Tuesday, July 31, 2012

Olympics

I love the Olympics. I love everything about them. I could sit for two weeks and just watch nothing besides the most talented people in the world swimming, running, and tumbling.

Most of all, it is motivational. I love watching people achieving really great things after having dedicated their lives to an arbitrary fitness skill. With my limited experience swimming, I understand how much of an accomplishment it is to hold your breath and pump out that last 25 meters just under the world record. I love seeing the most talented gymnasts and swimmers in the world burst into tears because they've won, or lost, and I realize that they are just like any other teenager. It makes me feel like I could do something really good.

I will never be an Olympian. I like to think that if I had decided to pursue figure skating when I was 12 I might have had the chance, but I know, deep down, that it never would've happened. I will definitely never compete in swimming, cycling, running, or triathlon. But, I think I could be that good at something. There is something out there, I don't know what, that I can master. I can be a world champion in something, even if I don't get the chance to showcase it in front of a billion people. It might be teaching; I don't know. I'll keep working at it. I know it's definitely not a lot of things, but teaching is still a possibility.

In other news, I have beaten some personal goals in athletics. I ran my best 5K of the year in 32:06.  I'm still looking to break 30 minutes, like I did once in April 2011 (I still think it was a fluke, or a short course). I've run over 12 miles per week for the last 3 consecutive weeks. I slogged through a seven mile run on Sunday, even though I didn't feel like it. I was sore and had stomach cramps, but I totally aced the mental game. I split up the run into bits, focusing only on jogging two more minutes, and then two more minutes, and then two more minutes, for a total of 90 minutes. I was proud.

Last week, I accidentally did two long bike rides. My first ride was on Monday, but thinking it had been on Sunday (and therefore counting for the previous week), I did another one on Friday. I could have looked at my log, but forgot. Instead, I ended with my best week this year (possibly ever), with total mileage approaching half ironman (HIM) mileage. My first goals are always achieving triathlon distance spread out over a week, before I can aspire to completing the distances all within a day. A HIM is 1.2 mile swim, 56 mile bike, and 13.1 mile run. Last week, I completed 1.1 miles of swimming, 52.1 miles of swimming, and 12.1 miles of running in about 8 hours of training. Definitely my best training week ever.

As the training gets harder, I'm getting a couple of aches, but nothing overwhelming. My knees, especially the right one, get a little sore as my long runs and bikes get longer. I've reached the point where my long run is making up more than half my weekly mileage, which is actually a terrible idea. It means that I'm not building up strength by longer runs. After doing or not doing the Olympic tri on August 12th, I'll step back and build up smarter, but putting more mileage into shorter runs and building up weekly mileage rather than only  weekend long runs. I've also developed shin splints in my right leg, but the pain goes away pretty quickly, as the muscle soreness subsides. All in all, one of my most successful and least painful summers.

This afternoon, I'm planning to do a nice long brick, which is a bike-to-run workout. Bricks are terrible. It'll hurt. I hope to do 1 hour of biking followed by 30-40 minutes of running. But, to get myself psyched up for it, I will watch the women's gymnastics team finals!

Friday, July 27, 2012

Batting .500

And again. July is the month of black cloud. Once is an anomaly; twice is a pattern. Another code.

This one didn't go as well.

The dispatch was for unresponsive male at a frequently visited nursing home. I left the dinner table for it, figuring it was a really tired guy or something. I got to the fire house in time to see one of the department's volunteer paramedics pulling up. He took his time putting on his department apparel, because it's usually not a huge emergency. In fact, the previous call I had been on, we had to wait while the patient, an elderly woman with a recurring heart valve problem, picked up the phone and had a polite conversation with a wrong number. While it's sad that there are so many people who don't have family close by to drive them to the hospital, it's usually not an emergency.

By the time we pulled out of the ambulance bay, the dispatcher had announced that CPR was in progress on scene. Oh boy. We were on scene in 5 minutes, and it was my job to grab the ALS (advanced life support, or paramedic-related stuff) bag. Of course, I had forgotten that as of a couple of months ago, the bag was locked up because the department decided that a huge department with only a handful of paramedics should have a supply of narcotics. Hey, morphine is pretty cool. I learn quickly that the key is hanging in the ambulance, right above where the bag is stored. Ah, nominal security at its best.

We head to the patient's room to find a bunch of nurses scrambling or staring uselessly, and the RHFD (the other FD in our town) EMS captain doing (a nice job of) one-man CPR. the nurses stand in the way for a few seconds before the paramedic, other tech, and I kindly nudge them aside to prepare the patient for transport. While we ready the stretcher, the paramedic turns on the EKG. Asystole. Flatline.

How long has he been down? He was checked on last an hour ago.

A patient's chances of survival decrease exponentially every minute that goes by without effective CPR. This is why it's important for everyone to understand how to give chest compressions, even if nothing else. One hand on top of the other, right between the nipples. Compress the chest 1 1/2 - 2". Push hard and fast, but allow for full chest recoil. That's it. That's all it takes to keep someone alive. After as few as 10 minutes without CPR, a patient's chance of survival is down to only a few percent.

I took over compressions as we wheeled the patient out of the nursing home and into the ambulance. The tech doing ventilations was not getting very good chest rise, which is the obvious indicator that the lungs are getting the air we were forcing into it. The paramedic intubated the patient pretty quickly, and we realized we weren't getting chest rise because the patient's lungs were not very healthy. According to his medical history, he had COPD, as well as a history of colon cancer. He also had esophagitis, which could explain the blood leaking out of the ET (endotracheal) tube when I took over ventilations. The paramedic also managed to start an IV on this man with old veins and no blood pressure, and then we were off to the hospital.

At the hospital, we went right into the trauma room, followed by every ER resident on staff (including a third-year, who is a good friend of mine). They continued to work up the code as I continued ventilating the patient. I don't know if they didn't notice I was still there, or I was doing such a good job (or they didn't have much hope for the patient), but I stood there the entire time. I got to see the entire workup.

July is a time of transitions for medical facilities. All of the graduating medical students start their residencies. Residents become attendings for the first time. In other words, a bunch of n00bs are running around. July is not a good time to need medical care.

It's not that I doubt any of the doctors' training, it's that they were new. Doctors who had never been in charge suddenly were. I was in a room full of doctors that had studied this scenario a million times, but had never been through it in this trauma room. There was fumbling for objects. There was excitement over doing compressions. There was searching for drugs. There was nervous joking and laughter. There was a room full of doctors wanting to try things and do things.

It appeared to me as if the code was run longer than normal, to give more residents opportunities to do procedures. A cardiac ultrasound was done a couple of times, to look for any remnants of cardiac movement. (Uncoordinated movement is bad.  No movement is much, much worse.) A few rounds of code drugs were administered. An IO line was started. The doctors continued to work. And the patient was lying there, arms splayed off the table, blood dripping out of the ET tube.

And then they called it. The patient was declared dead at a certain moment, and after that moment, all medical interventions ceased. In reality, he had been dead nearly 90 minutes at this point, but it wasn't official yet.

I didn't feel guilty, or upset. I didn't mess up; I did my job, and gave a full effort towards reviving a deceased man. He was gone long before we arrived. I tried my hardest, going through the protocols and maintaining this man's dignity the best I could. There was nothing we could have done better or differently.

I went home and took a long shower.

Tuesday, July 24, 2012

End of the White Cloud

For nearly five years, I have been a white cloud in EMS. When I'm around, there are no emergencies. I can walk into a fire house, and have the alarms be silent for hours. Days, sometimes. And, the moment I leave town, the pages start coming in.

No more. I have lost my white cloud status.

Part of being a white cloud is that I do not have a lot of experience with the most extreme type of EMS call, the code. The code, code blue, cardiac arrest. When the patient has no pulse, no heartbeat. And in nearly five years, I did not have a single code.

Then came July.

A few weeks ago, I had my first code, and it was as smooth as codes can be. We were dispatched for something vague and non-emergent, something like "female not feeling well". We originally thought that the county ambulance (primary response, with a paramedic) would be responding, but learned that they were at least 10-15 minutes out, so we jumped in the bus and rared out.

We arrived on scene at a restaurant (a pretty fancy steakhouse). The driver, the other tech, and I were quickly ushered into the restaurant. I turned to the other tech, who was a new EMT and going through the process of getting his department credentialing, so he could tech on his own, and said, "Alright, this one's all yours." He responded, "Let's see what it is first." The assistant chief, who was first on scene, was hurrying us along. "She doesn't look good," he called out.

I was wearing a brightly colored t-shirt and my Roslyn EMS scrubs (we are required to wear something with a FD logo), but the officer on scene asked me to go back and put on a jacket, so I'd look more professional at a public place like a restaurant. Whatever. I did that, while the rest of my crew grabbed the stretcher and took it inside. I put on a giant FD jacket, made for a man three times my size, and sweated across the 90-degree parking lot into the restaurant. I opened the door, and saw that they had already pulled the stretcher out. I held the door open for them, and then jumped in the back of the bus while they lifted the stretcher inside (I'm rubbish at lifting; I'm better off leaving it to two big guys and a couple of cops). At this point, I don't know the condition of the patient...that is, until the chief shouts to me, "Start compressions!"

Oh, ok. I've never done CPR. I've never seen a patient without a heartbeat. As I found out later, she coded the minute before, which gave her a better chance at survival, although she was about ninety years old. And frail. I took half a second to silently freak out, and then began compressions.

It was easier than it is on a CPR dummy. There's less resistance on a little old lady than on a flexible lump of molded plastic. And ribs didn't break, they just kind of--separated. Everything in her chest separated as I pounded on it. And her face was expressionless. Just...there.

After everyone got on the truck, I passed off the compressions to my partner, so I could take off the jacket. I then took over ventilations with the bag-valve-mask. At this point, the paramedic from the county bus showed up, so he hopped in with us. He intubated the patient, and after one failed IV attempt, sent us rolling. The heart monitor indicated PEA, or pulseless electrical activity. In other words, the electrical signals were working, but the heart muscle wasn't doing what it should have been doing. That was a good sign, or at least, not a bad sign. It meant that the heart knew what it was supposed to do, even if it wasn't.

We arrived at the hospital about 3 minutes later, and took the patient right to the trauma room. The medic had called the hospital ahead of time, so they were prepared for us. The patient was treated, and our chief met us in the ER. Fortunately, the medic would be doing all of the paperwork, but we had to go help clean the truck. We didn't all need to do the cleaning, but none of the three of us wanted to admit that we'd rather watch the code in the ER than help clean, so we all got to work.

After the inside of the truck shone like the top of the Chrysler Building (really, the only standard of cleanliness), we walked back inside the ER to get an update. We didn't hang around to get details, but I was satisfied to hear "BP 110/70." The patient had a normal blood pressure. The patient had a blood pressure. The patient's heart was beating on its own and we did that.

A few days later, at the FD's monthly meeting, the chief congratulated us on our good work. The woman was doing well.

Friday, July 20, 2012

Better Days

Okay, everything's under control. I got the alarm and cable set up. It took some feelings shared over the phone to both companies, but eventually it got done.

I also got my bike ride, although it wasn't like I expected. It was really hot (~95 degrees F), and I got lost on the way to the bike path...a couple of times. I ended up walking a bunch and stopping to look at a map a few times, and ended up with only about 10 miles in an hour and a half. Oh well.

Wednesday, once the heat finally broke in a thunderstorm of epic proportions, I managed a quick 2-mile jog in the drizzly parking lot of my grandmother's nursing home.

(While writing this last night, I was interrupted by an ambulance call. I went, but missed the truck. I'll help save lives another time.)

Today, I managed an even rainier 6(-ish) mile run. I was hoping for a full 6, but miscalculated my route, and after circling the parking lot I was only at 5.88, and people were watching, so I called it a day. Still, not bad, and I was SOAKED. My iPhone case did a pretty good job at keeping my phone dry, so it all worked out.

I'm hoping to add another 4.5 miles in the next two days, to round out the week at 12 miles, because it's not good to have one run be more than half of my weekly miles. It's too hard on the body. A pretty good week for working out, despite the chaos of Monday. Tonight, I'll end the week with my family's Shabbat dinner. There will be food and wine (or depending on how I'm feeling, food and ambulance calls).

Tomorrow, I have a nice walk planned with my mom, and maybe I'll run and/or swim and/or bike in the afternoon. Sunday: the boyfriend's big move!


Monday, July 16, 2012

Terrible, Horrible, No Good, Very Bad Day

I should have stayed in bed today.

Yesterday, I moved into my beautiful apartment. And it really is beautiful. When I moved in, there was a little bit of trash in the apartment: some bags of chips, a bag of candy, and a dirty magazine in a drawer. We called maintenance, and they cleaned up and vacuumed for me. It was probably the cleaning crew or some workers. No big deal. Lock the deadbolt, no more worries.

Today, I arrived at my apartment to find the door destroyed and the TV missing. There was some soda spilled on the carpet and a can was presumably missing from the box of soda in the kitchen. There were a couple of new holes in my recliner's leather. Many boxes had been opened, and my clothes were all over the floor in the closet.

The police came in (and were wonderful). As much as it sucks being on this side of a Law and Order plot, they were very kind. They even offered to accompany me if I ever felt nervous getting into my apartment.

The building super and maintenance staff were very helpful. They immediately took a door off of an unused building (still under construction) and replaced my broken door with it. They steamed the carpet and then kept me company until they went off duty at 3:30 PM. They also shared personal anecdotes of similar experiences, and advice, and information on all of the places that were MORE dangerous. They also told us that there had been a homeless man seen breaking into and squatting in empty units. I bet he was really unhappy that I got rid of his snacks.

The woman at the front office of the apartment was not helpful. I couldn't reach her, but when my dad did, she did not help at all in getting our alarm system set up or sharing any other information. Thanks.

The apartment management company called me and let me know that they had called the alarm company, and that they'd be there between 3 and 5 PM to install the alarm system, and that they were sorry this happened. My dad pointed out that they were eager to call me back, rather than him, because he is very good at...getting stuff done. I'm a little less effective.

The other frustration of the day came from Cablevision. I had installation of phone/internet/TV scheduled for 2-4PM, but I called around 1PM to cancel--I no longer had a TV and did not want to deal with that. Unfortunately, I realized that I still needed the phone line installed (what, it's cheaper to have all three than just internet/TV), so I called them back at 1:15. After waiting on hold for 10 minutes or so, I was told that my appointment slot had been rescheduled. I explained the situation to three Cablevision employees in the next 45 minutes, eventually having an assistant supervisor squeeze me in between 2 and 8 PM. Can't it be earlier? The alarm company is coming 3-5. Nope. Can't do.

I spoke to my boyfriend in Israel. He was upset, of course, but mostly concerned about my safety. He suggested we find a personal safety class when he gets back. He also agreed that there was no reason to move just for the sake of moving, because we really weren't going to find a safer area. He also must have called his parents and good friend, because I got contacted by both of them to make sure I was okay. Of course I'm okay. Overwhelmed, cranky, but I'm okay. My recliner, on the other hand, needs some leather repair. Besides, I had even considered giving away my TV, because Boyfriend already has a TV, and I don't REALLY need a TV in the bedroom too.

Alright, the alarm company came around 4, and were very pleasant. I was a little nervous letting strangers into the apartment, but their ladder had "Safelight Security" scrawled on it in black Sharpie, so I figured they were trustworthy.

And then I waited. And waited. I read some internet on my phone. I unpacked the kitchen (so much space!) and some clothes (not so much space!). I stood on my balcony (I have a balcony!). I watched couples stroll around the complex after dinner. A guy washed his car. Another guy saw my old damaged door sitting by the dumpster and took some pictures with his phone. It looked like a really safe neighborhood.

Around 7:00, I called Cablevision to get a time estimate on the technician. They took my phone number and said that dispatch would call me with a time estimate in the next 15 minutes. By 7:45, I'd heard nothing, so I sat on hold with Cablevision some more, and they told me I wasn't getting a technician. There was no recording of the rescheduled appointment, only the cancellation. And by the time I got off hold, it was after 8, and no technicians did service after 8. I could have gone home four hours before. Or, I could have gone biking at the nice bike path near the apartment. I YELLED at the customer service representative, which is something I never do, and I'll probably feel guilty about it on another day. Not yet, though. I angrily drove back to my parents house, where I'll stay until Boyfriend returns from Israel. There was no traffic and my mom had dinner and drink waiting for me.

I also forgot to mention that I arrived at the NJ DMV this morning to get a new license, but, after waiting in line for a few minutes, realized that I forgot my lease (proof of residence). Whoops. Try again tomorrow.

I have some supportive people in my life, but I'd really like to give a good scolding to Cablevision and Vagrant Burglar.

Tired. Hungry. Headache. Bedtime.

I should have stayed in bed today.

Sunday, July 15, 2012

Moving

I moved today! I officially have a residence in New Jersey, and by tomorrow, I'll have a NJ driver's license as well.

The move was long and exhausting, but smooth. I packed up all my stuff early in the week, so it was all ready to go today. My dad and I met the movers at early o'clock this morning, and we napped on the couch while they did a great job of packing the truck. So worth it. It was all moved to the new apartment by 2PM, and the movers were polite and wonderful.

When I got back to my parents house, I went out for a really great run. It was my first interval workout that involved running/jogging intervals, rather than the usual jogging/walking intervals. It was tough, but I was proud. It helped that the weather was a magical just-cooled-off, sky-about-to-burst pre-rainstorm weather.

I'm working on running faster. I ran in a 5K yesterday morning, and finished in a nice 33:26 (10:47 min/mi). It's not my best time ever, but I finished with no gas left, which is a nice feeling. The race was pretty boring, although not perfectly flat, through suburban neighborhood streets. It was a pretty big (~400) women's only race, which meant that I was solidly in the pack. I finished about 2/3 of the way through the pack, which is better than usual.

Although I was pretty happy with my time, I've been wanting to finish a 5K under 30 minutes (9:40 min/mi), which is about a min/mi faster that what I did. I did it once, last year, finishing a race last April in 29:47. I still suspect that race was shorter than advertised, but can't confirm it, so I can only work harder to race that fast again. I wasn't training for speed at the time, but was training for the half-marathon, which did make me faster. I guess.

Tomorrow, I'm going back to NJ to do some unpacking and hang out at the DMV for a while, and I will reward myself with a first visit to the lovely bike path near the new apartment. If I can get in a good 20 mile ride (under 2 hours?), then I'll feel pretty confident about completing an Olympic Triathlon on August 12. By tomorrow, I will have recently completed long workouts of a 1.1 mile swim, (hopefully) 20 mile bike, and 5 mile run, which is not a bad start for training for a triathlon in four weeks that includes a .9 mile swim, 25 mile bike, and 6.2 mile run. I think I can.

Thursday, July 12, 2012

Slump

I've reached the summer blahs. The doldrums. I'm so unmotivated to do anything, because I don't have enough to do.

After an awful 5-mile slog/run, I didn't feel like working out today. I managed a nice 30-minute ride on the stationary bike, but that was it. I think I'm going to sign up for a 5K on Saturday, which should give me some motivation and an excuse to rest tomorrow.

I've accomplished much of the moving tasks, such as canceling and scheduling utilities. I'm getting really good at spelling my name over the phone. I even finished accumulating all of the paperwork I'll need to get my NJ teaching certification, so I can mail it out tomorrow. It's too bad that I don't really trust the USPS, and worry that a big envelope of important documents won't get to where it's supposed to go.

I've run out of internet to read and I've finished watching two seasons of Torchwood again (it's brilliant, really, but does everyone have to die?). I'm bored, but I hate complaining about it. I know that once school starts, I'll be working my butt off and exhausted (in a productive, satisfied way), so I really want to enjoy the summer. Oh well, I'll figure something out.

Tuesday, July 10, 2012

To-Do

One would think that with fewer obligations, I would be more able to accomplish what needed to be done. And one would be grossly incorrect.

I work better under pressure. When there is too much to do, I make lists and schedules, and manage to get everything done. Usually, early. But, when I only have one thing to do, or have too much time, I dally and procrastinate until there is no more time left.

It's taken everything I have to finish packing nearly a whole week before the movers come. But I did it! I did! It took to-do lists and schedules and calendars and goals, and remaking lists when I failed to accomplish tasks the first time. At one point, I had a to-do list embedded in another to-do list. But, I finally finished packing. And I'm proud of it.

I still have a bunch of moving-related stuff, but it's less urgent. I still have to cancel utilities and schedule utilities and register my car and get a driver's license and, of course, unpack everything, but it's not urgent. So, I'll sit and watch TV and play games and go running and do everything other than what I have to, until I have to.

My trip to SF started with a stomach virus and ended with a cold, but it was still nice. I enjoy hanging out with my sister and her friends, and they show me how to eat well. When I returned home, I went to NJ to sign the lease on my new apartment. It is a beautiful apartment, with granite counter tops and a laundry room and an office and 1 1/2 bathrooms, although the living room is a bit small. We may have to replace my pretty white couch with something smaller, if we can't make it fit.

Due to illness(es), I've been light on training lately, but have begun to catch up. Yesterday, I settled for a 2 mile run due to some congestion, but ended up pushing the pace and doing it at 10:40 min/mi. I was out of breath at the end, but it felt good. This morning, I did my first ever 1 hour swim, slogging through 2000 yards. It was really relaxing, although after about 45 minutes my brain started turning to mashed potatoes. Tomorrow, I'm hoping for a long run, maybe 5 hilly miles. Maybe more? Who knows. The weather has cooled and I can't wait to go long.

Tuesday, July 3, 2012

Vacation

I like San Francisco. It's like a college town on the scale of an entire, productive, city. I can walk two blocks to the store, jog half a mile to a park or science museum, and easily access the some of the world's best eats. Moreover, a short drive will get me to some lovely hiking or wineries. On Sunday, I went hiking. It was a not-too-strenuous 4-ish mile loop, which we covered in a brisk two hours. We also stopped briefly in the middle for a picnic of chee, crackers, peaches, dried mango slices, and apricot ale. That evening, I took part in an exceptionally indulgent dinner that involved homemade bacon bread, lobster tempura, oyster shooters, and illicit foie gras. I might have met my match, though, and I think I'll have to end my 11-day workout streak today. That dinner left me with either food poisoning or other GI distress, and after my 1-mile slow jog, I ended up spending the rest of the day on the couch watching tv (rough life, no?). So, today, I will skip my workout and maybe enjoy some of the city in a less strenuous fashion. I'm still hopeful about a solid run tomorrow. Now, I'll stick to watching Boy Meets World. I love vacation.