We made it back to Paso, our new home. The trip to Quincy was very nice. Got to hang with the parents, see my dad's new shop (which he did a really nice job on), eat some fantastic meals, and do a little snow shoeing. Would love to write more, but after a long day of traveling, and the endless unpacking (which will most likely continue for some time to come), it is late, and Michelle is ready for bed. Reflections on Quincy for another time.

We made the move to Paso Robles. It was undoubtedly the worst move I've ever taken part in. The excitement of moving into a new place, the first house I've owned, was buried under hours of stress and fatigue from the move. I still am struggling to unearth the excitement of having my own place, three full days after the move.

I sit now at my parents computer in Quincy, CA. Michelle and I made the drive yesterday to get away for the weekend and to play in the snow. The drive was somewhat interesting. We were to meet up with Dan for lunch, but sometime around 10am little Danny fell and put a two-stitch hole in his lip. So that plan was canceled for the time being. Then it was snow 40 miles west of Quincy. There was a moment of serene beauty, shortly followed by a slight skid towards the edge of the road and an eternity of panic (0r so it felt) that Michelle could never shake the rest of the drive. Getting into my parents, we relaxed, I had a Arrogant Bastard Ale with my dad, ate some French onion soup and cheese fondue, watched the snow fall in the driveway, and walked the dogs in the calm of the snowy night, making crunching footsteps around the block. I didn't wake once during the night.

A document came out recently concerning the idea of Kern County Fire Department staffing paramedic engines. I thought about including it here, but it is far too long.

I've only skimmed protions. It is long even for me! But a couple of thoughts on the subject.

It states as an advantage that having two ALS providers at the scene of a major casualty incident improves patient care. This is very true. But what the document leaves out, and what many people seem to miss is that having two ALS providers on any critical incident would vastly improve patient care. Indeed, when there are several patients, the more medics on scene the better. But even with one serious patient, there is more than enough interventions to perform to keep two paramedics busy. This seems to be a bit idealistic though, due to funding constraints. Perhaps that is why the thought of dual medics is rarely entertained by the various boards and committees deciding patient care.

Having said this, a disadvantage brought up by the document is that with a fire based medic program, there will be instances when two medics will be on scene. (It is amazing to me that this is even considered a disadvantage.) The potential problem they see with this is a disagreement on patient care. First I would like to point out that this is a potential problem. I have an issue with making decisions about something based on what might happen. Second, every medic is held accountable to his or her actions no matter who they are employed by. Having spoken with a medic about this topic, she stated that if a fire medic did something she disagreed with, she would simply take him or her along in the ambulance to transfer care and explain their actions at the hospital. And finally, disagreements about patient care are not new. It happens in the hospital continually between doctors (who share the same medical authority) and people are expected to ultimately do what is right for the patient. At the very most, a disagreement about patient care is a short term issue. But it is a long term benefit, causing careful consideration of the best treatment of the patient and a determination to perform the proper treatments before the eyes of fellow medics.

Fianlly, another disadvantage brought up by the document is that a fire department based medic program would basically "steal" medics from the ambulance companies because of the more "competetive" salary and benefits of the fire department. This viewpoint brings up a disadvantage that is not connected to greater levels of prehospital patient care. First, this is a disadvantage of private ambulance companies, not a disadvantage of a fire based paramedic program. Private ambulance paramedics leave their career for a variety of other medical professions, including nursing, physician's assistant, and even medical school, with the fire department just one of these other professions that offer better salary and benefits. This happens regardless of a fire based medic program or not. Because as I stated before, this is a problem with the ambulance companies, not with any proposed paramedic program. And any connection it has to patient care is remote and fabricated.

My mind is full. A contributing factor would be my lack of sleep recently. Insomnia is new to me. I've always been the one that sleeps deep, hardly remembering a dream even, awaking early and refreshed. Lately this has not been the case. Perhaps it is just the dogs and nothing more. Michelle's love of animals carries over to a desire to have them sleep in the same room as us. But like any animal, they tend to be somewhat active at odd times of the night, a scratch here, a licking session there, and sometimes a snore or groan. Not to mention the dreams that always give rise to little whimpers and kicking motions. For whatever reason, these noises wake me, and once awake, I can no longer get back to sleep. Last week, it was 1:30 in the morning, last night it was 4 in the morning. My eyes ache. I can see why people complain about insomnia. I do plan on the simple solution of removing the noise to see if that helps.

Came across a letter from Pastor Terry dated sometime in 1997. Ten plus years ago. I don't remember the circumstance of receiving the letter. I must have been in contact with him in some form or another. It was on MVCC letterhead, just longer than what a normal postcard would contain. Upon rereading it, I thought about how influential he has been in my life. So much so that when I think about what a Christian is, how he should act, what he would say, I often think about Pastor Terry. Makes me think about how to influence people. Something he said in the letter that sticks out in my mind is an encouragement to put on the armor of Christ. Following that encouragement, he said to avoid fanciful or superstitious methods of resisting the enemy. Christ himself is sufficient. Good advice, and at a time when I would shortly thereafter be exposed to all sorts of fanciful methods of battling the devil. He closed with, "In the Lamb, Pastor Terry." There is a sting of nostalgia I feel in that. I've burned some bridges. Perhaps someday we can reconnect.

I saw a bumper sticker yesterday that said, "Beep If You Boop," with a picture of Betty Boop to one side. Just for the record, I don't know why people like Betty Boop, and personally I think it is a little freaky.

I delivered my first baby yesterday. It's part of my clinical training to be a paramedic. Yesterday was OB time, already completing assignments in the ER, NICU, ICU, Pediatrics, and the Psych ward. As I stood back in the room watching the doctor prepare for the delivery, he turned to me and stated, "I should let you do this." Immediately frightened and excited, I timidly replied, "Ah, yah, I can do that." Needless to say it was an amazing experience. But it brings me to something else I've realized in my time at the hospital.

Hospital staff can be rather awful. More often than not I was confronted with nurses that gave me nothing but poor attitude. This came as a surprise, since I was warned on several occasions prior to my hospital time that it would be the doctors to steer clear of. However, this was not the case. I was never snubbed by a doctor. But nurses would often make complaints about my poor performance, though I was learning almost every skill for the first time, and ignore me and my peers constantly. Many times, when asking a nurse a question, it was met with a one word response and a tone of annoyance. With doctors, once I learned that they were approachable, my questions many times led to lengthy discussions about the topic.

Not every nurse was this way. I can think of a few that were very helpful and approachable. But the vast majority of them were not. In a nutshell, I was made to feel like an in-law that this family of hospital staff begrudgingly had to put up with. In just one more example, when passing a few doctors in the halls from my time in the ER, with whom I had very little contact with compared to the nurses, they were friendly, recognized me, and talked with me and my peers. But when I saw a nurse from my ER time walk through the cafeteria the other day, it was with a look of contempt, void of any friendly gesture, just a cold brisk passing, despite my smile and initial attempts to say hello (which I quickly gave up on from the body language I was receiving).

Which brings me to this: There must be something about the profession of nursing that somehow contributes to this poor attitude and disrespect. Only a few were committed to excellent patient care and the wisdom to teach others their knowledge and skills. Something in their beliefs and personality was able to overcome what seemed to drain the life out of the profession. I suspect it is several factors. The 12 hour shifts, the endless disrespect from patients, time constraints, close working quarters, and finally what I can only describe as a feeling I got. It felt that the hospital staff was in constant conflict with one another to prove their medical knowledge. In a place where there are many highly trained medical professionals, there was one ego battle after another, each trying to assert themselves as the medical guru if you will. Very exhuating. And easy to become a player.