Bringing Some Peace & Quiet To The Patio

Materials for my fountain

Last week I spent a few minutes organizing my bookshelves and found some books on water gardening I'd picked up for a dollar at the thrift store. I've always wanted to have a water garden. Something about the sound of running water is really soothing. A little research proved that it's not very expensive to start one. So over the last couple weekends, it happened. 

I started with at trip to the hardware store.  Everything I needed is shown in the photo above: fountain pump, planter bowl, drill (to widen the hole in the bottom of the planter so the cord would fit through), rocks to hide the pump, and of course water (not shown).

I started with at trip to the hardware store.  Everything I needed is shown in the photo above: fountain pump, planter bowl, drill (to widen the hole in the bottom of the planter so the cord would fit through), rocks to hide the pump, and of course water (not shown).

Fountain pump.

The pump I got came with a couple different nozzles to change the spray pattern for the water. Not all of them come with it. There's also different sized pumps depending upon how much water you want to move and how high you want to make it go.

Enlarged hole for the pump's cord.

Step one was to enlarge the hole in the bottom of the pot so I could run the cord for the pump through. This isn't exactly necessary, but I thought it would make the finished fountain look better. I had a rubber plug already fitted around the cord to make the hole water-tight, but not all of them are that way. It is also common to use some sort of sealant to close up the hole around the cord.

Pump placed in pot and hole around the cord sealed with rubber plug

Initial finished fountain

I didn't like the way it looked with just the rocks in this photo because the pump was still visible. I found a wire basket at the dollar store, cut a hole in the center and placed the overturned basket over the pump. This keeps the rocks from blocking water flow to the pump and reduces the amount of rocks I need to hide the pump. I added more rocks until the basket was no longer visible.

Finished fountain!

I'm planning to eventually add plants to the fountain. Until then, I think this will work fine. I have been running the fountain almost once a day and draining the entire fountain and cleaning it to prevent algae from growing.

Fountain in the corner with (L-R): Geranium, White Oxalis, Citronella plant (far back), cactus garden, Purple Oxalis, and Asian Jasmine.

Due to all the turmoil that goes along with a new job, I haven't been able to spend time running rescue or doing paramedic-y things other than working on the re-certification process. Re-certification has to be done every two years in order to maintain National Registry certification. There are a bunch of different topics that you need to receive training in, for a total of 60 hours of training. I have about 8 months to complete 5 hours of training. Easy enough. Until I get back into the field on my own as a medic with my new job, it's time for more garden therapy. Until next time...

The Complete Idiots Guide to...STEMIs?

When I was a kid, a family friend gave us a wooden chess set and a book titled "The Complete Idiot's Guide to Chess." While we definitely aren't complete idiots, that book broke down a complex game into concepts we could understand.  We had so much fun learning to play chess... After awhile, it becomes easy to play the game and you can start focusing on more important things: like strategy. I find that doing the same thing for complex medical conditions or trying to learn how to cultivate bonsai (Bone-Sigh) plants helps. If I can explain it so a layperson can understand, then I generally have a good grasp of the subject.

Minerva watching it rain while trying to ignore a bonsai tree I was trying (and failed) to keep alive.

So the last couple weeks, I put in a decent amount of time as the Region A medic. I missed the lunar eclipse (which was also a full blood moon) because well, as folklore says, wild things happen on the night of the full moon. I was so busy running calls and writing my reports that when the clouds cleared I still didn't get a chance to see it. The theme of my last couple weeks seems to be responding for complaints of "chest pain."

Current medical practice in response to chest pain is very different from what it was 50 years ago. Fifty years ago, if you started having chest pain and you picked up the phone to call someone to take you to the hospital, you probably would have dialed your neighbor's house instead of 911.

I think that comparing the chest pain protocol suggested by the American Heart Association with common practice in 1965 might be enlightening. Please note that different jurisdictions have different protocols and may prefer to use different medications. This is normal, but the goal is the same. (And to anyone in the medical field who reads this, feel free to message me if I get something wrong. I'm happy to make corrections).

Let's start with some terminology: the medical term for a heart attack is an Myocardial (My-O-Car-Deal) Infarction (In-Fark-Shun) which is abbreviated to MI. When someone has a major medical event of any kind, we typically monitor their heart activity with an Electrocardiograph (Electro-Cardio-Graf) machine which is abbreviated either as EKG or ECG. There are two kinds of MI: ST-segment Elevation MI called a STEMI (I pronounce it Stem-Ee) and Non-ST-segment Elevation MI, or NSTEMI. I'll discuss the meaning of the ST-segment later.

And no, I don't expect you to remember all this. I also don't expect others to be as fascinated with cardiology (the study of the heart) as I am. 

Diagram of a myocardial infarction (2) of the tip of the anterior [front] wall of the heart (an apical infarct) after occlusion [blockage] (1) of a branch of the Left Coronary Artery or LCA. In the diagram, RCA is the Right Coronary Artery. [Diagram found on Wikipedia.][1]

My protocol dictates that when the patient I've been dispatched to help complains of chest pain, that patient is instructed to take 4 baby Aspirin if available. When I arrive, several things should happen quickly: somebody gets a set of vitals, and I get a 12-Lead EKG reading. Vitals consist of blood pressure, pulse, oxygen saturation, respiratory rate, listen to the lungs and check skin condition (because if the patient is pale, cool and sweaty, it tells me a lot about how sick they are). The 12-Lead is kind of like an electrical picture of the heart taken from 12 different angles. If the patient's blood pressure is above a certain number (and the 12-Lead isn't showing lack of oxygen to the right side of the heart), I will administer the first of up to 3 doses of nitroglycerin and transmit the 12-Lead to the ED for the doctor to look at. If the patient's oxygen saturation is below 94%, I'll have someone put the patient on a little bit of oxygen. At this point I typically like to move everyone to the back of the ambulance because I can do everything else in the ambulance on the way to the ED.

An MI is truly an emergency. The longer that area of heart muscle goes without oxygen (take a look at that diagram above again), the more permanent damage to the heart there will be. So this is one of the cases where I try to keep my time on scene short and sweet. Once in the ambulance with an emergency like this, I have to get vitals every 5 minutes (that's my EMT's job if I have one in the back with me), start an IV, radio the hospital to let them know that they're getting a STEMI, get a follow-up 12-Lead if possible, administer the other 2 doses of nitroglycerin if appropriate, and if that does not help the patient's pain, give morphine. And meanwhile, I'll be talking to the patient and my crew, asking for this or that, and trying to keep everyone calm and as comfortable as possible. If it's a long transport or something important changes en-route, I'll call the ED again to give them an update or to ask the doctor for orders. Oh, and did I mention the paperwork? I have to get patient information for my report and so I have it to give to the hospital so they can register the patient when we arrive.

If you're wondering how I know if the patient is having an MI, it's a combination of the patient's symptoms and my lovely little 12-Lead EKG. There's a whole science to reading and performing those 12-Leads too. First, not all MIs will show up on the 12-Lead EKG. However, most will show up on the EKG, and most of those that don't initially show up on the EKG will show up in the lab test the doctor will run once we get to the ED. And there will always be some that are never discovered--because that's just the way life is, right? The ones that show up on the EKG in the field are typically the ones that I'll be the most worried about. Especially if the patient looks really sick.

If you're curious, here's an example of a 12-Lead done on patient's having active MI's.

Check Anesthesia UK's website for full article "Ischemic Heart Disease"
http://www.frca.co.uk/article.aspx?articleid=100690 

Check Anesthesia UK's website for full article "Ischemic Heart Disease" 
http://www.frca.co.uk/article.aspx?articleid=100690 

Each segment of the heart beat tracing has a letter name.

So when you look back at those 12-Leads, do you see that little portion between the S-wave and the T-wave? In a normal EKG, that little line is parallel with the baseline. But wait, it's NOT on the baseline in some of those tracings. It's either above or below. When it's above the baseline, we call it ST-elevation. When it's above the baseline in several leads that are from neighboring parts of the heart it indicates lack of oxygen to that part of the heart due to a blockage of one (or more) of the arteries (in one or more places) supplying oxygen and nutrients to the heart muscle. And that's why we call it a STEMI.

An NSTEMI is simply where the patient is having an MI but there is no ST elevation in their EKG. NSTEMIs are typically diagnosed by labs run at the ED.

Ever wonder what happens after your local paramedic brings a STEMI patient to the ED? They usually get a couple more medications in the ED that help with preventing more blood clots and then are taken to the Cardiac Catheterization Lab (Cath Lab). In the cath lab, the doctor will place a stent in the clogged artery to allow blood to circulate to that part of the heart again. If that fails, it's open heart surgery and a coronary artery bypass graft. There are an awful lot of people out there running around and living their lives with one or more stents or coronary artery bypass grafts!

Back when the first paramedics hit the streets of America in the 1960's things were different. Medicine has come a very long way in the last 50 years allowing people who would otherwise die the chance for a second lease on life.

As fall hits full swing, the plants in my garden are hanging on. Several of them have new growth. I love seeing the new leaves mixed in with the colorful ones that are falling from the trees. My front porch doesn't look as pretty as some of the back roads around here.

So take a few minutes to step outside and enjoy the weather and thank God for the weather and the beauty of the world.

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[1] https://en.wikipedia.org/wiki/Myocardial_infarction#/media/File:AMI_scheme.png [Accessed 10/5/15].

A Day (Or Night) In the Life of a Volunteer Paramedic (Part 1): Typical Shift At The Rescue Squad

I was recently asked by a member of the public what a typical day is like for me. That is such a hard question to answer because each shift is so different. Being a bit of a smart aleck, I asked them "what day?" I work a rotating 24hrs on/72hrs off schedule with the private ambulance transport company. My volunteer paramedic schedule of 12hr shifts is set up around my work schedule. I prefer running as the Region A medic on Sunday and Monday nights. Sometimes I run Sunday days because I can take the chase car to church and respond from there. I also volunteer with the Fire Company which is separate from the Rescue Squad. Fire duty crew is a 12hr shift every 6th night. I work holidays, am out in all sorts of weather and I don't know what a "weekend" is anymore. And I haven't even started on the regular continuing education classes I have to take to keep my certifications current.

But let's give this a try. Let's assume that I'm on duty at the volunteer rescue squad as the regional medic. The shift begins at 6pm, but since everything in fire-rescue goes off 24hr clock time, it's actually 1800. I usually leave home at least an hour before the start of my shift to allow for travel time with rush hour. If it's one of the days when my roommate is working night shift and won't be home to take care of the pets I leave earlier so I can drop my dog Fiona off for a sleepover at a friend's house.

Well, she's already asleep in the car. Apparently, Fiona was more than ready for a sleepover while I'm on duty.

Once I get to the station, I change into my uniform if I'm not already wearing it and call the county dispatch center to place my unit in service. Then I do a quick duty check to make sure I have everything on the unit and change the battery in the portable radio.

One of the ALS Chase vehicles we used to run from the rescue squad station. Oh, and a helicopter.

Then it's time for dinner. You never know when you'll get a call, so food is always a high priority. Every time you sit down to eat, go to the restroom, start your workout, etc., you feel like you're tempting fate to give you a call. Most shifts, I end up coordinating dinner with the ambulance crew on duty. After dinner, I like to do training of some sort.

Extrication Training

Training can be pretty much anything. If you don't train your skills and knowledge gets rusty. You don't want to be trying to relearn that splinting procedure on a call. Training is important! Two of my favorite evening shift training options are doing area familiarization/driver training and practicing ALS/BLS skills. If you know the shortcuts, major streets and intersections--and even better the addresses, your response times are faster because you already know where you're going. Long summer evenings are perfect for this kind of area familiarization. Practicing skills such as intubations on the dummy, doing a drug bag check (and reviewing the indications, doses and contraindications for all the drugs in the bag), and teaching basic skills to new members are other good options. The more you know, the more you practice, the better you will be under stress in a critical incident. I also try to review at least one of the local protocols per shift. Knowing the protocols is very important, and there are always protocols you don't use very often.

Bunk room at the station. The night this photo was taken, I ran a lot of calls and consequently didn't spend much time in here.

After training, sometimes there is time to use the station gym, work on projects, and watch TV before bedtime. I usually pick a bunk room as soon as I'm done with my duty check and before dinner. And at any point in time, this routine can and will be interrupted by calls. In the area I cover, the average time it takes to run a call once you allow for response time to the scene, an on scene time of about 15-20 minutes, transport time and the return trip to the station (often via the scene to retrieve the chase vehicle) is about 2-2.5 hours. Critical patients require more documentation, so the report-writing time at the ED is longer.

People often ask how busy we are. The truthful answer is that it depends upon the day. Calls seem to come in waves. At one point in time, there will be 4 calls going on at once and I'll be on one and there will be units from 3 other stations on calls in my area. Other days I'll run nothing the entire shift. Some shifts I will run 6 calls and never really see the station.

Another question or rather statement I hear a lot, is "so you're an ambulance driver?" Well, technically, yes, I am. But I'm a whole lot more than an ambulance driver. I'm actually a paramedic. I've successfully completed about 2,000 hours of classroom and practical training, followed by about 8 months of field training before I was allowed to run calls on my own. So, "Yes, Ma'am. But I'm a little more than just an ambulance driver..."

Patio Garden Therapy

Late last summer, the garden and I moved…to a bigger patio about 8 miles down the road. There’s no space for an actual garden bed here and the management is really particular about what is on your patio. So I’m making do with a few more pots. I also had to get a storage bench to hold my gardening stuff. Not that there’s anything wrong with more pots, beautiful flowers, or a nice reading spot in the middle of them…

Rocking chair and patio tomatoes...and the lovely Fiona with her frisbee.

Back in March, my “black cloud” showed up again, and I ran a series of tough calls. It didn’t seem to matter if I was riding backwards in the bucket seat on the engine, covering as the Region A medic, helping a friend with driver training in preparation for EVOC or having another insanely busy day working at the ambulance transport company. It all began with a code that went out a couple miles from the station Wednesday night.

Every new medic needs at least one confidence-building critical call, where given all the variables everything goes pretty much like clockwork. I’d come down to the station to take one of the new members out in the second out (unstaffed) ambulance for pre-EVOC driver training. Just as we were about to head out, the station tones dropped for a cardiac arrest and an EMT/driver walked in and asked if I wanted to take the call. A quick check showed that we were much closer to the scene than either of the two medics initially dispatched and the first out unit wasn’t at the station. So I grabbed my drug keys, we squirreled it and arrived on scene just after the engine and before all the other EMS units. I grabbed the drug bag, walked in and handed out work assignments to the crew to facilitate the “pit crew method” I heard about at the EMS Today Conference earlier this year. From there it went like clockwork. The patient started in asystole and when we reached the ED 10mg of Epi and 50mEQ Sodium Bicarb later the patient was still in asystole and the doc called the code. Unfortunately, asystole (aka flatline or no heart rhythm at all) is the stablest rhythm of them all.

The next day I was at work, and it was one of those really busy days. One of my patients that shift was a tiny premature baby who had developed necrotizing enterocolitis. Necrotizing enterocolitis is the death of tissue in the intestine and occurs most often in premature or sick babies with a 25% mortality rate according to the National Institute of Health.[i] I checked with the doc in the Peds ED the next week and he confirmed that thankfully this little one was treated in time and survived.

A dressed up patio storage bench turns this corner of the patio into an inviting place to relax outside.
Mama ducky is admiring that orange Gerbera daisy too. 

The next night, after a busy day acquiring the patio storage bench, I had fire duty. Riding backwards on the engine can be fun and a nice break from bossing a medic unit... until you get dispatched on that 2:50am stabbing three doors down from the firehouse, are the only medic on the engine and are first on scene after the police. We did everything we could. This patient's wounds were too severe and he practically bled out in front of us and in the end did not survive. The calls where a patient starts out talking to you and ends up dead are the worst. This one was particularly difficult due to the circumstances.

Needing some version of therapy after those calls, and now that spring had arrived, I started working on the garden again. I still have a few pots I haven’t planted yet. Between turning an old bookshelf into a potting bench and acquiring a storage bench/seat per request from the management company, the patio has become a lovely place to read and work.

New job for an old bookshelf: potting shelf.

The rest of the garden is still in the works, but I have squash, beans, cucumbers and a variety of herbs and flowers growing.

Planter of Basil varieties and the lonely Zucchini plant.

When you spend a significant portion of your time caring for ill, injured and dying people, it's nice to be able to come home and care for something healthy and alive.

Green Beans.

Cucumbers and trellis.

I like to daydream about God being the supreme gardener. He has more plant varieties than I could ever dream of...and He's got the whole universe to grow them in. But you can also think of gardening as an analogy for life. Any gardener knows that caring for a garden requires weeding, thinning, pruning and re-potting. God does the same for our lives. We may not know the master plan for the garden, but He does. And in the end, He works everything together for our good and His glory-- even though we may not see it at the time. In the end, God is the one who gives and takes life. I've gotten to see a decent share of both recently. It's a good reminder that it is a privilege to be alive. Use your time wisely and don't take it for granted. We never know when our time on earth is up. Don't waste your life.

Citronella, Violas and Oxalis (shamrocks) decorating a corner of the patio.

For me, that means doing my job at work or as a volunteer to the best of my ability and then coming home and taking care of my garden... and spending time playing with and training my dog Fiona.

Fiona at 9 months

Besides, who knew Border Collies loved to swim?

Yep...she's out there swimming after a stick.

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[i] http://www.nlm.nih.gov/medlineplus/ency/article/001148.htm

Elfin Thyme, Shiny Objects, and Helicopters

Small things, shiny objects and flying things all tend to fascinate people. Who wouldn't look at a very small plant and smile, wonder how the Hope Diamond could be real and take every opportunity to watch a helicopter? I do.

Speaking of shiny objects, I had the opportunity to visit the gems and minerals exhibit at the Smithsonian Museum of Natural History last Wednesday. The photo below is of the Hope Diamond. It's about the size of a walnut, and if you view it from the right angle it's a spectacular blue, from other angles it usually looks charcoal gray. And it's apparently a priceless bit of rock. Isn't is wonderful that anyone who visits the museum can go see this rare bit of God's beautiful creation for free?

The Hope Diamond on display at the Smithsonian Museum of Natural History.

While I was there, I also visited the butterfly pavilion on the 2nd floor. You do have to pay admission, but I thought it was worth it. All those beautiful butterflies and moths from all around the world. Wow! I'm still in awe of the wonders of creation and the God who made them all. I think I need to add a butterfly bush to my plant collection, too bad I didn't think of that when I stopped by Southern States my last Region A medic shift.

In my wanderings while playing Region A medic last Saturday afternoon, I stopped by the farmers market in Purcellville to pick up fresh local vegetables. One of the booths at the market was Loudoun County Master Gardener's. The ladies and I ended up talking for a good 15 minutes about the fun and challenges of growing things in Loudoun. I've been having trouble getting rid of mealybugs on my plants, so we naturally got started talking about natural pest deterrents. The best solution to my problem seems to be regular applications of insecticidal soap. But did you know that planting certain things together can help with other pests?

For example, planting marigolds tends to repel rabbits. And nematodes. And marigolds are pretty. I need to plant some. Growing citronella helps to reduce the mosquito population on the patio. One of the plants I picked up and planted over the weekend is a beautiful little citronella plant. 

Citronella plant in the foreground.

While I was in the process of planting stuff, three little praying mantises turned up. They were about the diameter of a 20ga IV catheter and maybe 1in. long. I hope they stay and eat all the bad bugs.

I must also be obsessed with helicopters. I really enjoy calls where we get to fly patients only because I get to watch the helicopter land and take off. Here's this post's helicopter picture.

This the only double flyout I have run to date. Aircare 1 and Fairfax County PD transported the two patients from a rollover accident in May.

Until next time...

Allergic reactions...that turn into Codes.

You can call me a coward, but there are some situations I hope I never have to face as your friendly neighborhood paramedic. I'll train for them so I'll be prepared if they come, but I pray they don't happen when I'm on duty. Firefighters, EMS personnel and law enforcement officers come across extremely sad and often gruesome situations as a regular part of the job. So often, you show up and even with all of your training and expertise there are situations where you don't know what to do and sometimes there is absolutely nothing you can do. These kinds of situations take an emotional toll on those entrusted with handling them. 

Wildflowers

Running cardiac arrests is a fact of life as an EMS provider. We call them codes. Usually, if they are dead when we get there, they tend to stay dead. We do our best, but few un-witnessed codes actually end in a "save." In my five years with the Rescue Squad, I've been on at least 6 codes, not counting the one described below. Only one of them made it to the ER alive, but he died in the ICU a couple days later. The one that died in front of us...well, he had a massive Pulmonary Embolism (blood clot in the lungs) and never had a chance. I've never truly had a cardiac arrest "save" who made it home from the hospital...until this week.

This past week, I was on duty as the regional medic in the west end of Loudoun County--Region A. Think of this as being the EMS equivalent of a K-9 unit. In the 1/4 of the county that I cover, there are a lot of ambulances with EMTs, but I'm the only medic--or ALS provider. If I need a medic for backup, they are about 15 minutes away. To continue the story...I'd gone out to dinner with the ambulance crew from my station. It was a hot, muggy day and a large storm center had just hit the town we were in. Thunder, lightning (lots of ground strikes) and a huge downpour. 

In the middle of this, our food had just arrived when the tones were dropped at 19:28 for a 15 year-old-female having and allergic reaction w/trouble breathing at another restaurant in town about 1/2 mile away. I had a bad feeling about this one, and beat the ambulance to the scene by about a minute. As I pulled into the parking lot, the mom came running out into the storm to tell me the girl was barely breathing. I unlocked the drug cabinet on my chase vehicle, grabbed my drug bag and went into the restaurant. The girl was lying there on the floor next to the bench near the entrance breathing like a fish out of water. I didn't have enough time to give her anything before she stopped breathing. Praise God the ambulance crew came in just then, because respiratory arrest very quickly turned into cardiac arrest. We did CPR for about 2.5 minutes before we got her back, and went through the allergic reaction protocol. 

Another medic just happened to be at the restaurant and jumped in to help. I was incredibly glad to have him there helping because the next closest medic was coming from 12 miles away and I needed help yesterday. We got her to the hospital alive (she was complaining that her chest was sore), although three minutes out from the hospital the medications wore off and in less than a minute she breathing like a fish out of water again. We were assisting her breathing with a BVM again by the time we arrived. She was quickly sedated, intubated and placed on an Epinephrine drip by the ER doc before being transferred to a children's hospital. She was extubated about 11:30 that night, was discharged from the hospital later the next day. For me, this allergic reaction code was a big deal. Not only was it the first severe allergic reaction I have run since getting released as a medic, not to mention the first code, but the patient was the same age as my youngest sister. Very scary. All things considered, the call went well. Praise God this one ended so well!

I've found several ways to de-stress after a significant call like this one. Usually after a call like this, I end up reviewing and criticizing the actions performed on scene to see what can be done better the next time. But when that's over, it's time to deal with the stress. Some form of exercise usually works, running, swimming, hiking, taking a ballet class. I also like to make a trip to the library for a new book and will spend hours working on my garden while listening to music. This time around, I picked up a book on the science behind the Sherlock Holmes stories. As for music, I'm currently into a CD of harp concertos I picked up from a thrift store and the soundtrack for Captain America: The Winter Soldier that I found on YouTube. The garden looks lovely now after a bit of cleaning up.

On Thomas Jefferson, Peas, and Getting Called Out of Church

I remember reading that Thomas Jefferson was an avid gardener (of course his garden was gigantic compared to mine!). One of his favorite vegetables was English Peas and he had a friendly competition with his neighbors to see who could have the earliest ones. So I looked it up--he grew 15 different varieties! (Check it out here: http://www.monticello.org/site/jefferson/fun-fact-peas). I planted peas this year, on April 5th. Too bad I only have space for one variety. And they started poking their little leaves up April 16! I meant to take a picture several times, but kept getting distracted and forgetting.

I did not forget to take pictures of the cherry blossoms in Washington D.C. this year. Unfortunately pictures like the one below cannot do them justice.

This particular tree in full bloom was located next to the tidal basin near the Jefferson Memorial.

I've been enjoying the privilege of being the regional medic and having a chase vehicle. It means that if I run on a Sunday day, I can take the ALS chase car and go to church.  I take a radio or minitor and my phone, turn the volume down as low as I and sit near the back so I can get out fast without disturbing too many people. Unfortunately this plan has backfired on me a couple times and I have had to leave the service rather abruptly. Like on Palm Sunday.

I heard that one go out about halfway through the sermon. It was for a hand injury--initially BLS. Some guy was doing training and got the tip of his finger pinched off. I had a feeling I'd be going on that one and sure enough, they called for ALS. Nothing really I could do when I got there. It was a frustrating call on numerous levels. Turns out the hand doctor was not able to reattach his fingertip. Oh well. You win some and you lose some. All you can do is your job to the best of the ability God has blessed you with.

Have had some "good" calls the past few weeks. Let's start with the typical definition of a "good call" from the medic's standpoint. A bad call is one where things do not go smoothly. And average call is one where things go well, but the reason you were called is not notable. Like getting that 3am "I stubbed my toe 4 hours ago" or also at 3am "I've been short of breath for 3 days and nothing has changed but it's now an emergency because I can still talk your ear off non-stop for 5 minutes without getting short of breath" call. Yeah. Then you have calls where the illness or injury is genuine. That finger amputation call was good except that things on scene were a bit messy. Seems like I've been going through a steep learning curve after being released.

For example, there was the first time I gave pain medication after being released. This tough little lady fell off her horse in the middle of a field. The ambulance got there first and if a) someone hadn't showed me where to go and b) the ambulance crew hadn't been standing right next to her, I would never have found her. The grass was at least a foot tall and you couldn't see her. She'd broken her ankle. It was extremely painful, swollen and deformed. I wasn't able to completely remove her boot and there really was no good way to splint it. I started my IV and gave her pain medication out there in the deep grass. Unfortunately it didn't do her much good. We eventually got her to the hospital and even three doses of pain medication later it barely took the edge off her pain. In all honesty, she warned me she had a high tolerance for pain medication. I wish I could have managed to splint her ankle better, but she refused to let us touch it and it was going to take us forever on scene. I have a feeling it would have helped with the pain though. Next time.

So much for that. Been rather busy with hospital rotations for paramedic class lately. Speaking of paramedic class, I'd better get going. More homework to do.

Spring Cleaning, Shamrocks and Drug Keys

So spring finally happened. It came much later than I would have liked. Not that I wasn't enjoying winter, it's just that I finally got really tired of being cold all the time. I mean, how could one not enjoy this?!

The famous Rescue Squad snowmen in the making.

Almost done, just needed a few more finishing touches.

Finally done. See?! Poor snowman got impaled by a dead tree branch and had to be rushed to a trauma center by the snow medics for emergency surgery. They've done everything right to include exposing the injury, using full spinal precautions and placing the patient on O2. The patient was too cool for all this and insisted upon wearing his sunglasses during the trip. :-)

I've been so busy with precepting out as a medic in Loudoun that I really haven't had much time to work on my garden. But the hard work and time paid off--On March 17, I was finally released by the EMS council and I was finally issued a pair of shiny new drug keys! I was working the day they were issued, and I was incredibly excited and so worried that I wouldn't get them right away. The medic who was supposed to get them to me was flying out at 6 am the next morning and work was super busy--and I had a rescue squad shift the next day. If I wasn't able to catch up with him that evening, I'd have to wait until the end of the week to get them. I shouldn't have been so worried. I managed to meet him at the ED while I picked up yet another patient going to Fairfax Hospital and  I was finally officially a released Loudoun County medic!

My new keys...and well used PTS ambulance. ::huge smile::

Since I've been so busy and it's been so cold, I haven't done much with the garden yet. We've had some interesting things going on--namely the pipes in the apartment complex froze and broke at the beginning of January. Since we live on the ground floor, all the water naturally drained into our place. We were living out of a hotel room for about 3 months and almost all my plants died. Spring cleaning was fun--moving back in and trying to get the remainder of the flood damage cleaned up.

So I acquired a new plant to start the garden back up again.

It's a little shamrock plant--Oxalis to be more precise. It has beautiful white flowers and so far has been rather tolerant of not getting watered as regularly as it should. Something about me being very busy with paramedic class homework and rotations. Speaking of which...I'd better get busy.

Choosing Plants is Easier than Choosing a New Car

Last week through an unfortunate series of events, my car was totaled in an accident. So I've spent a good portion of last week when I wasn't doing rotations or precepting searching for a new one. By the time church got out this morning and it was time to go back into car shopping mode, it was the last thing I really wanted to do. I honestly thought I knew what car I wanted to get earlier this week. Now I'm not certain.

Turns out that car shopping and plant shopping are somewhat similar. I need a car that I can afford without a big loan, is reliable, gets good enough gas mileage so it won't break the bank when I have to fill it up every week, has excellent safety ratings, low maintenance costs, does well in snow... In addition, I want a car that handles very well--turns tightly, accelerates and slows down well, and has a a sunroof and manual transmission. I still don't know what I'll end up with--essentially it's all going to depend upon availability and price.

Choosing the plants for my kitchen garden is similar--it usually comes down to availability and the cost of plants and seeds. The varieties you start from seed may or may not survive long enough to make it into the garden, so it often comes down to what the nursery has available. Because I have very little space to work with and watering is such a chore, I have to take those factors into account in addition to the climate region the plants will be living in since I keep them outdoors. Disease resistant and heirloom varieties are usually best. Heirlooms have been around for a long time because they taste good. And diseases and pests can destroy the harvest. I usually choose dwarf varieties because my biggest problem is space.

One dwarf tomato variety I've enjoyed growing and plan to grow again this year (I did not take and do not own this photo) is called Tiny Tim. It's a very compact cherry tomato. Last year I had another dwarf patio tomato that produced tasty golden yellow fruit.

Herbs usually don't take up a lot of space. Planting several commonly used varieties in a window planter that can be pulled inside during the winter is a great way to A) have a constant supply of fresh herbs, and B) decorate. Here's a photo of my planter from last summer: 

From L to R: Thyme, Rosemary, Parsley & Oregano

In two separate pots I had chives (a perennial) and several different varieties of basil. Plan is to  start by rehabilitating the herb garden next week since it's still too cold out--in between work & car shopping. We'll see how well that goes...

Starting a Garden on an Apartment Patio

Everything begins somewhere. My gardening experience started when I was a child helping my mom and younger siblings plant a garden in sunny southern California--where there are two seasons: the sunny season and the rainy season. My medic experience began Spring 2009--not long after I was first one scene when my youngest brother was hit by a car in front of our house and broke his arm.

 I didn't realize how much I'd miss gardening until I left for college in Virginia. Within two months I had a pansy growing on my windowsill. Six months later I had a small herb garden and a long-suffering African Violet. During my second year of college, I started volunteering with a local rescue squad and became an EMT. I loved learning about the anatomy and physiology, but unfortunately, they didn't cover enough of it to satisfy my curiosity. So after graduating from college and volunteer fire school (yay for being a smallish girl in turnout gear kneeling on top of the hose to control it), I got a job with a local ambulance transport company, moved into a small condo with two friends from college, and went to school for EMT-Intermediate Spring of '13 and graduated last summer. Finally I learned more about anatomy and physiology! To help deal with the stress of class, I started running and expanded my small potted garden. My schedule was ridiculous, and I only had a few hours here and there to work on the garden.

Last year, the garden began with a packet of tomato seeds. I found a dwarf tomato variety that was perfect for a pot. This is a different variety, but ended up in a pot on my patio as well.

Our condo is on the ground floor and includes an approximately 8x10 ft concrete patio outside a sliding glass door. There was a small area of grass between our patio and a neighbors patio (3.5x4ft) that I decided to turn into a small vegetable patch. 

As soon as the ground thawed in February, I started by removing the top layer of sod. Turned out there was a 6in layer of gravel 4in beneath that layer of sod...yay. It took me two months to painstakingly pick out pieces of gravel out so I could dig up another 8in of soil. 

Sometime in May, I found a beat up old rocking chair by the dumpster in the apartment complex. It soon had a permanent home on my patio. It was so relaxing to come home after Intermediate class or a long hospital rotation, go for a run on the trail, spend half an hour working on the garden, and then sit in the rocking chair watching the sunset and the fireflies after dinner.

By the end of the summer, I had about thirty-eight pots of varying sizes containing a variety of flowers and vegetables.

I choose to use a mixture of organic and commercial fertilizer and pest control products. They worked for the most part, but I still had a big problem with mealy bugs. A swallowtail caterpillar made it's home in my Parsley and two praying mantises took up residence in the garden in April, and helped with pest control.

 In late June, I started to get my first harvests. The most difficult thing was keeping everything watered. There is no outside hose. So it was a daily thirty-minute chore to haul the requisite eight gallons of water using a watering can (I have two of them: a 1/2 gallon and 2 gallon) from the kitchen sink to the garden. 

By August, the place was starting to get overgrown. The tomatoes were too tall for their stakes--eventually breaking the stakes and my zucchini plants were trying to knock down the little wire fence surrounding them.  

My cucumbers had reached the top of their trellis and were going down the other side. I started giving produce away because my roommates and I couldn't eat it before it went bad.

 By October, pretty much everything I'd planted was done. By then I was precepting as a medic at work and with my volunteer rescue squad, had just begun an Intermediate to Paramedic bridge course and was taking a condensed (8-week) college level Anatomy & Physiology class. The cold weather had killed off most of the annuals, so I left the pots sitting out for the winter.

As soon as the ground thaws enough for me to dig in it, (hopefully later this month) I'll start turning it over getting ready for planting in the spring. I can't wait.