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.

The Circle of Life

“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.

100 Hours In

So far I’ve got 100 hours in as an ED Tech. Actually it’s a bit more since I’ve had to work past the official end of my shift a few times. Now if anyone has done the math and read a previous post, they’re probably curious how I got to the number 100 and why it’s not 96 or some other multiple of 12. The truth is, my normal shift is 12 hours. However, during my most recent 12 hour shift a text went out to all techs asking if anyone was available to work a “Crisis Shift.” I volunteered. Now the down side is, as an orient I’m not eligible for the bonus differential for a crisis shift (which I’ve been told is fairly nice). But I wasn’t doing it for the money. I was doing it for the experience. Normally my shifts are 11:00-23:30 (that includes in theory 30 minutes for a meal). Since this 4 hour shift started at 23:00, it meant I worked 11:00-03:00. Yes, you’re reading it right: I worked a 16 hour shift. This allowed me to experience the ED at a different time of the day than I’m used it. And I will say it was worth it. The overall “mood” is a bit different. It’s definitely a bit quieter.

And best of all, I survived the shift. Granted the next day I resorted to a dose of caffeine between class and lab in order to stay awake, but overall, it wasn’t too bad. On the other hand, if I were 30 years younger, I think it would have been a bit easier to recover from also.

I’ll probably pick up more Crisis shifts in the future, especially once I’m eligible for the Crisis Pay differential since it gives me the experience and pays decently.

Footwear

For my original shifts I pulled out some old shoes to wear. I figured if they got covered in fluids or something I could toss them. Sure enough, on my second or third shift I stepped in something very sticky. I looked down with dread and was relieved to see it was only some apple sauce the patient had spilled.

However, fairly quickly I realized how uncomfortable they were. The one weekend I should have gone shopping for new shoes I didn’t. It took me a few shifts and some thought to realize what the real problem was: lack of arch support. Hence the photo above where I added some impromptu arch support. It was an amazing difference.

That said, this past weekend I picked up a pair of Skechers to wear at work. One big advantage of them too is they’re machine washable. I suspect at some point I may have to take advantage of that ability, but so far I’ve been, apple sauce aside, lucky.

And now off to another shift (and two more this coming weekend.)

And of course the disclaimer that I in no way speak for my employer Albany Medical Health Systems in this post. That said, I do hope not to see anyone of you in the ED any time soon. Drive safe over this break and please do not drink and drive.

Production Code for your SQL database

I realized after writing my earlier post that today was T-SQL Tuesday. I wasn’t going to contribute, but after seeing some posts, I thought I’d give a very quick shot at it. This month, Tom Zika (t | b) asks us to talk about what makes code “production grade”. You can find his full invitation here.

There’s some great columns there, but I’ve noticed something that many developers assume (and honestly, it’s a good thing) and that’s that they work in a company with good source control and a decent release procedure. Sadly, with my clients, it’s rarely the case. Often I’m inheriting code that’s only available on the production server itself, or there’s 20 different contributors (ok I’m exaggerating, but not by much) and each has their own stash of code.

Ultimately this means the production server really the only single source of truth. So that leads me to my first item.

Select * and other shortcuts

It should be obvious, but while I may often use Select * while developing code, I’d never put it into production. Even if it works, it’s messy. But I’d go a step further. I prefer to fully qualify all my columns. For example

select Emp_Num, First_Name, Last_Name, City from Employee_Table

vs

select E.Emp_Num, E.First_Name, E.Last_Name, E.City from Employee_Table E

Now the above is an extremely artificial example. But now imagine I want to join it to say a table of phone numbers (because the original developer was smart enough to realize an employee could have multiple phone numbers and didn’t simply add columns to the Employee_Table.)

So now someone comes along and rewrites the first as:

select Emp_Num, First_Name, Last_Name, City, Phone_Num from Employee_Table E
inner join Employee_Phones EP on EP.Emp_Num = E.Emp_Num

Now, they’re of course deploying to production as they go and suddenly the above code breaks. Fortunately, they’re fairly smart and realize the fix and go in and edit it to

select E.Emp_Num, E.First_Name, E.Last_Name, E.City, EP.Phone_Num  
from Employee_Table E  
inner join Employee_Phones EP on EP.Emp_Num = E.Emp_Num 

So it’s a simple thing, but by making a habit of fully qualifying your column names, you can avoid future errors.

Failing Gracefully

When I’m writing quick and dirty code, while I try to avoid errors of course, I’m not overly worried about leaving the system in unstable state. By this I mean, if I’m debugging code with a cursor in it and it breaks and I have to manually drop the cursor that’s fine. Same thing with transactions. Yeah, I might block someone else’s work, but I’ll pretty quickly realize what I’ve done and be able to commit or rollback my transaction.

In production code, without going into details on TRY/FAIL blocks and all that, I would argue that any code that contains a cursor, a transaction or anything else that could potentially block processing absolutely needs to have robust error handling. I’ll ignore the debate about what the best way to handle it is, in part because sometimes rolling back is the right answer, trying again might be the right answer, or even finishing the transaction and then cleaning up data later. The point is, you can’t afford to fail in an ungraceful way and leave your system in an unknown state.

Alerting

I didn’t have this on my mind when I started out with this post, but the last bit reminded me of it. It’s not code per se, but more jobs and the like. Generally, I’m a huge fan of alerts. If something has failed, I want an alert! But, I realized a long time ago, that alerts have to be actionable. This means the person receiving it has to both be able to act on it and that it actually needs to be acted upon. If something fails and it needs no action (and the action can be as simple as simply noting it for future reference) then don’t bother alerting. Log it or at the very least, retry before you send an alert. Years ago at one client they had a job that would fail once about every 100 days. It ran once in the morning. It had an alert that met the above criteria, I or another DBA could react to it and in this case the reaction was simply “retry the job”. I finally analyzed it and realized that given the failure mode, simply waiting a minute and retrying was a far better solution than alerting us. I did some math on the failure mode and realized that this new setup should cause failure on the second attempt (and then send us an alert) once every 10,000 days. So the initial alert was sort of pointless when there was a better way of handling it.

Conclusion

So, to sum things up: avoid errors, if you do have errors, handle them gracefully, and if you have to alert, ma

“Help me put out the drunk cat”

Just a short post today. The title comes from the little bit of a dream that I recall from last night. It was something my father said in my dream. There’s really no meaning to it more than what it seems. In the dream he needed help catching and putting the very overweight and drunk cat outside. Don’t ask me why the cat was drunk or why it had to go outside (though I suspect that’s a better place for a drunk cat).

Why do I mention this seemingly random line? It’s because it’s an insight into how my dreams of my father have progressed. In my dream I heard my father’s voice. This is very bittersweet for me. Of all the tangible things I miss the most since he’s gone it is his voice I miss the most. For awhile I didn’t dream of him at all. After a while I’d start to have dreams with him in them. They were often variations on discovering that he was actually alive and we had to figure out how to undo selling his estate and all that paperwork. Then my dreams changed a bit and within a dream I’d remind myself that it was only a dream. Then they changed again. This time it was an inner voice telling me, that at least this time it wasn’t a dream. Those were hard to wake up from. But they also all had one other thing in common. He was always silent in them.

That was the hardest, I was forgetting his voice.

That too has changed over time. More often now when I dream of him, I hear his voice in my dreams. I couldn’t tell you what it sounds like and honestly, I’m not sure it’s really HIS voice, but in the dream it seems to be and that’s good enough.

I miss him every day, but some days, it’s his voice I miss the most.

I am in the Right Place

A couple of weeks ago I asked “Am I in the Right Place?” The question will always be in the back of my mind and I think that’s a bit healthy. I think any time anyone gets too sure of themselves, especially when lives are involved, it’s a bad idea. That said, I’ve now done 3 shifts in the Emergency Department (ED) and the answer to my question is “yes.”

In 36 hours I’ve learned a lot. I’ve done at least 2 dozen EKGs and only had to repeat one of them at doctor’s request. I’ve done more than my share of Covid Swabs. I’ve done a psych sit. And one of my fellow techs let me practice a straight stick blood draw on her. According to her I did well (she commented on her lack of bruise the next day). I’ve also done chest compressions. I’ve also sat around with nothing to do. That’s rare and one savors those moments.

I’ve had sore feet and one night as I got into my car my lower back froze and I couldn’t move for a few seconds. I’ve gotten dehydrated because I had forgotten my water bottle one day and it was too long between getting some water. I’ve snacked on the run (fortunately however, as an orient, I’m in theory guaranteed an actual food break which I’ve taken advantage of so far, but once I’m beyond orient status that may no longer be available).

I’ve worked to 2 12-hour shifts back to back and then gotten up on the 3rd day to make it to A&P Lab after only 6 hours of sleep.

But, though I’m only 3 shifts in (and about to run my 4th) after the first night I was confident I’m in the right place. I’m gaining confidence in my skills and abilities and I’m earning the trust of my colleagues. And at the end of the day, I’m enjoying what I’m doing. At least so far. We’ll see what I’m saying in 6 months or 12 months.

But at the end of the day, so far, yes, I think I’m in the right place.

And now the obligatory disclaimer that I do not speak for my employer Albany Medical Health Systems and my views are entirely my own.

Having Faith

Over a week ago, I had someone tell my wife that they were excited about my applying to PA school and they’d love to be my patient if I make it. While I appreciated their faith in me, I reminded my wife that if my career choice goes in the direction it does, my preference would be to work in an Emergency Department and as such, that person might not want to be my patient. This reminded me of a time when a friend was giving me a tour of the med-flight helicopter he worked on and showed me the logo that was on the ceiling above where a patient would be laying on a stretcher and joked few people saw it the way I did. In fact he added, many in a position to see it from a stretcher were often not in a good enough shape to really see anything.

Last week on social media I posted a bit about a specific concern I had in the process. It was more a comment than anything else. I generally don’t post such things looking for support or the like, it’s often more a stream of consciousness. Well the amount of “attaboys” and “you’ve got this” was uplifting and encouraging. Now the truth be told, most of the folks posting didn’t know the specific details of concerns and while I appreciated the sentiment, it didn’t change the actual reality. But that’s ok.

Here’s the thing. I might not succeed. I might hit a roadblock. I might find a class that simply stumps me. I might find my time in the ED to be such a negative experience that I decide to go back to being a fulltime DBA. Most of all, even with all the prep work, there’s no guarantee my primary (or even backup) schools of choice will accept me. Simply statistically, the odds are long. (Fortunately it’s not as simple as a roll of dice, there’s a lot more to the process than simply that.) But at the end of the day, knowing people have my back, for better or for worse, helps hugely. It’s not so much “how can I fail when I have so many people cheering me on” as much as “whether I succeed or fail, people will support me”. That makes the effort that much easier. And for that I’m grateful.

So, a year from now, I really hope to be able to tell folks, “yes, I was accepted” but even if I’m not, I’ll know they have faith in me. That’s helps more than I can express. Thank you.

Am I in the Right Place?

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:

I make these look good?

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.

It’s Just Another Brick in the Wall

Actually, unlike the song, I feel like I do need education and I’ve been getting it. Ironically in A&P II we’ve been covering the adaptive immune system just as I’ve been going through my intake steps for my new position. I mentioned last week that I had go get a number of shots. As of today in the last week I’ve had the current flu shot (last Monday), the new covalent Covid vaccination (Wednesday), a TDaP vaccination (yesterday) and the first of two Hep B vaccinations (also yesterday). So it’s been just “another shot in the arm” for me several times now. Oh and the second of two injections of tuberculin to test for tuberculous.

I’m not sure if my immune system is hating on me right now or loving me. Hating me because I’ve asked it to respond to a foreign substance 6 times in the last 7 days, or loving me, because right now, there’s a series of T cells forming (or having formed in my body) with the net result that I’ll have a bunch of additional T memory cells floating in my blood stream and lymphatic system just waiting in case the real thing (for pretty much any of these things) come around. I don’t know anyone who really enjoys getting a shot or even the reactions we often get (for the record my reactions to all of the shots so far have been very mild).

That said, I am happy that at least for now, it looks like my days of being a human pin-cushion are over. I have one more Hep B shoot in about a month and then after that I’m good for awhile.

Just one more step to get into the world of working in the Emergency Department.

I start orientation on Monday and can’t wait. In the meantime, my immune system can deal with it. I know I am.