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.

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.

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.

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.

“We’ve got a Level 1 Trauma coming into A1, can you run up to the blood bank and grab some units of whole blood?” I hadn’t done this before so another ED Tech came with me to show me the ropes. We went up stairs, handed over the paperwork and they handed us two coolers (one with packed red blood cells, the other with platelets and other factors). I carried them downstairs. It was a humbling feeling: in my hands, I literally was carrying the liquid of life. Without this fluid coursing through our arteries and veins, we die. (and ironically if the iron inside the hemoglobin gets out of its proteins and starts to float around in our blood freely, that can be seriously dangerous too). I didn’t yet know what the trauma was or if we’d even need the blood, that was a decision the doctors would make, but I knew this could make a difference.

I was reminded of the above yesterday as I sat on the bench at the blood drive watching the blood leave my arm and flow down a small tube into a bag just beyond my sight. I have O+ blood, the second most preferred kind (after O-). In addition, I have not been exposed to CMV (cyomegalovirus). This means my blood is a preferred type for pediatric patients since I don’t have antibodies to CMV (most adults have been exposed at some point and probably don’t know it and as such have antibodies).

I don’t know exactly where my blood will end up, but I do know it’ll help someone. In fact it will likely help multiple patients. To me there’s a certain joy, even thrill in that.

It doesn’t take much to give blood. It can take about an hour of your time (more if you do a double-red, but then you only donate half as often) and a small, fairly short, painless prick in your arm. Then they give you snacks!

As I recall, in the above trauma, that specific patient ended up not needing the blood. But I’ve seen other patients since then who have needed blood. I’m glad they’ve been able to get it. It makes a difference.

If you want to give someone something this holiday season, consider giving the gift of life. Give blood.

(and small footnote, before anyone criticizes the American Red Cross’s policies, some which I think are overly stringent and even discriminatory, please note it’s actually the FDA that sets the rules and the ARC has argued for changes. So make sure your frustration and anger is directed a the right group.)

Include the usual disclaimer that I do not speak for or represent my employer Albany Medical Health System.

First this question came to mind when I arrived for the second day of orientation. Technically there was no sign for where ED Techs should report to, so I made the assumption that it would be the same classroom as Patient Care Associates. But when I went to the classroom it was dark and no one was there. I fretted a bit, but not too much, after all I was early.

Fortunately my assumption was right and I was soon seated among a number of other students. Turns out only one other was also a Tech, who happened to be assigned to the ED, but all the others were PCAs in various departments.

The second time the question came to mind was while waiting for the class to start and I’m reviewing the material and start reading the requirements and wondering, “umm, I’m not sure I really have the experience they expect. I’m sure I’ll be found out shortly.”

Fortunately, again the answer appears to have been yes, I was in the right place. This became more evident over lunch when 4 of us started talking about our backgrounds. Yes, some clearly have more experience in the medical field than I have. But some are starting at about the same level I am, or perhaps with even a bit less experience.

So yes, I’m in the right place. At least so far.

This is not to say it won’t be easy. There’s a lot to learn. Some of it I’ll learn tomorrow, some will come later. Like any job, I suspect the learning will never be over. So it’s two days into my new job and so far I’m still loving it.

And today I’m officially a step closer:

And now for the first time I have to add that the above are my own words and do not reflect the opinions or views of my employer Albany Medical Health Systems.