Change of Pace: June 2011

June 26, 2011

Kate SPADE!

Omigosh, for those of you who know me, I absolutely LOVE kate spade! On the way back from Orlando there was an outlet and I got two large bags and this gorgeous pair of pink shoes (the shoes were less than $40!!!):

June 23, 2011

The ABCs

As I mentally prepare myself for the biggest transition of my medical school career- from pre-clinical to clinical student- I can't help but be reminded of my humble beginnings in EMS.

For the past two years, I've been sitting in a classroom with 160 other students and an "even" playing field- most of the classroom knowledge is so specific that no one really goes in with an advantage. But as I review my schedule for orientation week, I cant help but fixate on the Wednesday afternoon CPR class.

I'm sure that most of my classmates have taken the class, but I wonder how many of them have had to put it to use. Not only that, but frequently be in situations where the life of a patient depends on the split second decisions and actions of a 20-year-old paramedic.

Driving today, I reflected on some of the calls that have heavily shaped and influenced my "clinical personality." For some reason, a call that I hadn't thought about in years kept replaying in my head.

Returning from Duke University's ER after one critically ill patient, I vividly remember the dispatch to another ambulance for a pedestrian struck on a highway. I was trying to get back to my district before letting the dispatch center know we were available, and we weren't there yet. But we were, by far, nearer than the next-closest ambulance.

I immediately weighed the options in my head: keep going, and avoid a messy call, or go the ethical route and handle the call. My EMT partner, who was driving, looked at me as if to ask me what I wanted to do. I know she wouldn't have judged me if I had ignored the call, but I knew I couldn't live with myself if the patient died. I would always wonder if the extra few minutes could have saved him.

I picked up the radio and notified dispatch of our decision. Later I realized that I could have been reprimanded for not alerting them I was available, but at that time, that was the last thing I was thinking about.

I was a new paramedic- I think I'd only been "fully released" (allowed to function without another medic) for a few months, and with no other scene information, I had no idea what I was walking into.

We literally pulled up on the scene within a few minutes, and it was something I'll never forget. It was a huge highway (540 for those of you familiar with Raleigh), with four lanes on each side. In one of the middle lanes I saw a heavily clad African American man (it was the middle of summer) lying on the pavement. The speed limit in that area is 65mph. A few cars had pulled off to the shoulder- out of the corner of my eye I noticed a few hysterical bystanders.

To this day I have no idea what possessed this man to try and cross the highway at rush hour, but the woman who struck him (purely by unavoidable accident), believes he had dropped some sort of tool and had run out to retrieve it. She was clearly upset but talking to her for any longer would be futile, so I turned to the patient.

We strategically parked directly behind the patient to protect us and the patient from traffic, but the entire time I was on the scene I couldn't help but think about all the passing cars going 65mph inches away from me.

As a crew of two females, we had little choice but to stay put. My poor partner had to endure my frantic demands- radio for help, get a backboard, get the EKG monitor. First responders, usually on scene before us and better equipped to deal with heavy traffic, were several minutes away. They were also coming from the other direction on a divided highway so I had to watch them drive by my scene as I helplessly pushed on this poor man's chest.

While it seems impossible to survive such an impact, I could not find any actual injuries on the patient, as desperately as I searched. Based on that alone, I made the decision to work the cardiac arrest- in other words, attempt to resuscitate him.

Between the two of us (my partner, aptly named Angel, was truly was an angel that day), we managed to have the patient packaged for transport by the time help arrived (which is a feat, just take my word for it!). He didn't have a heartbeat, but there was still electrical activity in his heart, so I did my best to jumpstart it. Since I couldn't defibrillate him (PEA for medical geeks!), I did CPR for about 10 minutes. If anyone had ever done CPR, you know that it's exhausting. It's recommended that you switch people every few minutes in order to maintain adequate technique.

With help, we loaded him up and went back to Duke. I felt so ashamed pushing the stretcher into the ER. He had no IV, no endotracheal tube, nothing. I basically just ran a BLS code. I had one fireman to alternate CPR and ventilating him and that was all I could manage.

Looking back, I realize that I did the right thing. All my decisions were sound and logical. I could defend any one of my choices in court.

In medicine, you always start patient care with the ABCs- airway, breathing and circulation. Truly, the basics were this patient's best shot. I could have stopped CPR to intubate him so I wouldn't be humiliated by the doctor, but that would've been for my ego, and not the patient's best interest.

The team of doctors and nurses who took over had just seen us leave and knew our time limitations. They even commended our efforts. They continued resuscitation efforts briefly, but everyone knew it was futile.

I learned a lot that day. A lot about myself, and a lot about sticking to my guns. There wasn't anything I could've done differently (I believe) that would have saved this man's life, but I did the right thing. I gave him the best shot possible.

I still don't know why he died; I can only make the assumption that he had a traumatic brain injury with severe hemorrhage. I also don't know why he ran into the highway, but it must have been something important that led him to risk his life.

I'm really dreading this CPR class next week with a hundred fellow students who don't know what it's really like, but I know that as I sit there I'll be reminded of the countless patients who did (and some who did not) survive because of my basic skills from training at the beginning of my career.

June 22, 2011

20 dumbest things about being in your 20s

I "hole-hartedly" disagree with most of these statements. While they may apply to many people, I think they are far from accurate in describing a majority of people in their 20s (and by that I mean, I don't think most of these apply to >50%). Here is the list, from a TruTV article (things I REALLY disagree with are highlighted):

You discover that a college diploma doesn't mean squat.

Fact: More than 40% of college students graduate owing over $20,000 in student loans.

You're thrust into college at an age where you barely know your ass from your elbow, let alone what you want to do with your life. So you end up paying out the wazoo to study something dumb, like philosophy or religious studies, because it sounds cool. Four years later: Congrats! You have a nice piece of paper, no professional skills and thousands of dollars in debt.

That darn "Quarterlife Crisis" hits when you least expect it.

Fact: The average age of those first diagnosed with Generalized Anxiety Disorder is around 25 years old.

That awkward, anxious, uncertain period of time that hits as you transition from adolescence into adulthood is known as the "Quarterlife Crisis" — a trendy term for the freak-out that comes with the realization that you, and only you, can accept responsibility for your decisions. I know I suffered from the QLC because I was given a book about it as a graduation gift, which I read thoroughly in between teary, frantic phone calls to my father and the occasional dosage of Klonopin. But no amount of drugs, friends, fancy cars or books can save you — you simply plow through this twentysomething purgatory as best you can. Though if you must, feel free to purchase Quarterlife Crisis: The Unique Challenges of Life in Your Twenties.

Dating is a joke.

Fact: Two-thirds of twentysomethings spend some time living with a romantic partner without being married.

Dating doesn't exist in your 20s. If you're not busy hooking up with everyone and their mom, you're diving headfirst into a relationship with the first person who will put up with your sh*t. Unless you take the time to really get to know anyone (including yourself), and find out exactly what it is you want in a partner, you'll wind up in an unhappy relationship, battling your own personal Weinergate.

You don't take care of yourself in any shape or form.

Fact: In 2008, approximately 27% of people aged 18 to 34 did not have health insurance.

Note to Invincible Man: The chain smoking, heavy drinking and excessive amounts of sun exposure will catch up with you. Your Speedy Gonzalez metabolism will eventually slow down and you'll have to swap the pizza and beer for fruits and vegetables. And strawberry-flavored edible panties don't count.

The place you call home is no more than a disgusting, dumpy squalor.

Fact: One-third of people in their 20s move to a new residence every year.

Unless you're living with your parents, what little place you can afford is merely a step above a cardboard box that comes equipped with a couple of obnoxious, lazy a-holes known as "roommates." The dishes pile up and you refuse to clean, because you always clean, and hey, it's the principle. The good news is that when you do finally get your own place, you'll get to furnish the cockroach-infested squalor with hand-me-downs and plastic junk from Ikea!

You're not as smart as you think you are.

Fact: A person's brain is not fully matured until at least age 25.

Just because you graduated from high school and you pay your own bills, it doesn't mean you have the world on your own personal brightly colored string. You may as well take your youthful arrogance and go invest in some diapers, because You Know Nothing, a fact which you will repeatedly be reminded of throughout your 20s.

You work way too hard for too little pay at a crappy job.

Fact: People go through an average of eight jobs in their 20s, more than any other stretch.

Once you do choose a career you think you will be able to tolerate for the next 40 years, you have to start from the depths of hell. Whether an intern, an administrative assistant or somebody's personal slave, starting from the bottom isn't exactly glamorous. Sometimes you don't even get paid. While interning at a popular tabloid rag, I worked grueling hours for free, fetching coffee and transcribing interviews. The only thing I learned was how to avoid carpal tunnel. This is called "paying your dues," and it sucks balls.

You think you're fat and ugly.

Fact: Nearly 30% of people who got Botox injections in 2009 were under the age of 30.

You hate your big nose, butt chin, love handles, forehead wrinkles, etc. In truth, you look as good as you're ever going to look, so embrace it. And if you think you're fat now, just wait until you're a 50-year-old sloth with a beer gut and age spots.

You're broke, but you spend money on stupid stuff anyway.

Fact: We are the first generation not projected to do better financially than our parents.

You can barely make ends meet on your pathetic entry-level salary, so you sign up for a credit card. Having an emergency card is a nice thought, but applying for five credit cards is notworth the free coffee mug. I didn't get the memo and wound up with a coffee mug, some useless handbags and $8,000 in debt. The interest made it impossible to pay off, so I cashed out my 401K in order to dig myself out of the financial suckhole, and now I have no retirement savings. Lesson? The minute you start seeing credit as "free money," you're in trouble. It's easy to swipe but a pain to pay off.

You still behave like a kid, so no one takes you seriously.

Fact: Most Americans believe that "adulthood" begins at age 26.

Blink-182 had a point: "Nobody likes you when you're 23, and you still act like you're in freshman year." What the hell is wrong with you? Much of the crud you pulled in adolescence is no longer acceptable in your 20s, but you're not an adult either, no matter how much youthink you are. So in turn, no one really takes anything you say or do seriously. Sad face.

The dreaded draft could happen at any time.

Fact: In case of a national emergency, every male aged 18 to 25 must register for the Selective Service, otherwise known as the "draft."

We haven't used the draft since the Vietnam War because we have an all-volunteer military. But in the event that the government calls up the draft, the burden will fall on dudes in their 20s. So practice those squats and push-ups now.

You drink too much.

Fact: Rates of binge drinking are highest among those aged 18 to 25.

Young adults often seek reprieve from this tumultuous decade by drinking their emotions through a big plastic funnel. Whether because of stress, boredom, insecurity or simply the aching desire to get laid, twentysomethings get out-of-control tanked far more than any other age group. The onslaught of stupid beverages like Four Loko and silly get-sloshed-quick challenges (you've been iced, bro!) don't exactly foster responsible drinking, either.

You can barely rent a car, and if you do, you have to pay for your age.

Fact: In 2008, approximately 27% of all U.S. car crashes involved drivers under the age of 25.

You learn to drive at 16 — that's nine solid years of behind-the-wheel experience! Yet you are stuck paying insane fees if you want to rent a car and are under the age of 25, because apparently, you are not to be trusted. Then again, it could be because you drink too much.

You can't take back those stupid, impulsive decisions you make.

Fact: 36% of those aged 18 to 29 have at least one tattoo.

Twentysomethings are fickle beings, so if you love Tweety Bird now, you might not love him at 40. Therefore, it might be best not to get the dumb yellow cartoon tattooed on your forearm, unless you've given it a lifetime of thought. I proceeded to get a large, emo-esque star tattooed on my wrist (see above) when my boyfriend and I broke up. Maybe I wanted to deflect the pain from my newly broken heart, or perhaps I was acting out, but either way, I can't help but wonder what the hell I was thinking.

Your friends are jerks, and you neglect the important people.

Fact: Between the ages of 15 and 25 is when most people establish lifelong friendships.

Many of your buddies are suffering from their own mid-20s meltdowns, so in turn they behave like selfish, jerky turdheads. You don't really care, so long as you don't have to sit alone at the bar. Meantime, you often neglect those who really matter, who love you no matter what — your family and friends who stick by you through all the boozy blackouts, broken hearts and bad hair days.

Crazy, crippling, ridiculous insecurities are around every turn.

Fact: Of people 20 to 29 years old, 41% feel significantly pressured or have "almost more stress than they can bear."

Full of firsts (first job, first apartment, first raise, first bounced check), this third decade of life can come as a shock. Nothing (I mean, nothing) is ever how you plan it. You're probably not going be married at 25 and making six figures at 27. You might get laid off or knocked up or terminally ill. There's no way to tell, but you focus so hard on the destination, you miss the journey entirely.

You're overly obsessed with social media and your imaginary friends.

Fact: 48% of 18 to 34 year olds check Facebook right when they wake up.

Facebook, Twitter and FourSquare — these are the only links to your old life, your friends from high school or college. You hang on to this time period desperately, spending more time than you like to admit voyeuristically obsessing over everyone else's seemingly better, more interesting lives. But no one posts photos of their breakup or that time they got fired. Their lives suck as much as yours does! Besides, most of these people aren't even your real friends.

You're a whiny, spoiled brat.

Fact: Nearly two-thirds of young adults in their early 20s receive economic support from their parents. The number of twentysomethings living at home has risen by 50% since the 1970s.

Twentysomethings often take their parents (and everyone else around them) for granted, thanks to a false sense of entitlement because it is so haaaard being a young adult these days. So they sob into their smartphones and iPods and MacBooks, when they should really be slapped for being such silly, clueless tard monkeys.

You freak out over turning 30.

Fact: At age 30, you're older (and wiser) than 42 percent of Americans.

Attempting to survive your 20s can be so startlingly horrific, it would only make sense to get psyched about your 30th birthday, right? Yet so many twentysomethings obsessively dread entering this newer, gentler, kinder decade, when we should all take solace in the fact that the 30s are when the fun really starts. (Or so I hear.)