2022 in Review

It’s that time of a year again to look back. This will probably be a shorter post than I might want to write, but that is in part because of the good things that did happen this year.

First a link back to my preview I wrote on the first of this year.

  • I had said I was going to keep writing for Red-Gate. Turns out, that didn’t happen. Too many other things were going on to really write any articles. I did keep my Friends of Red-Gate status and helped talk my largest client into adopting many of their tools.
  • I talked about premiering a new NCRC class called “Tip of the Spear” (TOTS) for medical folks. Again, this didn’t happen and probably won’t for 2023, but the team and I are making progress and I hope to make more this week on developing the curriculum.
  • Continue Blogging: this I definitely did. I may have missed a Tuesday or two, but I also had some extra posts, so I think I probably hit 52 in the year anyway.
  • Travel: Other than 2 trips to Washington DC to see friends, nothing really happened here.
  • Biking: I had hoped to break 700 miles again this year. I’m 38 miles short. And ironically most of that is because I was 33 miles short of my goal in September. That said, I did buy a new bicycle, so I’m excited about that.
  • Hiking: definitely didn’t happen.
  • Caving: I did get in a few new caves thanks to the Week-Long cave rescue class in Clifton Forge, Virginia, but I didn’t get into any new ones locally. I’ll call that a win.

So on one hand, it may sound like I didn’t manage to reach a majority of my goals, but the reality is, it’s been a very successful year. As noted in the post at the start of the year, my primary goal was preparing to apply for PA School. I had given some initial thought to completely all my requirements so I could apply sometimes in the 3rd quarter of the year for entry in January of 2023 for completion in 2025. After some thought, I realized that just wasn’t practical, so I reset my goals a bit. My plan is to apply to several in 2023 for entry in 2024 and completion in 2026. It’s a far more realistic goal.

So, in January I started with 3 classes a the local community college:

  • A&P I – one of my favorites. I love learning how the human body works
  • General Psychology – an interesting class and the professor was good, but psych isn’t my future
  • Biology I – two different professors, one for lecture, one for lab.

I’m proud to say that I got As in all of them. I felt like I was off to a good start. My undergrad grades weren’t great, so I need some wins here.

Over the summer I took an accelerated version of Organic Chemistry that I wrote about several times. I had hoped to eek out at least a C, given the horror stories I heard while at RPI. And honestly, in some ways it was one of the hardest classes academically I’ve ever taken. But, the professor was great and I learned a lot and managed to get an A.

For the fall I slowed down a bit and only look A&P II and Biology II. The tread of keeping my 4.0 continued. It does help that both classes sort of build on each other.

But the biggest change, and consumer of time was finally getting a position as an Emergency Department Technician. For the primary school I plan on applying to, I need at least 1000 hours of “patient contact time”. I had delayed applying long enough that I was starting to get nervous I might not get a good enough job in time. But, as they say, fortune favors the bold, and I got fortunate here. The first seven weeks were spent in orientation. Since then I’m a full-fledged “Blue Badge” tech and I’m working on getting my “Red Badge” so I can be a lead tech on Level 1 and 2 traumas. I’ll write about that more in the future.

One advantage of being out of orientation is I can pick up extra hours (at a higher rate which is nice). And so, after just over 2 months of effort, I’m at over 30% (i.e. over 300 hours) of the way towards my goal of 1000 hours. I fully expect to far exceed that 1000 hour metric long before the application deadline. And in fact, will be 1.2% closer by midnight tonight. And that’s why I can’t a better blog today. Time to jump in the shower and head to work. This will be my 2nd of 3 12 hours shifts in a row (my schedule for now is a 12 hour shift every Friday and then every other weekend (giving me 24 hours a week). But I also picked up a bunch of work earlier this week so I’m well over 40 for the week. Right now, I’m getting hours when I can. And so with that, I’m off.


My life lately has been dominated by numbers. There are good numbers. There are bad numbers. There are less than ideal numbers and there are holy-shit numbers.

It may seem crass at times to reduce a patient to their numbers, but there’s a certain effectiveness to it.

First, there’s their medical record number. I honestly don’t care about this other than the fact that for parts of my job (such as recording an EKG) they need to have a bracelet on them with their name and medical record number on it. I’d call this a neutral number.

Then there’s a number like 130/80 for a blood pressure. Generally this is a good number. But context can matter. Was it 180/120 a few minutes ago and is continuing to drop? If the next reading is similar, great. If the next number is 100/60, the nurses and doctors are going to start to get a bit concerned. If it was 100/60 before and now has risen to this and stays here, they’ll relax.

Even a number like 170/120 might not elicit much concern if the patient is otherwise stable. Yes, your cardiologist might be concerned long-term, but for short-term if it’s stable, the nurse will consult with the doctor, but won’t be rushing around too much.

60 is another number. Are we talking pulse or blood sugar or respirations? In the first case, that’s a pretty good number. In the second, it’s a bad number and again will get folks moving a bit. In the final case, that’s a very bad number!

346 is another number. If it’s a blood sugar, then we’re starting to talk holy-shit (to the point where the hand-held monitor I use to measure it will require an extra notation in the recording.)

When I was learning my wilderness medicine and later started teaching it, I developed the idea of what I call “Sesame Street Medicine”. This was not a knock at all at what we were doing but more on an approach to take. There’s a lot to be learned from “One thing is not like the others”, just like in Sesame Street.

In the cases here, other than blood sugar, which I suspect most of my readers have never looked at theirs, one can often rely on their own experience to get somewhat of an idea of whether a number is good or bad. This can be a useful guideline when looking at numbers. Consider your own numbers. Consider numbers you’ve heard from friends. Now compare.

Now, obviously a trained medical person can definitely glean a lot more information from the numbers than a layperson can, but that doesn’t mean as a lay person you can’t look at some of the numbers and start to think, “that seems less than ideal.”

But yes, in the end, we look at numbers. A lot. In context they can have a lot of meaning. So no one wants to reduce a patient to only their numbers, but numbers can be a good start.

Death Does Not Take a Holiday

Content warning: death and depression follows. But also hope and happiness.

Disclaimer: Events are also a bit fictionalized in time and details

Yesterday I felt a man’s life leave his body.

Today, I felt the life course through a man’s veins, a man who had been dead moments before.

One dead. One alive.

I know my time in the field has been short, but I don’t think I’ll ever fully appreciate the difference.

One dead. One alive.

In another room a woman dies while her family still is on their way. Too late to say their goodbyes.

In another room a man comes in on the worst day of this life, but leaves alive.

One dead. One alive.

Later a man, who had wished for death, comes in and now fights the nurses trying to keep him alive because he fears they’re there to kill him. He survives to fight another day.

One alive.

In one of my favorite episodes of M*A*S*H, Hunnicutt, Hawkeye, and Houlihan fight to keep an injured soldier alive at least long enough so they can record his death on the day after Christmas, rather than Christmas Day itself so the soldier’s children don’t have to think of Christmas Day their father died. In the end, they can’t do it and end up falsifying the records in order to cheat death.

Despite the title of the episode being “Death Takes a Holiday”, the truth is, death never takes a holiday.

In my very short time working in the Emergency Department I’ve seen people die and I’ve seen people live.

But this shift, the eve of Christmas Eve has been especially poignant and has hit me a bit harder than other shifts. The death of a loved one, especially an unexpected death can be hard. I think so doubly so during the holidays.

But also, as I said above, I saw a man who was dead come back to life again because of the efforts of all those around him, complete strangers doing their best to give death a holiday. This time the succeeded.

Today and tomorrow, I’ll be giving my family an extra hug. I hope you can too.

Disclaimer: my views do not represent my employer: Albany Medical Health Systems or Albany Medical Center.

A Typical Day in the ED

Ok, let’s start with the most important thing. There is no ‘typical day’.

There are certain tasks that are typically done every day, but every day is unique. This really struck home over the weekend where I ended up working 4-12 hour shifts over 4 days.

Day 1 doesn’t really stand out in my mind. I started in C-zone (where things are relatively quiet) and acutally had time to take some notes and work on some other items. I was eventually moved to B-zone for the final 8 hours. Here I was definitely busier.

Day 2 was both easy and hard. It was easy because my tasks were fairly well defined. It was hard because it’s both physically demanding as well as requiring one to juggle a lot of requests all going on at once.

I was tasked with “55 Phone”. This means I have to carry a phone (you can guess the last two digits of the phone number) and my job is to transport patients to/from various parts of the hospital. For example, it may be taking a patient from an ED room to the CT scanner (a short trip) or to MRI about 1/5 of a mile round trip. Or, for the first time for me, take someone to Nuclear Medicine, which is about as far away as one can get in the hospital without going outside. That trip is about 1/3rd of a mile round trip (and I did it twice, once to drop them off and once to later pick them up.)

I’m one of the strange techs who actually doesn’t overly mind doing 55 Phone. I did it for my entire 12 hour shift (which is really uncommon, most techs will do it for 8 hours or less). First 4 hours however was slow and I had a lot of fellow techs offering to help. But there weren’t many requests to move folks. Then the second 4, there were fewer techs on duty and the number of requests started to back up. Inevitably the phone won’t ring until you’re half-way down the main hallway with a patient. Now you’re trying to move the patient while answering the phone and then writing down whatever the request is (one of the top rules, write everything down, you’ll forget otherwise!). Sometimes while you’re on the phone another call will come in! So there was about a 1 hour period where I simply couldn’t catch up and I had no available help. Then my third 4 hour stretch started and I noticed things started to improve. Well unbeknownst to me, a “transporter” had arrived on his shift. Their job is to help transport patients. While in general we appreciate the transporters, this guy really works at it. He had already done three ‘upgrades’ (moving a patient from the ED up to their room elsewhere in the hospital) before I even knew he was there. So the final 4 hours was relatively easy.

Day 3 I started in B-zone for the first 4 hour. At the start of the 5th hour, one of my fellow techs who I started with orientation with (we did our classroom work together, so I got to know him then) and who is, mostly due to scheduling, technically still on orientation was assigned 55 Phone. So I was asked to sort of shadow/back him up. After the first hour it was obvious he had the hang of it, so we basically would tag-team each other. I ended up putting another 8 hours in for 55 Phone. So in two days I had down 20 hours of 55 Phone! I certainly burned my calories those days. This day we had 12 techs on duty for a period. (Ideal staffing is 11, we rarely if ever actually achieve that!)

Day 4 was the most atypical. I started in A-zone backing up another tech. A-zone as I’ve mentioned is where the traumas come on. This means that at least one “red-badged” tech has to be on duty. Red-badged techs have gone through training and been checked off to help on traumas. I’m not one yet (though went through the training yesterday and have just a few things to check off on to get tehre). Sure enough we had two patients come into the trauma bays. Since they weren’t technically Level 1 or Level 2 traumas, I was doing a lot with them. But the work was relatively easy and at one point consisted entirely of simply sitting with one of the patients, talking. Finally I got swapped into B-zone so the red-badged tech there could take over for the one going off-duty in A-zone. Unlike the previous day where we had plenty of techs, now we were down to 4 for most of the day. I was at this point the only tech in B-zone. I had literally just logged into my workstation to see what needed to be done when I got called into 3 “Code Browns”, one after another. For the day I ended up at total of 5 or 6 (I literally lost track) and helped nurses with two Foley catheter placements. Note that prior to then if I had done a single code brown a week, that was busy and I’ve only helped with a total of two Foley catheter placements up to that point. So to say that Sunday was unusual would be an understatement. It was literally 4 plus hours into my stint in B-zone before I was able to sit down at my workstation and see what other stuff had to be done.

Most of the rest of the shift was relatively “normal”, or as normal as anything can be. That said, shortly before I left, the attending asked me to help transport a pregnant woman up to Labor and Delivery with the L&D nurse. Typically this would be a 55 job (see above) but 55 was busy and they really wanted to get her up there right away. It was, thankfully uneventful and even in a sense sort of an uplifting way to end the day that way.

Oh did I mentioned 4 12s in a row? Well on Day 5 I went in for Red Badge training and since I was there, figured I’d pick up another 4 hour shift from 3:00 PM – 7:00 PM. This was again in the A-zone. For the first 2 hours there was literally nothing to do. Then the last 2 hours was extremely busy taking in patients, doing EKGs and more. In fact about 5 minutes before I was ready to check out, I saw that the patient in the hallway I had just done a repeat EKG on and that the attending had remarked the EKG looked unusual had been moved into a room where he could be better monitored, so of course I went in and helped the nurse get him setup in there.

So, there you have it, 5 shifts in the ED, all very different from each other. So no, no typical day.

Closing Out the Semester

Editors note: I had planned on posting this last week, but realized 1/2 the class had not yet taken the lab. I hope by now they have. So all times are relative to last week, not this week.

Technically I’m a week or two early depending on how one counts, but I consider this close enough. Final exams are next week, so I’m not technically done until after Wednesday next week. In the meantime I have the following: yesterday an A&P practical (more on that in a minute), a Bio II Unit 4 exam tomorrow, an A&P Unit 4 exam on Friday, and then next week, both on Wednesday, an exam in each. And this coming weekend I have at least one 12 hour shift, probably two. And in a few hours, I start a 12 hour shift. So this should be an interesting week.

It started with the A&P II practical yesterday. Our practicals are, in my mind, fairly simple. The professor lays out models or pictures on the lab benches, labels 40 parts, and then we enter, pick up a keyword sheet and an answer sheet and fill in the blanks. The focus is knowing the parts of the body and where they are, not necessarily on spelling. Occasionally it can get tricky. Last semester for example while I had focused on pictures showing the muscles of the upper leg, the practical used a model and as a result of where the leg model ended, trying to pick out the pectineus was harder to do than expected. At one point I was holding up two different labeled models doing a “compare and contrast” of labeled muscles to figure it out by the process of elimination. It ultimately worked. (for those who are more curious, because the model didn’t show the origin of the pectineus and the insertion is under other muscles, all I had to go on was a small fan-like piece of it showing at the top of the model.)

Yesterday though was a bit different. We were supposed to cover the urinary system and reproductive system. Honestly, I thought it was pretty easy to study for. But when I walked in, two of the labels confused me. Internally to the kidney are structures known as the minor and major calyxes. Basically minor calyxes drain into major ones. So I’m standing there looking at label number 36 which has two lines on it. I can’t quite tell, but it appears to me that they’re pointing to the minor calyxes. So I put that on the answer sheet.

Then I get to label number 17 (because there are 10 stations and multiple students, you don’t necessarily encounter the labels in order). It’s sitting on top of what appears to be a minor calyx. Now, I know the professor well enough to know he’s not one to try trick questions like having the same body part appear twice on the practical. So I’m stuck. At times like this often I’ll pick up the model and walk over to him to ask. But I didn’t want to pick up two different models and bring them over. For one it would have been a bit unwieldy and for another, it would deprive other students of two stations to work at.

So I tried to reason it out. I figured since station 36 had lines pointing to the minor calyxes, that station 17 must be a major calyx, even though it really looked like it was sitting on top of a minor one.

Anyway, I finished, confident about my answers except those two. I waited outside the classroom to talk to a couple of my other classmates. At least one other admitted the same confusion. This actually made me feel better, that I wasn’t completely confused or misunderstanding the labelling. As we waited for our final classmate to finish up, the professor popped his head out the door. So I asked him which was which. I was impatient. I didn’t want to wait until he corrected them. “Well, the lines on 36 show the flow into the major calyx, so that’s the major one and 17 is the minor.” When I explained my confusion he had a stricken look on his face, went back into the lab and peered at station 36. I saw him quickly pull out his sharpie and update the label. He then came back out, “You’re right, I didn’t actually show the direction and I can see how it would be confusing. Don’t worry, I’ll make sure you all get credit for it.” The other class section has their practical on Thursday, so with the updated labels, I think they’ll do fine.

But now I wish I had asked while taking the practical itself. It might have solved the confusion earlier.

An addendum, turns out by the time he corrected the practical he had forgotten to credit us and I had to go in and get my grade updated.

Another Day in the ED

In about two hours I’ll be setting off for the Emergency Department. When I prepared for my first shift well over a month ago now (it seems like a lifetime) I was nervous, but I made it through it and ended up feeling fairly confident in short order. Today I face another first. It’ll be my first shift on the Pediatrics side of the Emergency Department. (if you want to be hip on the slang, we all just calls it Peds, but pronounced peeds). There’s a door between the two sides and over it, it says, “Two Departments, One Team” but the truth is, generally, at least for the Techs one pretty much spends their time on one side of that door or the other. For example, all the techs I’ve worked with so far on the adult side haven’t spent much time on the peds side (and probably not since their orientation) and the few techs from the peds side I’ve met have been in very brief encounters. But, as the sign says, in theory it’s really one team, so I need to be oriented on both sides of the door.

So today and Saturday are my two shifts in peds. I’m looking forward to it, but as I noted above, I’m definitely nervous. I’m not entirely sure why. Yes, there are differences, but at the end of the day, the work is going to be similar.

So, in 14 hours I’ll have my first shift done and be that much closer to having my orientation done. I can’t wait. Even if I am nervous.