So today was my last day at work.  It started out lovely enough.  We were posted to one of my favorite spots (it has a bathroom and a sofa).  I slept on the sofa for about 90min before we were moved to another part of the county.  It was C-O-L-D for Oregon standards this morning.  It was 33 when I arrived at work.  Brrrrrr.  Its not the dry cold of New England either, it is a damp and windy cold that makes you shiver to your bones.  Anyway, yeah, it was a cozy peaceful morning and I was looking forward to basically "phoning it in" today.  I assumed it would be another day like the rest of my week and month really, people 75% full of crap who really don't need an ambulance but need a shower, a social worker or more hugs from their parents as children.  I didn't think today was going to be anything special and I HOPED today would be slow and easy.

At 0700 we were toned out on an auto vs pedestrian. We get a lot of these and they almost ALWAYS turn out to be nothing.  A scratch or a bruise maybe a head laceration that warrants some stiches.  Most often it is people seeking to make someone else pay for their pain and suffering and thus we take them to the hospital where they can have some narcotics and get some medical documentation to warant a renewed medical mary jane card or a trip to the methadone clinic for their "back pain".  It is not usually a true 911 emergency.  As we drove up on this scene, however, it started to become apparent that this was a bit different.  PD had not yet arrived, nor had fire.  We parked in the middle of the street and I got out into the freezing cold air.  I could see a car with its flashers on and I could see a lump in the road up ahead.  I could see two people on the sidewalk talking on cell phones....What the?   It became clear very quickly that the lump was my pt.  "Oh shit, this is going to be bad isn't it?" I said to my partner.  "Hmmm, could be."  He said.  The two people on the side of the road continued to talk on their cell phones.  "Ok, I need you both to hang up and tell me what happened."  Nothing.  "Hey!  You two, get off the phones and come over here.  I need you to tell me what happened."  One woman tried to talk to me and the person on the phone at the same time.  "I said, hang up.  You can call them back.  I need to know what happened NOW!"  She hung up and told me she had been on her bike and saw the woman just after she had been hit.  The woman was 25-30' from the crosswalk face down on the street, not moving.  "Are you the driver?"  I asked the other witness.  "Yes".  "What happened?"  I asked.  "I don't know where she came from and then I hit her and I don't know what happened or where she came from".  He was visibly upset. I couldn't blame him.  She still wasn't moving.  I stabilized her neck and continued to ask questions.  My partner pulled up along side me with a backboard, the stretcher and all the necissary equipment to immobilize this pt.  All I needed now was fire.

After what seemed like an eternity, fire arrived and just as my partner and I were finishing cutting off her 4 layers of clothes we were able to safely roll her over while still protecting her spine, on to the long board.  At this point she was breathing on her own but not all that well and we could see she had skinned her face pretty well and had the distal part of her femur sticking out just above her knee.  "Oh, shit!"  I said, "On my last fucking day?  Really?"

Fire helped us get her packaged up and we hustled her into the back of the car where my partner was busiily setting up the medications to perform a rapid sequence intubation.  The plan was to paralize and sedate her, place a tube in her airway and breathe for her in order to protect her airway from vomit mainly.  Head injuries have a way of making people puke and puke in your lungs is not good.  The savingest of graces was the fire crew.  I had been pissed at them in my head for taking so long and then not "putting a husle on it" when they finally DID arrive.  Once in the ambulance however, it was all business and it was good.  I realized I had two of the most sr medics from a VERY medic oriented system.  They were people I knew to be good, "old" and they were being very proactive.  One was meticulously writing down everything as it unfolded and the other was cranking away to get an iv while I got my act together, placed the pt on oxygen, got her on the monitor and set up the best I could for airway management.  My partner was double checking his drugs and getting ready for the flash/bang of RSI.  It was a clustered up mess but it was pretty typical of how this sort of thing works.

In my head I was flipped out.  "F! F! F! F! I do NOT want to do this!"  Kept ringing in my ears.  I wanted to pass the buck onto anyone else.  I was spinning and anxious and fumbling.  Then I remembered the words of one of my old partners.  He had given me a several hour lecture about how you won't ever be successful at an intubation if you go into it thinking you're screwed.  With this lady...I WAS screwed.  She had everything wrong with her except facial trauma, to make this a very difficlt tube.  Short, fat neck.  Anterior structures, VERY small mouth, VERY large tongue.  To top it all off she was in a C-collar to protect her neck.  Damnit all to HELL!  I was just about to find some way to flake out when I felt a calm come over me.  "You are going to get this tube.  You are going to protect this woman's airway.  Everything is going to be allright" drifted through my head and I believed it.  I felt peaceful and clear and started to think about all of the times (All whopping 5 times mind you) in the last 2 years that I had tubed someone and what I had screwed up and what I wanted to do differently in hindsight.  I grabbed my tools and positioned the pt.  I even insisted that she be given more medicine since her jaw was clenched and that was going to make it impossible.  When I was ready and she was loose I went in with a plastic stylet and shot in the dark.  The fire medic told me she could feel the stylet and after advancing it just a bit more to be sure I was in we slid the tube over it and made an attempt to ventilate her.  IT WORKED!  WE DID IT!  She was being ventilated and her numbers looked good.  We were headed down the highway by now.  "Ahhh"  I could breathe.  I reminded myself to breathe every time I squeezed the bad pushing air into her lungs.

We delivered her to the hospital in better shape than we found her and the MD (a doc who has LONG intimidated me with his brilliance and ability to take medics to a new level of respect or to take them apart) told me "nice work"  NOT something he says often or lightly.  I felt like I had done a good job.

The rest of the day was full of less acute but similarly labor intensive people.  We ran our next call on a diabetic person who had not been eating but had been taking inulin and was found on the floor of their friends house having a sz.  Old IV drug abuser, no IV access AT ALL and lower than 'lo' reading on our blood glucose monitor.  "Shit"...again.  This was my partner's patient and thank god!  This pt was a totall and utter mess.  Bad heart, no veins, and seizing...awesome.  By the time we finished with this pt we were out of sedative drugs and the car was TRASHED.  We had to go back to the base and get more drugs.  We were starving so I bought us lunch in the cafeteria while my partner wrote his chart.  An hour and a half later we were back in business.

Next up?  Pneumonia with a bad fever in an elderly person in a care facility....Uggh!  This pt was SICK.  They needed a ride to the hospital for SURE.  By the time we arrived at the hospital I had been having braxton hicks contractions for hours.  This day was very physically demanding.  lifting, stairs, anxiety, climbing....It was time to be done and my body was telling me better than anything.

So, now, I am sitting in bed willing myself to stay up just a bit longer so I can time the contractions I am having..... Boo.

I am now 33 weeks and holy shit that is crazy!  The house is a disaster and G and I are overwhelmed but optimistic.  I just hope to hell this baby doesn't come early.  I am SO not ready.  The baby shower is this weekend and I am very excited about that.  In the mean time I need to pound some water and go to sleep. I need these contractions to stop.  They are painful and tooo early.

I will write more about them in the moring.  For now just know that my last day was full of learning, over doing and doing right.  I am glad I had such a bananas day.  It is good to be reminded of everything you 'do'.  And keeping skills sharp is important as well.  I am sure I will be one oatmeal brained fool by the time I get back.  Poor partner.....