Thursday, August 13, 2015

Terminus.

Just got asked to work the program for terminal cancer patients.  I'd be the only one in the infirmary. No partner.  Am I up for this?

Wednesday, August 12, 2015

Lumbricals

Understanding the lumbrical muscles has long caused me confusion. Always stoked to stumble upon something that can illuminate their actions. For instance, Judy Colditz contributes this:

"An infrequently mentioned explanation as to why it is safe to fully extend the fingers with the wrist at zero degrees extension is the protective action of the lumbrical muscle.

"It is well known that the lumbrical muscle contracts during active finger extension pulling the flexor digitorum profundus (FDP) tendon distally because of its origin on the moving FDP. When the lumbrical muscle meets the resistance of the resting tone of the FDP muscle, the distal pull on the FDP stops and the lumbrical muscle contracts to contribute to IP joint extension. The lumbrical muscle therefore contributes to IP joint extension by decreasing the FDP tension; it is the only muscle able to diminish the tension of its own antagonist!! (3-6)" - from another great piece by Judy Colditz

Monday, August 10, 2015

What I found inside her earlobe...

What is surgery? After seeing a patient the other day, I decided to look it up.

Sure, there have been some stupendous splinters lately, and time spent under someone else's skin is always quite exhilarating. But so far nothing comes close to encountering the earring-backing that had been swallowed by the wearer's earlobe.

The person hadn't taken her earrings out in a couple months and the skin had started to close up, engulfing the whole back of the earring inside of it. It was swollen and quite bizarre-looking, but fortunately it did not appear infected. The person had been unable to remove it herself and was anxious to get it out ASAP.

I sent her to get some ice to a) numb the area and b) buy myself some time. I couldn't reach my colleagues so it was off to the world's most trusted medical expert: google. Just as with my frosting-tip-stuck-on-finger incident last spring, this, according to someone on the interwebs, has happened before to some people somewhere. And they all lived, as far as I could tell. Some needed surgery (O_o) but other than that, no big deal.

Armed with the highest quality* of lightly-googled "medical" "knowledge", and determined to turn this person's day around, I set forth with forceps and wonder. The end of the backing was just peeking out. I gripped it and instructed her to let me know if it became to painful.

Moving slowly, I was able to gently ease the backing up and out of the hole. It seemed to grow in size as it emerged from its burial. At last, with an inaudible pop and a great deal of rejoicing, it was free.

As if I'd just unearthed a precious gem, we stared at it with a degree of surprise and wonder.

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Good running, good sleeping, good weekending with 8+ miles each day, half of which were are beautiful Brad. It's the best time of year. I say that at a lot of times of year...

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Of note, on one of the recent splinter-kids -- I looked down at the big, dark splinter and tried to carefully dislodge it. It wouldn't budge. When I looked back up, she was crying. My fault. I made her cry. Me. Right here. Add it to the list of unforgettable moments, bad and good. I am so, so grateful for all that each and every one of these people is teaching me, just by existing.

Friday, August 7, 2015

A suitable question: what are we?

"I don't know what we are, here," said my partner, "but we are definitely not EMTs."

I can only imagine that she's right. We must be having way more fun than they do.

Today I took another mother-of-all-splinters out of a tiny foot. There was a lot of screaming but all I had was ice for the pain. It hardly helped. I inwardly gnashed my teeth and silently demanded lidocaine from thin air but there was none to be had. Then I remembered that, even if I had some, I had no idea of the proper way to use such a substance. Doh. Getting ahead of (beside?) myself...  If I'd been thinking, of course, I'd have remembered to fantasize about all the exciting ways to do a regional block.  (Kidding, I promise.)

Better than any drug though was the rally of other counselors who sat by her, hugged her, held her hands, cheered her on non-stop, and... played to her videos about three-toed sloths (her favorite animals). Sloths. The whole scene was medicine.

I have been very roamy, inwardly and outwardly as of late. I ended up out on the point, under the ropes course. I found and shadowed Hanne for a bit, garnishing a few belaying pointers which should soon come in handy.

Later I examined a sore thumb a couple times. I'd told her to come back if it wasn't better after icing for a few hours. (I need to reiterate the luxury of having access to one's patients for weeks on end here.) It didn't, but I had more ideas the second time around. The best feeling is knowing what to ask, and maybe also where to look, but I need to learn to get these things largely correct the first time around. And my technique remains in need of serious work. Be more methodical. Slow. Down.

Hay's and my differences in EMT med and wilderness med came up today - interesting. I guess we do have pretty different backgrounds...

Saw a parody video of first year med students this evening, and there was a great scene where a student in a fancy white coat was bolting down the street, chasing her potential patient, who was running away as fast as humanly possible. :)