Wednesday, April 29, 2009

This just in; swine flu

I'm considering applying for a MD/MSPH combined program. That is, ONLY to be more able to do research as part of my practice. Any part of me that actually wanted to work in public health has been finally scared away by the mass hysteria over the "swine flu". Seriously, I couldn't deal with this stupid of people all day...

Sunday, April 26, 2009

Pissing off the FAA

(Image "Dope on a Rope" from www.tetonat.com )

That's a picture of a "short haul" technique used to insert rescuers and evacuate patients from highly technical terrain. Its certainly one of the perks of SAR because its a ton of fun and certainly something different from the normal EMS routine (which is "treating" patients who don't really need your help).

Advantages include decreasing the hover time (which is the most dangerous time period of any helicopter operation) and staying away from the more complicated winch in/winch out mechanics.

Disadvantages include no visual communication with the pilot (radio only) and it requires a tremendous amount of skill on the pilot's part to avoid flying the rescuer and patient into trees, buildings, rock walls, etc. Sadly, such an event happened recently with one of the most accomplished mountain rescue teams in the country. The patient was killed and the rescuer critically injured.

Usually, our team is inserted via helicopter on a ridge and then we descend to the patient. In this manor, the ship is usually on the ground (or has one skid down) and we exit out the doors onto non technical terrain. Per FAA regulations, short hauling, winching, and rappelling out of civilian helicopters is strictly prohibited except by a very select few trained individuals who work for the helicopter companies. For example, there is only one civilian air ambulance company who is allowed to winch patients and their medics in and out.

That's great... but I really don't give a shit. If inserting via technical means (mentioned above) is the safest way I can get to my patient I'm going to do it and ask for forgiveness if necessary. I've always followed the motto that "The fastest way to the hospital is the best". We're lucky that we have a helicopter crew that is willing to support these transgressions.

Case in point; a few days ago we had a MCI on a large rock face. Multiple patients took extended (500-1000 ft) falls or slides. We had a few fatalities and a lot of patients circling the drain- including pediatric patients. We had two options- climbing in from the top or bottom or short hauling in.

Hiking in would have exposed our rescuers to an extreme avalanche danger, rock fall, and a slope that was melting out. It also would have meant the death of many patients because it would have taken us an hour to reach them.

We choose to short haul two of our rescuers in and extricate the patients as soon as possible. No worries, it has become standards operating procedure. We did, and not one patient died who wasn't already dead when we arrived on scene. Considering the nature of their injuries, that is a huge accomplishment and uncommon in SAR.

In typical fashion, the news crews (who could ruin a wet dream) published the footage despite us asking them not too. The FAA saw it. We're in deep shit. But, ya know what? I'd do it again, and again, and again without a thought otherwise.

Get the patient out as fast as possible and they live... all I give a damn about.

Thursday, April 16, 2009

Prostate Watch 2009 (Last One, I Promise!)

Final pathology came back for the lymph nodes sampled during my dad's surgery. The cancer was contained to the prostate, Gleason remained at 6, and there were no other indications of a spread. Hooray! The tough old hoot went for a hike today, I'm proud of him!

The lesson in all of this is to get checked out early and often. His PSA never rose past about 2 and had been consistent there for a few years (with negative biopsies). But that, combined with a strong family history, kept him going in for biyearly exams. The list of people whom have died from prostate cancer they ignored is long and distinguished and thank god my dad isn't one of them.

Peace

Wednesday, April 15, 2009

Have you farted yet?

If you're asking my dad then the answer is yes!

His robotic prostectomy went well. The procedure as a whole took 3 hours from pre-op room to post-op room and bleeding was contained at 500mL (slightly more than usual because some of the bleeders were near nerve plexi that the surgeon wasn't going anywhere near with a cauterizer). The surgeon caught the tough old stuborn man walking around the ward about 12 hours after surgery and promptly told him to get back to bed. Doctors truely are the worst patients.

30 hours post-op he was back home and eating solid food AND refusing pain meds. I love my dad, one day I hope I'm as stuborn and tough as he is.

Sunday, April 12, 2009

Oh, FSM, why do you hate us

My little brother broke his nose. He broke it really, really badly. Hence, he will be going into surgery the same day as my dad to have it repaired. They'll have to put him under general anesthetic and it'll take about 2 hours. My poor mom will have to deal with it all because my asshole Ochem professor won't let me out of my exam that day. I hope his rotting carcass burns in whatever hell he believes in.

I am the only one in my family who won't have had surgery this year. I guess we used our deductible. Maybe I should get my tonsils taken out (they're friggin huge).

Friday, April 10, 2009

I'm a dumbass....

I got my father (a classical rock aficionado) a mint, two sided, Frank Zappa LP (The front and back are below) and original concert poster from the mid 1970s for his birthday.

His birthday is the day before he goes into surgery to remove his cancerous prostate

Frank Zappa died of prostate cancer...

Dammit.



Tuesday, April 7, 2009

Lights Flashing and Bodies Stiffening



It was a bizarre scene, lights flashing through pine trees weighed down with powder alternated breaking my view of a perfectly clear night. The stars were so beautiful against the high alpine background that it would distract me for minutes until the reality of what we were doing came inching back to me, dripping down my neck and reminding me of our situation.

A kid, 16, had been missing since about 2pm. It was now 8pm. Six hours at 10,000 feet in rapidly cooling conditions and with feet of new, light snow on the ground decreases your survival time significantly. She was without any survival gear, without an avalanche beacon, and had been in a resort skiing with her family. High winds turned around our helicopter so we were alone and searching a mountain on skis.

The beams from our headlamps are really what sticks in my mind. I'd be alone, or I'd feel alone, then one of my teammate's lights would splash across me and be gone as they turned to complete another traverse. The reality of the situation was that we were searching for a body. All of us would like to think she was still alive but I doubted it. In an area with excellent cell phone coverage we would have heard from her by now.

When one of us skied across her skis... literally skied across them, their edges stopping my teammate, our suspicions were confirmed. Her skis didn't move, they were firmly attached to her boots and thus to her. She was upside down, headfirst in the soft snow of a tree well.

People have warned me of the gruesomeness of Search and Rescue... or Search and Recovery... but I hadn't experienced it yet. All of the dead bodies I'd seen were fairly benign before this. She had obviously struggled, attempted to free herself, then passed out from the lack of oxygen.

I wondered if the light filtered down to her like the lights from the snow cat above us randomly filtered down to her. Five feet of snow was probably too much though; and her last images were almost surely dark. She was within sight of a groomed ski run.

Cold bodies with rigor don't fit well in body bags and fit even more poorly into ski toboggans but we did what we could. We skied her awkwardly to an ambulance. It was clear that she was dead but there are less questions if they declare her than if we do.

No one really talked, even at the debrief. Some team mates made mistakes traveling in but no one was in the mood to criticize. I answered some of the medical school student's questions and thought about my little brother, 16, loves to ski, loves to ski through the trees. Then I went home to a warm bed, a cuddly girl, and promised to not dwell.

I lied to myself and said it didn't bother me, it did.

Sunday, April 5, 2009

Bad Weekend

Two rescues. A lot of time on skis, with avy probes and shovels out. One fatality- he didn't see anything coming and did nothing wrong. One survivor- a knowledgeable skier in a spot no knowledgeable person should have been.

Maybe I'll write about it later...

The medical school students I'm teaching sure saw what a lot of SAR is about this weekend.

Thursday, April 2, 2009

New Blog and Some Motivated Students

EE pointed me towards a blog co-written by a psych resident and an ER resident. It *almost* makes me want to go back to working in an ER. But then I think about playing with helicopters and all those silly feeling go away. Anyway, check it out: http://serenitynowhospital.blogspot.com/

I started teaching our annual Wilderness Medical rotation for the 4th year medical school students today. Needless to say it'll probably be their easiest rotation, but I'm hoping we can make it a lot of fun. I did get a call from the Dean of their medical school this morning:

Dean: "I'm a little nervous about a lowly EMT teaching a med school class, what makes you certified"
Me: "(All of the BS letters behind my name, blah, blah, blah) and I think I have enough experience to be able to introduce them to real life wilderness medicine.
Dean: "Oh, well, ok. They'll be writing evaluations on you though. So be warned. I don't want this to be a 2 week vacation for them. Med school can't be fun..."
**paraphrased slightly... and over exagerated

To be honest, I'm really excited. All of the students are motivated and learn quickly. Traits lacking from 99% of my undergraduate students. I guess that's why they're in medical school.

If you're a medical school student interested in a fun rotation leave me a message on here and I'll get in touch with you. Topics we're covering:
-Search and Rescue basics
-Patient Packaging
-Patient transport decisions
-WMS approved wilderness medicine curriculum (same stuff we teach the docs)
-Basic Rope skills (raising, lowering, low angle evacuations)
-Helicopter operations
-A few practice rescues

Plus, you'll get too do some rotations with the docs on ski patrol (assuming you can ski or board) and any call out I go on while you're in my class you get to tag along on.

Enough shameless plugging. Back to writing lectures on acute abdomens:

Wednesday, April 1, 2009

Its the little things

I have the best girlfriend known... I swear. Why? Because this is what I woke up too: Click Me

Except in a tuperware and in my back pack. What'd you think I was going to link you too?
On the morning before a big mutha of an OChem exam it really is the small things in life. And a lot of Red Bull. And some trashy pop to keep me awake.