entelechyproject

We always put off turning on the heat. As September rolled towards Equinox, with fuel prices still hanging impossibly high, we put it off over and over again.

“I’m cold.”

“We could turn on the heater.”

“Um, well. I guess … never mind. I’ll find the wool socks.”

or … “Nyssa is crying.”

“Cover her up.”

“She is covered up.”

“Oh … maybe we should turn on the heat.”

“Well … I’ll just give her another blanket.”

Mornings are brisk, but we are out the door quickly. Nights aren’t bad, with quilts and down comforters and wool blankets. We probably have enough to survive a nuclear winter – which isn’t far from what we have up here for nine months anyway. But when you are reading in bed under eight layers of insulation and your hands get too numb to hold the book, it is time to give in.

Last week, after Peter harvested the rest of our carrots and parsnips, I brought an outside thermometer into the cabin. When I saw that it was still reading below fifty in the middle of the afternoon, I went out to start our stove up for the season. We almost managed to make it to Equinox with no heat, but not quite. Maybe next year.

After much wrangling with our landlord, we did manage to get our windows, eaves and floor-edges re-sealed, and an arctic entry installed around our drafty front door. When she came by to take a look in May and realized that no, we weren’t exaggerating when we said we could see daylight around all four sides of the door and around the purlins on the ceiling, she agreed to do some work. I wish we’d had this conversation a year ago, but suffice to say we won’t be using quite as much heating oil this winter.

Last weekend, I worked as an EMT for the Equinox Marathon that runs from the University up Ester Dome (a Dome, in Alaska, is a Really Big Hill … it is not an easy Marathon.) I was hoping for pretty views of Denali and the Tanana Valley as we watched runners struggle by, but instead we parked the ambulance in a cloud and spent the marathon warming up runner after runner with numb hands and mild hypothermia. It was a nippy morning down at the start, but nobody was dressed for the cloud of sleet at the top of the long climb. Although I felt pretty lazy watching seven hundred people limp past shivering and soaked, sitting in my warm ambulance studying RSI drug dosages and downing bowls of chili our fire chief’s wife brought up for us, I was just as happy to put off my own attempt for yet another year. Especially when we started getting runner after runner with a dozen bee stings from running through a nest on the trail.

That evening, I managed to pass this year’s Medic agility test with a minute and a half to spare -completing it at all being miracle in itself given my current state of endurance. Then Sunday night, I showed up at the University Rec Center for a league indoor-soccer game. Only five Paramedic students showed up, and we played against a team of sixteen undergraduates – eight of them on the court at a time against our five. Given the odds, and the fact that the other team actually knew how to PLAY soccer, I thought our 5-2 loss was pretty impressive. Especially since one goal was a header off a perfect corner kick by yours truly that didn’t go where I intended but ended up perfectly placed for another teammate anyway and the other was a fluke I managed to tap past the goalie as I attempted to keep myself from tripping over the ball and doing a nose-dive. Apparently everyone on the other team thought I did it on purpose and were thoroughly impressed. I am not going to relieve them of that impression. The short of it is that as the oldest player on the court by seven years, I was feeling my oats for the first time and wishing I still had an inhaler, but I managed to show the Impertinent Youths how things are done regardless of my inability to breathe for most of the game. I have been limping ever since.

Paramedic clinicals have started in earnest, and true to form I am already behind on paperwork. I spent last week in L&D watching babies get born in various ways and with various complications, and I feel like I learned more in those three days than I have in the five weeks of eight-to-five note-scribbling classroom frenzy preceding them. This week I had the Colonoscopy Special all day Monday in Outpatient procedures, where I learned the ins and outs of conscious sedation. Then last night and this evening I’m scheduled to skulk around the ER like a true trauma junkie.

Last night, while trying – and failing – to get an IV on an abdominal patient, I missed two … count them TWO … gunshot wounds. Truth is, though, I learned a lot more from hanging with the abdominal through his eventual admission than I would have from a couple of lucky-as-hell boys who both got an expensive lesson in very, very basic gun safety along with their discharge instructions.

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 …