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We have two days of respite while we go through orientation for our clinical rotations at the army hospital on post. After the first day of sitting through hours of mind-numbing powerpoint slides and military jargon, I’d rather be in class. But the food is good.

The lack of class does not translate to a lack of work. Or a lack of procrastination. I spent an hour and a half of my precious study time tonight watching Once. It was possibly one of the most beautiful films I have ever seen, and my stomach still hurts from the closing shot.

So I’ll leave you with this while I hit the books again:

[zucchini]

The last two weeks have felt like just a few days, and several months at the same time. The sheer amount of information we’ve been getting is hard to fathom, even though I’ve been sitting through it, trying to take at least some of it in. When I got home from class on Friday at five thirty, I fed Nyssa, kicked off my shoes and laid down. I woke up at eight this morning a little startled, but feeling calmer and more focused than I have in two weeks. It is amazing what fourteen hours of sleep can do. It’s amazing that I needed that much to catch up.

I spent my shift at the station today burrowed in a corner of the training room catching up on last week’s work and reading. I will spend tomorrow at the laundromat doing the same thing. We’ve covered basic chemistry, cell biology, pathophysiology, pharmacology, nervous, endocrine, respiratory and circulatory systems, related emergency medications, medication calculations, shock, fluid balance and resuscitation and advanced airway management. We’ve learned to start IVs and intubate unconscious patients, and started the process of learning to knock out and intubate conscious ones. After several days of being repeatedly stuck with needles (of varying size) by classmates, we all look like heroin addicts with bruises and trackmarks all over our arms. Those of us that weren’t shy of needles before are becoming so now. Those of use who were terrified of needles don’t mind them quite so much anymore.

But the bottom line is that I love this. After so many abortive attempts at finding something that will work for me, this just feels right like nothing else has. I love the crazy academic pace, the kinesthetics of skills. I love watching all the disparate pieces of information start to fall together in a patient. I love suddenly understanding even more of what I’ve been seeing in the ambulance, being able to think critically about calls and start to answer some of my own questions. I can’t wait for clinicals to start in a few months, as nervous as I am for that step up.

Not that there haven’t been a few hiccups along the way. The Paramedic program is experimenting with a new class & clinical schedule this year, working with new instructors and simultaneously integrating online components that have never been used before. The balance is far from perfect, and things have been a little on the chaos side at times. But with two weeks behind us, I think we are starting to find the sweet spot.

On the MRSA front, I’m almost through my round of antibiotics. Although the worst is over, the infection is hanging in there with every last bit of energy it has. I am going to be watching that spot very carefully in the days after the pills are gone. I won’t make the same mistake twice. (At least not this year …) I’m also starting to feel all the negative gastrointestinal effects that go along with a heavy course of these types of meds (perhaps the root of some of my denial.) There is lots of yogurt and probiotics on my horizon.

Peter is off on the east coast this week, visiting some good friends and helping his dad get their old Harrisburg home ready for sale. He’ll be back Thursday, just in time for the fall colors. The marsh-tundra at the bottom of Goldstream valley is crimson, and the aspen have started to turn.

Peter says I go a little crazy when I’m sick. If something is wrong, I sink into an irrational state of denial and declare that I am fine, that I will get better on my own, no doctor visit is needed. I have ultimate faith that my body will heal itself without intervention.

Two days ago, I woke up with a spider-bite looking wound just above my left knee. There was a tiny, pinpoint dark spot and a raised red area the size of my pinky finger. I have a bad history of reacting poorly to spider bites. I gritted my teeth, tried not to itch, got dressed, and headed into town for the first day of Paramedic Academy.

On examining my leg at lunch, I was startled to find the red area was now as big as all four of my fingers. When I got home, I could barely cover it with my hand. It was hot and stiff and significantly raised. I was sure it would be fine in the morning. Peter was sure I should go to the Urgent Care clinic. After a quick phone consult, so was my mother. I studied and went to bed instead. In the morning, it was worse and I was still convinced it would take care of itself.

I debated myself through eight hours of class today, as the heat spread and the swelling nearly doubled. After yet another conversation with Peter about how I should go to Urgent Care immediately after class, I was still undecided. It is just a spider bite, I told myself, while trying not to scratch through my jeans. My body will figure it out and be fine.

When they let us out of lecture half an hour early, I decided to drive over to the clinic. I would go in, hit the restroom and take another look before deciding. Besides, I needed to get another TB test and titers for varicella and measles for clinical rotations next month.

I muttered under my breath to the receptionist about why I was there. “I was bitten a couple of years ago, and it kind of blew up on me. My arm ended up all swollen and I got a nasty fever. And now I’ve got this new one … it’s just making me a little nervous. And also, I need a TB test.”

After weight (ack!) and height check and blood pressure (110/60, hallelujah!) the doctor walked into the room saying, “You have a spider bite? There aren’t any biting spiders in Alaska.”

I explained while I hopped up on the table and let her take a look. She poked the spot and asked me again how fast it had gotten like this.

“I noticed it yesterday morning.”

“You have an aggressive staph infection. In fact, it looks to me like MRSA.”

(For the non-health care crowd, MRSA is a very nasty antibiotic resistant strain of staph that is endemic in many health care facilities and starting to show up in the general population.)

She went on to prescribe me a round of double-strength antibiotics to be started as soon as I picked them up, a prescription ointment and instructions to heat-pack it every two hours and stay off my feet. She then told me to go home and mark the red margins with a sharpie.

“If the red is past your margins tomorrow night, come back in immediately. You’ll have to go on IV antibiotics. If you had waited two more days, you’d probably have ended up in the hospital.”

Oops. I guess my medical education has begun in earnest.

At eight o’clock this morning, I will sit down in a classroom with sixteen other students. Four are from my fire department. One is from the Fire Medic program. The rest are strangers. We are this year’s Paramedic Academy class. We won’t be strangers for long.

Early this week, faced with a stack of books best measured in feet and every Paramedic school horror story I’ve been told and re-told over the last four months echoing in my head I was having second thoughts. Lots of them. On Thursday, I responded to three very different calls that restored my confidence and resolve. This morning, I’m as ready as I’ll ever be …

I was restored to the fire line on the seventh day, and worked on the Cub Complex for a total fifteen. I was hoping to stay out for thirty – the maximum – and am only a little ashamed to admit I actually cried when I found out I had not been reassigned or extended at the end of my first fourteen (things in California were cooling off by then) and had to pack up and head north.

Highlights included watching a burn-out operation (where hand crews light a forest fire to burn an area ahead of the wildfire to create a line it cannot cross) blow up one afternoon from a ridge above the action. Radio traffic was heavy and helicopters were ferrying and dropping water to contain the burn.

[three hours into the burnout]

Another day, I was posted at the “top of the world lookout” at about seven thousand feet, where I had a smoky view of Mt. Lassen and an incredible 360 view of the whole Cub complex. It was like having a front-row seat for a day as crews were moved around, trees torched, spots were discovered and put out. My partner that day was a more experienced medic who used to work on the fireline, and he was doing double-duty as a lookout for our division supervisor. It was quite the education.

I got to know the faller team from my second day rather well, and ended up sharing several meals with them over the next two weeks. One day they took me with them as they cut down trees along the highway that the fire had closed down. They were looking for trees whose roots or lower trunks had burnt in such a way that they were likely to fall on the road, posing a major hazard to unwary cars. There’s nothing quite like having a massive fir tree fall straight towards where you are standing and explode as it hits the pavement a few feet away. My stomach was not the same for the rest of the day. (I know it is sideways … I can’t fix it.)

I was also posted with a crew of young Pueblo men from a reservation in New Mexico. For several days they were the only hand-crew on my division and I followed them around and hung out with them on their breaks. I got to know several of the squad bosses pretty well, and on the last day they ambushed me, painted my face and put me through the same ‘initiation’ that their rookies go through after their first fire.

[war paint]

On the second-to-last day of my tenure on the Cub, my partner and I left the line late and ended up heading down the mountain on logging roads we hadn’t driven before. We were well behind the crews and well ahead of the division supervisors who were waiting for night-shift to arrive. That day, crews had lit a huge burn-out which was still flaming hard even in the cooler, damp night-weather. They wanted the arriving shift to know exactly what was going on. My partner and I took a wrong turn at an unlabeled T-intersection. A mile later, we came around a corner and found ourselves in the middle of the burn with no way to turn around. The road was narrow with steep banks on both sides, boulders loosed by the fire scattered across the gravel and flaming trees all around in the dark. It was surreal, as was the quickly rising temperature in the vehicle and the crackling I could hear through the closed windows. When we came to a flaming tree that had just fallen across the road, we made a quick decision to risk a 150-point-turn and high-tailed it back to our wrong turn.

Thankfully, there were no major incidents or accidents on my fire. I saw a few decent burns and lacerations, and got more experience with the many and varied presentations of dehydration but for the most part the medical issues I saw were relegated to the blisters-and-sniffles I had been told to expect. When I got back to Alaska, I heard some wild stories about other medics who had some major trauma on their lines. As confidant as I am that I have the skills and perspective to deal with such eventualities, I’m just as glad my first fire was a mellow affair. It let me figure out how things work, what to expect and how to navigate the particular landscape of a long-term ICS operation.

I loved working as a fire medic, and can’t wait for next season. Being paid to hang out in the woods all day and patch up a kaleidescope of wounds is just the ticket for my little soul.