the patient and over the guys inside.

We flipped out the handles and unlocked the stretcher from the floor.

"All good?" I queried.

Steve nodded, as he continued pumping on the chest.

With every compression, blood seeped from beneath a universal dressing, flowing in an intermittent stream onto the ground below.

With speed but with care, we unloaded the stretcher, ensuring the wheels were locked, and wheeled into the open doors of A&E.

Red blood trailed on the ground, intermixed with bloodied footprints.

The trauma room was well prepared; all manner of doctors, nurses, orderlies and xray techs were around, all gowned up in yellow splash aprons, goggles and red stickers proclaiming their role.

It was relatively silent.

The beds were lined up, stretcher sides down and in a few seconds, the patient was slid across from the ambulance stretcher and onto the trauma bed.

Like clockwork, a medical orderly on a stool took over compressions from Steve.

"Stop compressions" the team leader shouted authoritatively.

Eyes focused on the ECG as it displayed asystole.

Simultaneously, a trauma surgeon removed the universal dressing from the chest, revealing a 10cm open laceration slightly left of the sternum extending to the nipple. It looked rather deep, past the intercostals.

"Continue CPR" the team leader shouted authoritatively.

The room then became quite loud filled with a furry of activity.

About 30 minutes later as we were hosing out the bloodied stretcher and ambulance interior, one of the nurses came up and had a quick chat. They had, expectedly, called the patient. She also mentioned that the chest lac was indeed deep - there was a 4cm lac to the ventricle. That explained the massive amount of blood inside the ambulance!

Messy.

Worse than death

She sits in the car, sheet wrapped around her.

An attempt to be human again.

With empathy and compassion, two female police officers and my female partner talks to her quietly in the back of the ambulance.

Doors shut, interior lights dimmed.

Thank God we have frosted windows!

A couple of minutes later, one female police officer comes out, holding brown paper bags.

We drive around to her house, not far, to fetch some new, clean clothes.

The police left us to transport her to hospital, but left advising her not to have a shower or wash her hands.

She nodded, knowingly.

Tears wept from behind two swollen blacked eyes.

Abrasions on her face.

She looks away as the door closes behind the police officer.

Rewind

SOB.

PR 92.

RR 32 and retractive.

BP 170/120.

GCS 15.

Poor historian.

Neglected to put on a cardiac monitor.

Neglected to put on an SpO2.

Was only just round the corner from the hospital.

Didn't cannulate.

No temperature was done.

No BGL done.

Wheelchair bound.

Polio affected; no use of legs.

140kg +.

Transported by non urgent transport with the capacity to carry / secure a wheelchair, but paramedic went with the patient.

Triaged by nurse, sent to cubicle.

Completing paperwork.

Triage nurse rushes in, ashen faced.

Patient arrest. Now in the resuscitation bay.

Wish I could rewind time and redid my treatment.

Sh#t.

Song

Another song stuck as an earworm.

Water

Water is a source of life.

Water is a cause of death.

2 year old children have a fear of water.

2 year old children have an innate curiosity about their world.

Fences should go up around pools, and ponds.

Fences helps keep little curious 2 year olds out.

Distraught parents screaming is the worst sound in the world.

Paranoia

Seated securely in the stretcher. 

Shoulder harness on.

Chest strap on.

Waist strap on.

Leg strap on.

Police Officer seated next to patient's feet.

Paramedic next to the head.

25 minute drive.

Bumpy road.

Ambulance bounces on the road slightly, amplified through the stretcher.

"What the?? Is someone punching the ambulance??? MAKE THEM STOP!!"

Paranoia.

Filter vs fingers

He was not a happy camper, standing in the water on a tiny ledge on the edge of the pool, hand caught in the water filter.

The power had been turned off and the motor stopped, however, his fingers were wedged firmly in the plastic grate.

The firies had their rescue tool kit out next to the pool, including a very long and sharp looking Channellock cutter and a hooligan bar.

Every time they tried cutting the plastic grate, the young kid would scream as the plastic twisted over his fingers and knuckles.

My partner didn't want to give the kid any pain relief, in case he passed out and sunk back into the water.

After a few cuts, the firies managed to cut the grate out, freeing his hand from the pool filter.

While not neurologically or vascularly compromised, a speedy trip into hospital with a whee bit of age appropriate pain relief was given by my partner en route.

At least, when this was all done and dusted, he would have a few good stories to share with his elementary school class!

Cone of silence

I'm currently on night shift, which lasts for 14 hours.

So far, it's been quite constant, with patient after patient.

However, as the attending officer today, I have not had one patient talk to me.

• Patient 1 was very intoxicated and slept en-route.
• Patient 2 overdosed on Valium and slept en-route.
• Patient 3 did not speak English, we had no interpreter and therefore we communicated by body language.
• Patient 4 suffered from acute psychosis and refused to speak with me.
• Patient 5 was again very intoxicated and slept en-route.

It definitely makes it challenging gathering a history but makes management easier! I'm not quite sure what I've done wrong...

New Ear-worm

I've got a new ear-worm and unfortunately I just can't get it out of my head.

It's Katy Perry's The One That Got Away.

Bleh.

Spring Clean

My house is a mess.

Plus my housemate moved out last week.

So, therefore, I finally bit the bullet and decided to give the place a bit of a clean, throw away a lot of junk and give the place a good airing out.

I feel so domesticated!

A little giggle

Today was supposed to be the day.

After an entire day thinking that offers would be out yesterday, I was a nervous wreck. (Logically I thought yesterday was the day, since the evening before the matching system had been completed. Plus most of the medical schools except three had all given out their offers, or rejection letters).

Unfortunately, the schools I applied for were part of the three.

There were tweets on twitter stating that offers would be given out at the school I applied for by mid-morning.

8am had passed.

Followed by 9am, 9:30am, 10am, 10:01am, 10:23am, 11:00am.

My refresh F5 key really needed replacing.

11:05am.

Surely by 11:30am right?

That went past.

I went out shopping to relieve the stress.

12:04pm.

Still no offers.

Bleh.

So I went and made lunch, watched a bit of Deadliest Catch on Discovery channel, just to keep my mind off it.

But it was hard to resist.

1:04pm.

Still nothing.

I still couldn't believe it. So I pressed F5 again.

1:05pm.

The screen was different.

Instead of the usual site saying the portal will open last week, it was replaced with a login portal.

I curiously entered my details.

The new screen refreshed.

"Dear Andy,


Thank you for using the on-line admissions portal to check on your status for entry to medicine.


We are pleased to let you know that your application for admission to the course has been successful.


Full details about your offer, including the type of place and any conditions, will be sent by post to your nominated address.


Congratulations on your selection and welcome to ABC University Medical School."


I let out a little giggle, followed by a long stressed laugh.

This was what I had worked for so many years for, what I had given up my polar program offer for.

I'm going to be a medical student!!!!

Some offers... but not ours

The magical system allocating medical schools have finished and some schools have given out offers.

But not the one that I applied to.

That F5 key is still getting a bit of a trashing.

Still waiting

Medical school offers were supposed to come out today.

Still no word.

My F5 refresh key is getting a bit of a work out though!

The Website of Anxiety

Medical school offers comes out the week commencing Wednesday 9 November 2011.

These offers are announced on what has been dearly (but appropriately) named Website of Anxiety.

Since it states it's the week commencing Wednesday (weirdly termed...), I've been checking that website about 200 times a day for the past few days.

GAAAAAAHHHHH!!!

Fast food

The clock read 4:38am.

Wiping off the last remnants of sleep, I called mobile on the radio, my voice betraying my fatigue.

The dispatcher sounded just as tired.

... 30ish year old female.... at the payphone... bitten by another person on the shoulder.... because they thought she was a piece of meat...

My partner and I looked at each other.

Right.

Off we drove towards the said phonebox.

********

The ambulance scan lights and headlights lit the phonebox and the park, bathing the area in a sea of white light.

No one could be seen.

Not even a drive through of the park and surrounding streets could we find a living soul.

"Perhaps we were too late? Perhaps she was eaten?" I dribbled to dispatch.

"Must have been fast food, or a midnight snack" they retorted.

My partner and I giggled as we drove back towards our station.

Innocence lost

The first thing I noticed was the children. They looked like only 5 and 3 years old, peering outside through the lounge room window.

I continued walking towards the front door of the house, guided by the man.

"Can you just narc (narcan) her?" he kept saying.

I didn't answer.

We walked into the rather messy lounge, saw the kids standing on the couch, and into the hallway.

He pointed at the bathroom, too small for both of us to fit.

I stepped in.

On the ground laid a woman in her 30s, feet against the door, head under the sink.

I called out, then squeezed her shoulder followed by a sternum rub. No response.

I checked the carotid.

That can't be right, I thought.

I checked again.

Not really realising it, I pulled the towel covering her chest and started compressions.

My partner looked in, said something unintelligibility and ran out to the ambulance, shouting to the man to get the children inside the bedroom.

The man looked in and all I remember was a distressed, piercing "no... no... no...".

The next 15 minutes flew by as pads were placed on, an LMA inserted, an autopulse applied and extra hands appeared.

I remember distinctly a police officer popping his head in and asking if he could do anything, however, there wasn't much to do. We couldn't get IV access and the autopulse took care of the hard work.

I felt a little helpless after a while as basically everything was done.

However, it was all futile. She was long gone.

Our Team Leader ran through the physical observations again and all were in agreement. We terminated the resuscitation.

We packed up, signed the police attendance sheet and reloaded the car.

Looking back, for some reason, I saw the children again, peering outside through the bedroom window.

Their world will forever be changed, etched with the memory of strangers dressed in green and blue standing in their house, on their lawn with a sheet over their mother whom will never wake up.

Courage on the internet

Been watching a couple of videos on Youtube about a US military person whom comes out to himself, friends and family over a couple of months.

Very courageous fellow and the emotions are visibly raw.

Have a watch, regardless of what your sexual orientations are - it's definitely thought-provoking.

http://www.youtube.com/user/AreYouSuprised

Options

I've been toying around with my medical school interview offer and my polar adventure.

It's caused me a lot of grief actually.

i) I really want to be a doctor. I've tried hard to gain good marks at university, I've sat the medical school entrance exams umpteenth times and this will be my best chance of getting into medical school.

however,

ii) It was a dream to go work in a polar research station for a season. I've already turned an offer down last year and they've reoffered this year which I've accepted. It was a dream come true, I've always found the polar regions fascinating. But, this was just a six month jolly, not a real job. Whereas medical school would offer me security, a career, fulfill a lifelong dream.

Options.

Ninja Firefighters

Pretty cool firefighters... I'm pretty sure our local firies can't do this!

http://www.noob.us/entertainment/firefighters-are-pretty-badass/

An unexpected offer

An email alert flicked up on my screen, jumping around like a little silky terrier, begging for my attention.

I clicked on the epileptic letter icon, knowing full well it would claim down.

It was an email from my local medical school.

"Dear Andy,


Thank you for your application to study medicine at local-medical-school. We are pleased to advise that you have been selected for an interview on 5 October 2011 at 1400...."


I didn't read anymore of the letter. Instead, I was now jumping around like the previous little silky terrier, not to crave attention but in joy.

Precordial (and Precranial) thump

A humorous look at recent guideline changes for the precordial thump and a proposed new "precranial" thump by Flobachrepublic.

Might have to try the new precranial thump on my next night shift! :)

Could you come check her out, please?

It was a lovely night, getting paid double time with another experienced paramedic to provide medical coverage to a community concert. There were some great bands playing, set in a nice park, lots of police and security, and best of all, it was a dry event (aka, no drunks. Well at least that was the intent).

I was really looking forward to this event and the live music.

An hour in, a well-dressed middle aged lady comes down to the ambulance.

"Sorry to bother you, but my friend is a dialysis patient and a diabetic. I think her sugar might be low, she's fainted a little bit. Could you come check her out, please?"

Not a problem. It was our job. Sounded like a hypo (hypoglycaemic - low blood sugar level).

Just in case, we took a few things - our ALS backpack with drugs, oxygen and a response kit.

She guided us through the rather thick crowd and into the park. It was getting rather dark, it we were quite glad she was guiding us as we would have never found her.

Sitting on a rug amongst the crowd was a middle aged woman, being supported up by some friends, head flopped back against her friend's shoulder. She was clearly out of it.

As I set up to take a blood sugar, I noticed her skin was extremely diaphoretic. Very diaphoretic. It wasn't a hot night.


Plus she was very tachypnoeic.

A few second later, 22.8mmol/L read the glucometer.

Obviously not a hypo.

I looked at my partner, whom reflected a near identical quizzical look back at me.

"I'll get the stair chair..."
"I'll get some oxygen and a line in..."

Sounded like a plan.

I weaved my way back towards the ambulance. It was near impossible to get to get a stretcher in, especially though the thick crowd and the mass of people picnicking on the grass. Thankfully, we have a nifty little fold up wheel "stair" chair which was quite good to get around in.

Passing a security officer, I informed her we needed some assistance and pointed to where my partner was.

Quick as a flash (well not quite, maybe like 3 minutes later), I was back. Walter had a high concentration mask on already and a tourniquet on one of her arms already, obviously preparing to cannulate. By now, we had accumulated a few bystanders whom was willing to help, though no security turned up (or ever turned up for that matter for the entire case).

While she wasn't exactly big, her current state meant that she was very "floppy" and resulted in a dead weight. Grabbing a foot each and a giant bearhug, a few bystanders and ourselves managed to get her onto the stairchair. Securely strapped in, we enlisted some bystanders to be bag holders and again, weaved our way through the crowd and into the ambulance.

Walter climbed in while I put away some of the assembled bags before climbing in to assist.

Oxygen changed to the ambulance supply, cardiac monitor dots attached, probe on finger, NIBP cuff on, cannula out and a vein located. Ordered chaos ensured for the first minute or two.

Walter looked into her pupils as we completed a set of observations.

"Andy.... could you check the pupils for me please?" he asked, even though he had just checked them.

I got my penlight torch out and looked.

They weren't overly large, but there weren't any reaction to the light.

* Raised eyebrows *

First complete physical observations: PR 112, RR 32, BP 185/110, GCS 7, ECG Sinus Tachycardia, SpO2 100% (on 15lpm via high concentration mask), BSL 22.8, Temp 36.7C (Tympanic), Pupils were a size 4 and unreactive.

There wasn't much we could do in this environment. She needed to go to the hospital, and quickly. However, as we were providing a community event coverage, we couldn't leave, so we had to call another ambulance crew in to transport. Ironic huh?

I got on the radio as Walter attempted to put an oropharyngeal airway in, albeit unsuccessful. She had some trismus.

"We don't have anybody at the moment, but we'll get one there as soon as we can" came back the reply from Communications.

Meh.

By now, she was grunting a little bit but still no improvement in her vital signs.

Walter provided some supportive suctioning using a yankeur suction catheter while I tried to get further information from the original friend whom had got us.

Apparently, she was just sitting, watching the concert and suddenly collapsed. She had been well before, did not complain of anything, had no alcohol nor drugs today.

A secondary survey didn't reveal any other injuries or anything of significance.

Some sort of cerebral event, a CVA, we concluded.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Our backup ambulance crew arrived 20 minutes later, and rushed her Priority 1 to hospital.

TST

The nurse looked at the small pinkish area on my forearm.

It wasn't raised but was, naturally, noticeable.

"It's fine", she said.

And like that, it was over.

Yay!

That was the Tuberculin Skin Test (TST), which I had done three days prior. A TST, otherwise known as a Mantoux, is used as an initial indicator of tuberculosis (TB) through the detection of Mycobacterium tuberculosis. It involves a 0.1ml intradermal injection of tuberculin on the anterior forearm, with the resulting induration (raised, hard area) measured (but not including the erythema (red swelling bit)). While the size of the induration varies depending on local health policies, a size greater than 5 or 10 mm is the normal accepted result (again depending on risk factors and the demographic).

A good fact sheet can be found on the Centres for Disease Control and Prevention (US) site.

First aid course

It may seem weird, but even though I'm working as a full time paramedic, I still need a current first aid certificate.

Which is fine and I kept an open mind, especially since I'm not paying!

So off I went to the local first aid training company which, ironically, is the same company I work for.

It was a good course and I enjoyed the day. There was the usual guy whom had done and seen everything the first aid trainer talked about (poor trainer!), but I learnt a few things that had changed since the last time I did a first aid course (such as DRSABCD with the inclusion of S = Send for Help; and a constructive bandage now being referred to as a tourniquet).

Overall a good day and best part was, I passed! :)

Fistula

The indigenous population in my current area has almost endemic renal disease and many patients that we transport to hospital are on renal dialysis.

Their quality of life decreases significantly as their disability-adjusted life year increases. Many relatively young people have end-stage renal failure, not something that the community should be proud of.

We transport a young 40 year old patient with end stage renal failure due to shortness of breath and fluid overload, a fairly typical callout. A dose of oxygen via a medium concentration mask did the trick as we transported him up to hospital.

He was a really nice chap and as we talked about his past, he showed his old fistula which had failed. It was probably the worst one I've ever seen and he was nice enough to agree for me to take a photo of it for educational purposes. As he rationalised, while he wasn't proud of it, he was happy to share it to educate other people.

So, please find this attached. I have received patient permission to use it, however, if you are offended or wish me to remove it, please contact me.

Blood tests and immunisations

A recent audit of my yellow card found that I had a few immunisations missing.

After a painful (aka near fainting experience from yours truly) exercise of blood collection revealed deficiencies in:
* Varicella zoster
* Measles

As well as the usual ones which I was missing anyway:
* Polio
* Cholera
* Fluvax 2011


A few painful needles and one very disgusting drink later (Cholera), I am almost up to date again (with the exception of Measles and Varicella which required another IM injection in a months' time, and Cholera with another oh-so-fantastic drink!).

Pack arrives

A big fat white envelope sits patiently in the letter box.

It's exciting. It's what I've been waiting for.

Plastered on top were numerous official looking stamps.

It's what I've been waiting for.

I could hardly contain myself for the oh-so-short walk inside to the kitchen.

I rip it open, rather unceremoniously.

Out drops a huge pile of forms and a six page letter.

It goes something like this...

"Dear Mr Andy,

Congratulations! We are pleased to advise you have been successful in your application for the XYZ Polar Program 2012.

Blah blah blah..."


I wasn't absorbing much of the latter.

I'm over the moon!!!!

Job Offer!!!

A job a dream job offer!!

More to follow, out.

Med school exam

Everyone in the room looked so young!

Or perhaps I was the old one.

I am. I was probably the oldest one in the room.

Now that makes me feel old.

Some of them were stressing. Quite a bit.

"OMG! I'm like TOTALLY freaking out."
"Sh1t! I forgot my school ID!!!!!" (Runs out of the examination hall)
"Breathe.... breathe... breathe..."

I couldn't say I was stressing. Perhaps old age had dulled it down for me. Or that this was like my 7th time sitting this exam.

Yeah, I know I'm dumb.

But I liken getting into medical school like a lottery. Only that the lottery has better chances.

I'm quitely optimistic... but not getting my hopes up.

Be careful of what you wish for

I've had a student with me this roster. She's good to work with, very relaxed and we've had some good medical work.

Like many ambulance personnel, she's quite fond of trauma and wanted to experience working with patients with trauma.

"Be careful of what you wish for..." I warned on numerous occasions.

I personally don't mind trauma, but don't particularly relish it either.

Still, our shifts were rather uneventful.

Our last night shift was rather busy and we've had very limited sleep. 30 minutes prior to handover to the receiving crew, the pager buzzed.

"Priority 1, Some-road-very-far-away".

Bleh.

The radio dispatch came through.

"If you can now proceed to Some-road-very-far-away for a truck versus tree. Patient has been ejected, query unconscious, query not breathing, disembowelment. You'll be on case number 1192 at 0732 and your priority is 1."

She became rather excited.

~~ 35 minutes later ~~

We could see quite a fair way off into the distance, given the flat terrain and relatively clear vegetation. We could, therefore, see the accident scene about a kilometre beforehand and we could see a number of cars parked off the side of the road and a police car with beacons flashing warning traffic.

We pulled up past the police car and prepared to get out with the trauma kit and oxygen.

The police officer turned and shook his head at us.

Obviously there was no point.

Still, we had to look to confirm death (or otherwise).

About 100m from the road, amongst some trees, rested a very damaged flatbed truck. The front cabin had suffered significant damage and the entire right door and seat had been ripped away. It was obvious that the truck had ploughed diagonally from the opposite side of the road; vegetation damage include three splintered trees and crushed undergrowth marked the route.

As we walked closer to the truck, we could see a blanket on the ground, about three metres behind the rear. Lifting up the blanket revealed a young man, obviously deceased, with a traumatic amputation to his right thigh ripping up through the groin and leaving a small broken edge of femur. He appeared to have exsanguinated from the massive blood loss from his femoral artery and this was supported by the large volume of blood (and attracting a huge number of ants) on the ground.

I turned to my student - we still had to go through the rigmarole to confirm death. This was her first death so I guided her through the process... check for carotid pulse, auscultate for lung sounds, auscultate for apex heart beat, check pupils and obtain an ECG strip.

Covering the poor fellow up, the police and ourselves hunted for the amputated leg.

It wasn't overly difficult, thankfully, as we followed the truck's route back towards the road. Wedged amongst a group of shrubs and a now-destroyed tree was a very disfigured truck door, part of the seat and the fellow's leg / groin. As it was a crime and investigation scene, we weren't allowed to move it, but we did cover it up with a sheet for some dignity.

There wasn't much to say, but we were able to provide some support to the bystanders on scene whom, naturally, was quite traumatised.

Our long drive back to our depot was rather quiet and sombre. Not exactly a great way to finish off a roster.

Be careful of what you wish for and please drive safely!!!

Le Fort fracture

A police officer held her head in alignment against the back of the seat; an improvised airway temporarily inserted using a plastic breathalyser stick. Blood covered her ungloved hands, staining them bright red.

"Spine board?" I queried.

A nod of agreement by Amy.

No time for proper spinal precautions, no time for a KED. 30 seconds later and we were out of the driver's seat and into the back of the ambulance.

She didn't look good.

Small arterial bleed above the eye and some visible brain matter, gurgled respirations exiting with bubbling around the mouth, significant flow of blood from the mouth, massive head and facial trauma, deformed thigh. GCS 6, HR 132, RR 28, SpO2 79% RA, BP 70/40.

Backup in the form of a Critical Care Paramedic and Operational Manager arrived fairly soon after, despite the peak hour traffic.

A laryngoscope was inserted but with significant facial fractures and an ongoing stream of blood in the oral cavity even with suctioning, it was near impossible to lift the palate let alone visualise the trachea.

"Let's go!" we all concluded.

It was pretty useless inserting an LMA as that would just pool the blood and offered limited protection into the trachea so instead a size 3 OPA was inserted with supportive ventilation and suctioning. 16g cannula and 1.5L of fluids helped to increase the BP to 100 systolic, but it was a fine line between increasing blood pressure and increasing the facial / cranial bleeding which we couldn't control.

The 20 minutes to hospital seemed like an eternity.

************************

Further investigations at the hospital found she had a Le Fort III fracture, which probably explained the difficulties we had with field intubation, a depressed fracture of the skull and significant head injuries. She passed away in ICU 3 days later.

I'm okay, seriously.

1.3 read the machine.

That's in mmol/L. Or 23.4mg/dL, whichever way you like it.

"I don't believe you." he stated, matter of factly. "I'm okay, seriously."

He continued.

"Plus, I don't believe your machine. Do it with mine."

My partner and I shrugged. This patient was going to be stubborn, but hey, it didn't bother us - I'll happily use his glucometer. Thankfully, he wasn't getting violent and still was relatively logical given his hypoglycaemia.

His glucometer was much faster thank our dodgy one. 1.5 it read.

Still way too low. And he wasn't okay. Thankfully though, he was convinced enough to drink his glass of coca cola.

Nevertheless, he still continued to argue.

"There's no need for you to be here. This coca cola will last me for a good 30 minutes. Plus the fructose will take hours to digest."

True, but that still doesn't make our treatment any less.

AmboPartner explained. No, we can't leave and no, we won't leave until your BSL is normal and remains so.

This time, it seemed to have got to him and he finished off another glass of coca cola.

5 minutes later, we try again.

2.8.

"See, it's great! And it's working. You can go now..." he exclaimed.

Not quite. It's still too low. We make a sandwich, it's the long term carbohydrates that will increase his sugar level and make it stay that way.

Plus another coca cola.

"You know there's like 50% sugar in this", pointing at the can of coca cola.

"Err... yes. That's the point" half serious, half laughed. He was a smart old geezer.

20 minutes, 2 sandwiches and 2 cans of coca cola later, his BSL read 7.0.

Another feel good success story.

Stop pushing

Bent over, legs outstretched and off to the side open for the world to see, she let out an enormous long winded abdominal grunt.

Everyone in the room shot off strange looks.

"Come on, let's get you out to the ambulance. You can't have your baby here..." trailed off AmboPartner. He was doing great, using a softly softly approach though it didn't quite seem to be working.

"IT'S COMING! MY BABY IS COMING!!!" she screamed, at the top of her voice.

"What'd she taken?" I asked the nearest police officer.

She shrugged.

"Stop pushing. You're going to hurt yourself." AmboPartner attempted again, in a more assertive voice.

She was in her own little world, so the five of us half supported and half dragged her onto the nearby stretcher.

Seatbelts appeared at lightning speed and a minute later, we were out of the police cells and into our awaiting ambulance.

A young constable rode with AmboPartner in the back as we drove quick smart to the hospital.

-----------------------------------------------------------------------------------------------

"Has she taken anything?" asked the nurse.

"Quite a bit of alcohol and some sort of drugs... we think."


10mg of Midazolam later, she was still sitting up, abusing the attending doctor and nursing staff.

Final diagnosis: Drug induced acute psychosis. And she wasn't pregnant.

Back home

I've enjoyed the last 13 months as an aid worker.

It's been fun - though not without its challenges, blood, sweat and tears.

However, it's time to finally call it a day and to head home.

I leave more humbled and with an open mind. I know I am a lucky young man to have been given the privilege to serve and work in a very disadvantaged country. I am grateful for the luxuries I have back home - clean water, 24 hour electricity, an education, road rules, actually having roads.

So Long and Thanks for All the Fish.

Handovers and Farewells

It's amazing how much stuff one accumulates even within one year.

I came to this country with just one rather large and very overpacked suitcase.

Thus far, I've got about 10 very large and very overpacked boxes.

Not good.

Over the past few days, and a few more to come, I've been slowly handing over equipment, computers, providing training notes and saying farewells to friends and associates.

Feeling a little melancholy at the moment...

Resignation

It's time.

I've enjoyed the past 13 months living here in one of the newest developing countries on earth.

However, it's time to move on professionally.

Plus it's good to be closer to my family during a trying phase in all our lives.

Today, I submitted my letter of resignation, effective 1 July 2011.

Getting back into it

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My sick leave ends tomorrow, I've been kind of itching to head back into work. I miss the camaraderie of the team, though I definitely don't miss some other elements of work. Naturally, it's hard to like everything, but all in all, I do miss it.

Probably because it was rather busy, just resting at home.

I should have done some of my assignments, but naturally, I procrastinated with Facebook, general mucking about on the net and Monopoly.

So today, I decided to be a bit more productive and start on my assignment.

In 2000 words, provide the evidence base for use of emergency breathing systems in rotary winged aircraft.

Yawn..... falls...... slowly........ back to........ sleep.

Barotrauma to the middle ear

Initially it's just discomfort, a sort of pressure. Before too long, it turns into a sharp pain, right behind the ears and radiating up to the temples.

I tried all the techniques I know - swallowing, performing the valsalva manoeuvre, using nasal decongestants and using lollies. Didn't work. Instead the pain just kept getting worse and worse.

I kept looking at the altimeter. 11100.

Too long. Too painful.

Involuntary movements occur due to the pain. Watery eyes, grabbing of hair. My hair that is.

My patient gave me an odd look. I know my face must have portrayed my agony.

I was rather glad I didn't shout out or scream.

7500.

Deep breaths.

3000.

I've now resigned myself to the fact that I there's nothing I can do, the pain is just intense and I'm cursing myself for flying today. I close my eyes and tried to imagine a better place. Instead, all I could focus on was the pain, the brain splitting sharp pain.

Touch down. Finally. It took so long.

On the tarmac, I promised myself never to fly whenever I feel congested again.

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The doc had a look through the otoscope.

"Barotrauma to the middle ear", he diagnosed a matter of factly.

"5 days off duty. We'll review after 3 days."

He writes out a script for various medications.

Co-amoxiclav 625mg TID x 10d
Diclofenac 50mg OD x 7d
Chloramphenicol ear drops 2 drops x 6 hrly x 10d
Cetrizine 10mg OD x 7d
Paracetamol 500mg PRN

That's a few.

I walk towards the door.

"Oh and Andy" he yells. "No flying for the next 2 weeks."

I'm grounded. A grounded paramedic.