Archive for November, 2008

Life Changing Events

November 29, 2008

Some life events can be easily linked to incidences occurring in the past. This takes in place some eight years ago. So references will make more sense when I blog, here is one I have written about in the past (old blog) that had different impacts on my life, and the person I am both physically and mentally today. Life has taken me through many journey’s and often, more adventures than the average person, hence the need to share my life with the world, as it seems I have more adventures regularly than I have time to write about.

Prologue on event leading to my spinal injury:
In the late 90’s, I had moved to the paradise I now call home.  No sunny beaches, so it was time to find a way to enjoy the snow, seeing how I was living in it. That was the point where I discovered the joy of snowboarding.  I was doing other things in life during those years including working a regular job, volunteering with the county EMS in my area, (Emergency Medical Services/ambulance) as an EMT (eggcrate mattress technician, every menial task, or Emergency Medical Technician, your choice).

It was in the winter of 2001 when I made a HUGE mistake, but a  life-changing event that has opened my eyes and world in many ways. With under 10 hours of snowboarding experience under my belt, and a huge dose of being over confident, I had a potentially fatal accident. Of course, had it not happened, there is a good possibility I never would have gotten into instructing a couple years after that, teaching and inspiring many how to snowboard, and many more on how not to repeat my very mistake.

Learning to snowboard (pre-accident of course):
In 2006, I moved to the pacific northwest and now back in the area I refer to as home.  It will be another blog entry, another time, when I write about what forced inspired the move. It was at this point in life I was trying to decide what I wanted to do. Roughly 2 years of college in the south, taking general classes just was not leading me anywhere. The more I explored careers, the more becoming a paramedic appealed to me. The local EMS agency was doing classes for EMT-basic training in exchange for volunteer hours. Despite having to wash the rigs, sweep, stock supplies, run reports, etc., I enjoyed what I was doing.

While trying to get involved and established in the community, I had signed up and started basic EMS training. At that same time I starting working a regular job, and found a local church where I got involved with the college age/singles group. It was my first or second winter (I don’t entirely remember), and there was ski/snowboard night at a nearby ski hill. I had NEVER snowboarded in my life, but it looked like fun and was something I wanted to try. I rented a set up and with the group I went. The “friends” in my group who were experienced skiers and riders were telling me from the bottom of the chairlift, “come up, it’s easy”. Not knowing any better, I bypassed the beginner slopes and I followed them up and rode up the chairlift. I remember the edges of the board catching and dragging and getting yelled at by the liftie the first time I tried to go up the chair; zero experience, so I didn’t have a clue what I was doing.

I ate it hard getting off the chairlift – again, never had done it, so made every newbie mistake in the book. I scooted out of the way and spent time floundering like a fish, trying to figure out how to steer this goofy thing called a snowboard attached to my feet. Within 20-30 minutes, I figured out how to do what in snowboarder terms is a heelside falling leaf. I was standing, going down the hill and at least had control of my speed and direction. Although not pretty or perfected – I was hooked!

A little more experience, changes, etc.:
Life goes on. The agency I volunteered with had been dissolved, and after plenty of politics, it was no longer a desirable outfit to volunteer with. Family events, job changes, etc., all played in many parts leading to the point in life where I was.

It was the winter of 2000 and I bought my first ever season pass to a nearby resort, “Ski Area X”. At that point, not having more then 10 hours combined in riding since the first time I had made the mistake of teaching myself how to ride. I had the worlds fastest heelside falling leaf and traverses, but wanted to “learn to ride my toe edge”.

I had been out 2 or 3 other times that season and decided to sign up for an intermediate group lesson being offered, thinking since I could slide down and push the snow down and off any run, that I was another expert rider. I observe others now who are at that same point. Ski Area X has an accredited AASI(American Association of Snowboard Instructors) program, but I obviously had been paired up with an inexperienced or new instructor who had little teaching experience. I let him know that my goal of the lesson was to learn to ride that toe edge. The number one worst advise ever was when he said/taught the method of “kick the rear foot” (How I shudder when I hear a person say that sloppy edge catching horrible technique to someone). I got to riding that toe edge, but it was not very good. I now know for a fact that due to fear, I was riding all the way back with my weight aft(tail) of the board, causing limited/less control. It’s amazing what knowledge I have gained since becoming a snowsports instructor – but this was some time after splatting myself into the snow.

The accident:
At the time of my accident, I was in my EMT-Intermediate training. It was the result of the spinal injury that sufficiently ended the idea of testing and graduating from it. My new found over-confidence at snowboarding is what got me into trouble. I saw others going off jumps and I thought to myself, hey, that looks easy and like fun. Hence, being too confidence and inexperienced at snowboarding got the best of me.

A broken mess for the ski patrol:

*SLAM* Smacking firm object at high speed from high height is going to result in a lot of pain from injuries. Thankfully, though my whole respiratory system was initially paralyzed from impact, I did spontaneously begin breathing on my own again. The two employees below building a new feature in the terrain park who witnessed the whole thing came up running towards me. I’ve later been told I was a good 20+ feet in the air before landing on hard packed ice. My only memory is that they were below one second and instantaneously at my side calling for patrol the next. My immediate concern was if any other rider were to have gone off that jump and landed on me; especially considering how wounded I was. I could not move at first which was VERY frightening.

In what I estimate was under 5 minutes, ski patrol was there. I’m sure I had a concussion which would attribute to my being argumentative, plus my stubbornness I was born with, but I somehow convinced and managed to refuse to be put on a backboard (not a smart move in retrospect, but this is the reason I know that when I have a patient with a suspected head injury, to NEVER cave in to their demands). I know us medical people type make the worst patients, and I think I was a well defined example of such.

I was not able to hardly move, yet the patrols at ‘Ski Area X’ courteously and gently helped me on the toboggan. They slowly took me down the hill. At this point, I had feeling and plenty of it – holy moly I was in pain. They helped me up and examined me in the patrol room upon helping me sit up on a bed. Then they helped me into my car because I decided I wanted to go home. While I was driving down the mountain, it hurt to breathe and I felt like I was getting worse. Instead of driving home, I realized I was in trouble and better go to the emergency room to be seen. The whole way down, I kept wondering if I would even make it. In hindsight, VERY STUPID idea, but likely I was concussed and not thinking too clearly. The drive from Ski Area X down the road to a Level 2 trauma center was not too far, but far enough. At that point, I think I was running off endorphins(for you non-med types, a natural substance the body makes in response to pain temporarily). Of note, yes I was sober.

I made it to the hospital. I pulled up right outside the emergency room door, car was valeted by staff. I couldn’t even get myself out of the car. Some nurses had to help me out of the car and into a wheelchair. Their nonchalant attitude didn’t impress me, but something that can be a lesson if you are reading this – You may have seen the same thing hundreds of times before, but this is an experience possibly new to patient. Of course, take a read at any of the nursing/ems/er blogs to the right in my blogroll, and the reasons for burnout, etc., make it obvious why my perceived attitudes of ER staff were so negative.

Incompetence at its finest in the ER:
(or ED if you’re Dr. WhiteCoat)
We all make mistakes, but one particular emergency room doctor who obviously does not know his elbow from the fecal hole he eliminates from, needs to find a different career. The triage nurse was acting like she didn’t believe me when I told her what happened…. some of this plays in to what is a real issue in society. I should have allowed ski patrol to secure me on a backboard and be taken in by ambulance. Someone with an “anxiety attack” or BS reason in town who didn’t need an ambulance was in it instead. I despise people who abuse the system, as that is the most direct cause for my being mistreated.

Fortunately for me, it was a slow weekday night at the ER(or ED if you’re Dr. WhiteCoat), at the level 2 trauma center, and my wait time was only an hour or so while I sat in that waiting room in a wheelchair in unbelievable pain before being taken into the back. Not sure how many people break themselves in half and drive themselves to the ER, but realistically, I can understand her disbelief.

Once taken to an exam room, the nurses attempted to help me get my jacket off. I was just hurting too bad to move. The incompetent doctor ordered 1 milligram of Morphine. Pompous, arrogant, so many words to describe. I think seekers often get more than that. Fellow med bloggers – input on this dose please?

“…and then it gets worse….”

Next it was off to get an x-ray of my back. I was still complaining of pain (ya think?). Apparently that burned out ER doc had missed the courses with regards to mechanism of injury(which was quite substantial). He gave me what I think were 5 mg hydrocodone tablets. They took the x-rays by helping from the gurney onto a slider board to get me on the x-ray table. Upon returning to the exam room, my roomate/close friend was contacted and was there, we BOTH saw the x-ray, showing a clear wedge deformity with displacement at the T7 level and adjacent thoracic fractures. At that time, the broken ribs and sternum were not apparent/disclosed. Only so much can be told from an x-ray though.

As if inadequate pain control and bad staff attitudes weren’t enough, — minutes later, the pompous doc returned room, handed me a sheet with the diagnoses of……. *drum roll please* “back sprain”. WTF!?!?! When my friend and I asked about the x-ray, Dr. ER-burned out doc just got in a tizzy and stormed out of the room. Hopefully this level of burned out incompetence doesn’t reflect the level of neglect so many caring ER physicians out there. It’s scary to know this particular one is STILL in practice.

I have no reasonable for his behavior, but I do have the sheet on “care of back sprain” with that date. Then I was discharged to go die at home. Home!?! Excuse me! It hurts to breathe, it’s difficult to move secondary to pain, I can’t do any of my ADL’s and I’m being sent home? I had excellent full coverage medical insurance at the time, so that certainly could not have been the case for such negligence. Oh, and that “generous” doc sent me home with a bottle of #10 vicodin tablets. I’ve heard of people getting more than that for a papercut.

Return to the ER:

My roommate was such a gem! (Some roommates end up hating each other, but he was amazing, going above and beyond what most would do!) He helped me into my bed where I laid for two days, increasingly short of breath where it was a challenge just to breathe. I was in such intense agony, I could not even get up to help myself to the bathroom. Considering I had the master suite of the house with an adjoined bathroom, this was pretty serious stuff. At some point, he helped me to the side of the bed and I urinated in a bucket. Even that was quite challenging and I remember the pain. The body’s natural endorphin process was long wore off. After two days of this painful torture of slowly deteriorating right there in my bed, he could see I was declining, so he somehow helped me to his car and took me back to the hospital, as I obviously was progressively declining with each passing hour. My friend/roomie pulled the car up close as possible to the front door. Before leaving the house I pre medicated(as much was possible) with 2 hydrocodone tablets (it’s difficult to stretch ten tablets of vicodin by day three with these kinds of injuries and pain).

We arrived at the ER(or ED if you’re Dr. W….oh you get the idea, I’ll quit picking on him now) around 7pm that evening. It was another slow weekday night. Maybe 2-3 other people in the lobby was all. I was doing much worse than a couple days prior when this happened. Nurse K is tough, but has sense, unlike the triage nurse on duty that night. I told my chief complaint. Now for the second time in my life I was at the ER, so I guess that made me a frequent flier perhaps since I was there a couple of days later?

Within 15-60 minutes, I was wheeled to the FAST TRACK room. What really irks me about that night, was in this pathetic situation, while laying most of the night in an uncomfortable fast track gurney, my roomie(bless him for staying with me) overhead and where it turned out they triaged and prioritized a kid with PINK EYE over me. It wasn’t until 3:30 a.m. the ER doctor(fortunately one with sense and not the one from the first visit) after seeing a kid with conjunctivitis, before ever checking on me came in. A little math here, and this wasn’t a busy weeknight like some ER’s in larger cities — 7:pm and sit then lay suffering without meds until 3:30 am — 8 hours. But the kid who came in after me with pink eye was seen first. I see a problem with the triage system here. The ER system sure failed me in this case.

The wonderful ER doc:
When the educated physician came in at 3:30, we explained what had happened to him. He looked at the char. The evil triage nurse I was mentioned above had written “fell out of bed” — talk about a nurse with both poor bedside manner and poor listening skills!

That does explain why I was sent to fast track, since from a medical perspective, an otherwise healthy 20-something year old female is not going to have morbid injuries from a fall out of bed. In retrospect, I’m certainly not angry with this doctor for taking all night, as he had no way of knowing the seriousness of the situation based on the misinformation he was given before seeing me. I can’t blame him since the triage nurse had been such a failure that night(and the doc three days before).

When we explained to this doc what happened – a 20+ foot fall onto ice from a snowboard jump with landing gone very wrong, he went to go review my records from a couple days prior and during that time, sent a nurse in to give me an intramuscular shot of morphine. (as opposed to IV, so didn’t work real fast, but even that much was a relief and I think a closer to appropriate dose than the first night two days prior). It wasn’t the best relief, but after being sent home to die and suffering for a couple days, anything was surely better than nothing.

ER Physician came back in the room and even commented on the “back sprain” as being the diagnosis written in the chart the couple days before. I speculate he was still in some degree of disbelief with all these discrepancies, but he iimmediately ordered a CT scan and did give another intramuscular shot of Morphine before sending me on my way.

Back from CT, and the tone of things change:

I was sent off for a CAT scan. They used a slider board to help me on that table, and even before putting me back on the gurney and taking back to the ER, the tone of everything suddenly changed. It was no longer a case of neglect and being treated like a liar, as the CT results revealed the seriousness of injury. Lungs completely contused, four thoracic vertebral fractures and one with minor displacement, two ribs, and sternum in several pieces. See! Told you so, I didn’t fall out of bed. Still leaves me speechless how that triage nightmare came up with that.

The tone of everything had changed to my being told told to “lie still, do not move.” While waiting for a room, doc ordered a PCA. An IV was started, PCA hooked up, and suddenly, I discovered nurses in the ER and a doctor could actually be human beings and decent people – of course when you’re on the good stuff, the whole world is painted a lovely rosy color.

My friend says that when he stepped out into the hallway, he actually overhead the doctor saying something to the effect of “what kind of idiot would have sent this patient home”. About 6 a.m.- about 11 hours since my arrival and now three days later since the accident I was taken upstairs and finally getting some relief and being cared for, immobilized, etc., and was in the hospital for a little over three weeks.


Voting, Politics, frustration

November 8, 2008

I’m usually not one to write about or get heavy into any politics, but one thing I disagree with is the electoral process. Populations are exploding and growing in cities everywhere.  The current system is broken.  Each state should have *1* electoral vote. Like the current system, the overall popular vote is the electoral vote the state gets. In the event of tie with each party getting 25 electorals, then go by the overall nationwide majority vote, hence actually making every vote actually count. The current system for voting is broken, last election most of us remember how Florida’s counting process was broken, current healthcare crisis is broken. After this recent Barack Obama vs. John McCain election, the economy and all the above, etc., are going to be some pretty hefty issues regardless of winner.

I sincerely wonder how campaigning efforts would go if the voting system were a little bit different; so candidates wouldn’t just work the states with the most electoral votes.

It’s time to vote for a new voting process.