EMSToday 2012 overview

Just got back from JEMS EMS Today 2012 this morning. It was a blast as always! It was so great to see old friends, make new ones and have fun while learning new things, seeing new products, and just having some great conversations with some amazing folks. I have so much going through my mind right now. The biggest thing that hit home for me this year was EMS 2.0. I have known about EMS 2.0 for a while now, but something clicked this weekend for me. While I had known about it, I didn't fully understand what it was until I tried to explain it to my best friend, an aspiring paramedic student. When she had questions I couldn't answer I went back and did more reading and research and a whole lot of listening this weekend. I finally get it! AND...I want to help! I want to do more than share a post here and there on Facebook and Twitter. I want to be an advocate, I want to learn more and understand what is going on with my profession, I want to make my way to the front lines! I would never have even heard of this if it hadn't been for the First Responders Network folks, Scott Kier, Sam Bradley, Justin Schorr, Ted Setla, Paul Bahnik, Cayce Justus, Maddog Medic, Patrick Lickiss, Random Ward, James Brasiel and all the others closely involved!

Ok, I have more stuff to talk about from EMSToday 2012 but am hoping to make another post about it.

As always, thanks for stopping by!

Designer Drugs

It amazes me the things kids, or people in general, manage to get themselves into these days. Behind us are the days of simply doing crack, cocaine, heroine, etc. These days people are into synthetic drugs and alternatives. First there was K2, now folks are sniffing, snorting, injecting, or even eating bath salts and taking 2 C-E, a synthetic version of Ecstasy. Unfortunately, there isn't much we as EMS providers can do except treat the symptoms, we have nothing in our arsenal of drugs to counteract these "designer drugs", as they have been coined.

So tell me, what are you and your company doing, if anything, to prepare for this? If you aren't seeing it yet, I have a feeling you will be soon....

No disapointments...

"Eat that damn chocolate cake, get your hair wet, love someone, dance in those muddy puddles, tell someone off, draw a picture with crayons like you’re still 6 years old and then give it to someone who is very important to you. Take a nap, go on vacation, do a cartwheel, make your own recipe, dance like no one sees you, paint each nail a different color, take a bubble bath, laugh at a corny joke. Get on that table and dance, pick strawberries, take a jog, plant a garden, make an ugly shirt and wear it all day, learn a new language, write a song, date someone you wouldn’t usually go for, make a scrap book, go on a picnic, relax in the sun, make your own home video, kiss the un-kissed, hug the un-hugged, love the unloved, and live your life to the fullest. So when you’re standing in front of heaven’s gate that chosen day, you’ll have no regrets, no sorrows, no disappointments."


Can't remember where I cam across this, pretty sure it was off of "and its love" tumblr. 


I found this a while ago and had completely forgotten about it until I rediscovered it again tonight. It really got me thinking about a lot of things in my life, particularly my professional life.  I have have been in EMS for about 7 years. I started off as a First Responder and I fell in love, after a year I took an EMT class while in college and I fell more in love, so much so that after 2 years I decided I wanted to be a paramedic. I worked hard, studied enough to get by, and here I am. I have been a paramedic for almost 3 years. I started off as a transport medic, a world completely separate from 911. While I was working as a transport medic I was also volunteering in a small rural college town as a paramedic. I was learning both sides, comparing them, trying to learn as much as I could and use it in both realms. I fell in love with both worlds, and decided my "dream job" would be to be able to do both in the same job, but little did I know that was actually a possibility. A year after I got my P-card I just happened to apply for a job 70 miles and 2 states away, assuming Id never even get an interview, but it couldnt hurt. Well long story short, I got the interview and the job, packed up my things and moved to a world where I had no friends and no family. I wasnt worried about that, I am good at making new friends, and family was just a few hundred miles away. Today I still work in a hospital based 911 system, and I made those new friends, some that I even consider family. I love my job, and I want to be the best paramedic I can be, I want to be better than I am, because I know I am capable of more. I feel like I am being held back though. I have learned how to network, I have people I can reach out to for questions, or articles to read, to get me thinking, heck thats how I ended up here with a blog. But I want to do more, I want to learn more. Unfortunately because the hospital system I work for offers all classes required for my job taking extra classes I am responsible for on my own. I only wish I could have the financial resources to attend more conferences to actually attend classes instead of just driving to Baltimore for a day (after all its only 50 miles) and visiting for a day and socializing and networking in the exhibit hall. I didnt even have a chance to attend the free classes...part of that is scheduling, working 60 hours a week cuts into free time. I know there are people less fortunate than me who cant even do those kinds of things. I wish there were several programs, grants, scholarships, or something for EMS folks to help them continue to educate themselves on new trends and topics. Heck, back where I grew up they just got a monitor capable of 12 leads in the last 6 months!!  


Anyways, the whole point of this, I am vowing to myself to start reading more articles, discussing with more folks, and hopefully attending some more events where I can ask questions, discuss topics, and have some hands on experiences with new products, not just for myself, but so that I can bring them back to work and share.  I feel like my coworkers are not just comfortable in their jobs but might be becoming complacent. I know I am comfortable where I am, and scared as hell that I might become complacent and thats where the problems are....

You can't treat what you don't see

I have noticed recently a disturbing trend with the BLS crews I that I work with regularly, they aren't doing full assessments. They aren't getting the full story. They are too worried with response times, on scene times, and turn around times, or they just seem like they don't care. This can make my job as an ALS provider difficult, especially if they are rendezvousing with me between the scene and the hospital, there's no family to tell me the story and the patient is unable to or is a poor historian, which in turn makes me look like the imbecile upon arriving at the hospital and telling the nurse nothing more than a generic chief complaint with no pt history, meds, or even allergies sometimes, just what I found in my assessment and what I did to treat my patient.
This doesn't apply only to medical patients, I have had run ins on trauma calls as well. (These are not every call events, but I am hoping its not a new trend either) Crews not getting a full story and by time I meet the BLS crew the helicopter is already 5-10 min out, I know my pt has some sort of traumatic injury, and the pt is still dressed.  I have 5-10 min to assess the injuries (including exposing the patient so I can properly assess injuries), try to gather a story if any family is present, or hopefully peek at the vehicle (if I meet crew on scene), and start treatment.
I am sure I am not the only person to struggle with this. I am not trying to whine or complain here, just want to  figure out a way I can reach out to these folks and express the importance of a full, proper assessment, no matter how minor the "emergency" may seem, no matter how close to the hospital you are, or how hard the adrenaline has your heart pumping. Our care needs to be more patient focused and less focused on turn around times or the fact that a patient is a frequent flyer.
Each patient deserves our very best, each and every time.

New drug: K2?

I recently learned of a new substance for our fellow druggies to favor. Apparently there is a new drug called K2. It is a synthetic cannabinoid. And the word I hear is it gives a much better high than good ol' MJ. It apparently was originally created for incense but people have discovered its other capabilities and it looks pretty close to MJ and is smoked in the same fashion. I have heard that it can not be traced in a UDS (urine drug screen) like MJ can I am not claiming all of this to be fact, just word of mouth. Have any of you encountered any pts on this drug or have any better info? I know some states have begun to ban it. Here's a little info courtesy if Wikipedia.

I'd love to hear back from any of you folks on this....

what would you do? interesting case...

Had an interesting call this shift. Got dispatch Class 1 for an ill person (gotta love those!) Pt wife states pt was sitting in the recliner after dinner and was fine she went outside for a little bit and came back in and found him "sleeping" in the chair and then she tried to wake him and was unable to do so, so she called 911, stating he was unconscious for 5-10 min before we got there. Upon our arrival pt was awake and sitting in chair, pt appeared to be aware of what was going on but was unable to talk. Pt had a pituitary tumor 5 yrs ago and recently the doctors found another mass this time to his left frontal lobe, took a biopsy last week, pt still has sutures in from biopsy procedure, suture site looks healthy. Pt VS are all WNL and I worked out communications with pt by asking yes/no questions and having him squeeze my hand once for yes and twice for no and again he seemed like he was aware of what was going on but just couldnt talk! Blood sugar was 143, no facial droop or arm drift, pt could stand and pivot to stairchair and then again to stretcher with a steady gait. So I took the pt 50 miles (telling my driver I wanted an easy ride, but not to fiddle faddle around either, to use lights and sirens if needed) to the hospital where his biopsy was done instead of the local hospital.
I dont know if I didnt sound sure of myself or what but the triage nurse seemed to focus on the fact that he couldnt speak and the onset time of that and immediately jumped to stroke, and she completely ignored the fact that they had drilled into this mans brain a week ago...so she called a stroke team member in who performed the same tests I had done in the field (looking for facial droop, arm drift, or weakness in extremities and checked his pupils/gaze) and stated "this is not a brain attack". Seriously? If I had compelling evidence this was a CVA I would have flown him instead of taking him an hour by ground considering he was almost an hour and half into the episode. Maybe Im in the wrong here, maybe I was being egotistical, but I did comeplete my assessment, several times, in the field and assumed this was an issue with the mass/tumor they had found recently.  Upon arrival of the hospital the pt could answer "yeah" and "no" to questions but was still unable to even state his name.

What would you all have done? Taken him an hour by ground or flew him?

I was having a conversation with a long time friend of mine that I met in the very beginning of my EMS career and I have to say I got very defensive for the first time in a while. I started in EMS in a very rural, small town. My hometown consists of a town of maybe 6000 folks in the city and thousands more in BFE. The average time for a call can be anywhere from 20 min (in town) up to hours long in the country. The nearest trauma center is an hour and half from town by ground on a winding back road or 2 hours on the straighter main road (depending on where in the county you are) while the local ER has a grand total of 6 beds, the next closes hospital has a 3 bed ER...you get the picture. From there I joined the local FD where I went to college, and while the pace was a littler faster it still wasn't much, we averaged 700-800 EMS calls a year and the local hospital had up to 12 beds and the local trauma center was only 45 min by ground. Now I work for a hospital based medic truck that averages about 3000 calls a year and well, I have to say I have tested the waters with city EMS, I did practicals in school in big cities, and did some ride time with my part time job in the city and it's just not me. I enjoy having the longer transport times and spending a little extra time with my patients.

Anyways, I was on the phone with this friend and he put down the fact I worked in rural EMS. This is not the first time he has done this, he has several times and it finally got to me. I have gotten this attitude from several "big city" EMS folks, like they are better because they run 20+ calls in a 24 hour shift and I might run 5 calls or I might not turn a wheel. Just who do they think they are? It really irritated me. It does not make me any less of a medic because I work in a rural area or because I like  it.

That is all...thanks for the steam blowing!

oxygen, harmful or not?

Im pretty sure oxygen is a good thing, in the majority of cases anyways. In the last 24 hours I have had 2 encounters where I thought a bit more O2 would definitely be a good thing, but was contradicted by providers with more schooling than me.

event #1:  severe asthmatic comes in to the ER and we take them straight to a bed, I pull out a duoneb treatment (cause it takes respiratory a few min to get downstairs after someone calls them) and give the pt a neb via mask on oxygen when the RN tells me "no, use the medical air"...what?? When she sees my confused look she says they normally use medical air, and I inform her we (the medics) use oxygen, pt got the neb via oxygen in the end....

event #2: 20 something y/o male, intoxicated, took a swan dive head first 6-7 feet into a cement trench. Pt unconscious and unresponsive, lac to right temporal, no active bleeding, pupils round, equal, but non reactive to light, pt breathing 12 times a min but shallow with snoring resps, lung sounds clear and equal, O2 sats at 02%, pt resps assisted via BVM, when OPA was attempted pt clenched down. 2 large bore IVs established,  24 min from on scene time to completing extrication of pt from the trench via stokes basket. Upon arrival of flight crew I asked if they wanted to RSI and they replied "no, he's breathing on his own".

I dont know if they were concerned with increasing the ICP, but found it interesting they opted not to intubate. Follow up of the pt was pt had an open fx to right temporal area, several closed fx, an epidural bleed to right temporal lobe and a parenchymal hemorrhage.  Pt was intubated at trauma center upon arrival. Pt was extubated approx 8-10 hrs later and is now alert and oriented but still in ICU at trauma center.

What do you all think?

Skills Day

This week we had our yearly skills day. The highlight of skills day is airway familiarization, for me anyways. Our boss arranges to have multiple sets of pig lungs for us to practice on. We have the typical "fred the head" for run of the mill intubation practice and for King airway and for S.A.L.T. practice, but its hard to practice the surgical airway on Fred. Our medical director was present and dove right in with us. We practiced a needle crichothyrotomy and then surgical crichothyrotomy. We then ventilated the lungs. We were even fortunate enough for one pair of lungs to still have a large heart intact. Our medical director gently removed it and we passed it around, you could look right down the aorta and see and touch the aortic valve, we then disected th eheart, we could see and touch the chordae tendineae, and the bicuspid and trucuspid valves. It was an amazing experience and great refresher.  I will post some pictures of skills day soon...

little work rant followed w/ needing your EMS advice...

I have always been a believer of "God doesn't give you anything you can't handle", "what doesn't kill you only makes you stronger", and "everything happens for a reason".  For whatever reason I have continued to carry these beliefs through all phases in my life, from growing up to college, to my professional life.  I know there are going to be times when I don't have a clue as to what I am supposed to do about a pt, but I am sure that most of the time I will fall back on my basic instincts. Tonight I had another one of those "oh sh*t" calls that when I look back on and talk with my co-workers (medics and doctors) that I know I did what I could with what I had in the amount of time I had. I just get really frustrated when I meet up with a BLS unit and they have nothing done for a critical pt, no history, no oxygen, no vitals. Oh wait, they had a grocery bag full of pill bottles for me. They were so concerned with this pts condition that they walked hin to the ambulance start towards the hospital that is opposit the direction I am coming from then realize Im 5 blocks behind them and cant catch up, so they stop and wait and then have none of the above mentioned done. But when you are called for a SOB and your pt is cyanotic from the nipples to the top of his head, i think any oxygen will help and walking him to the unit won't. Just saying...

I try not to get frustrated on these kind of calls. I try to use calls as teachings for these kind of EMTs who are new or just don't know what to do. During the critical calls I direct and after I try and teach, by explaining why I did or didnt do something or explaining why I did a 12-lead or why I didnt/did run lights and sirens to the hospital,, etc. I also take the time to answer any questions the EMTs may have which usually include "Did I do what i could/should have?" "or is there anything else I could/should have done?" and I answer them truthfully but without sounding like an egotistical jerk. I find that the next time I run a call with those EMTs they tend to be a little more comfortable with me and they have the things we talked about done, they have the pt on O2, they have a BP for me, or pt history for me.

I am sure Im not the only provider who runs into this. Any tips on how I can better this where I run? It happens with a lot of EMTs. Maybe some kind of "asisting the medic" class or something?

wow...

thats the only word I could come up with when I read about this...

Talk about an interesting call....

Thank you for involving me

I am so new to this blogging thing. Or at least I feel so new. I have been reading the numerous posts that resulted from the biggest fire/ems blogger meet up ever and it just makes me feel like a very small part of such a huge thing. While I was like the teeny bopper meeting a rockstar or a movie star, every single person I met was so nice. I got hugs from people who I have been follwing online for ages. I know they had no idea who I was and I am sure they will be quick to forget that they even met me, they have forever made an impression on me. And while I feel I made several new network contacts, I know I made one new friend. April (known as Epi_junky) made the experience for me, and she probably has no idea. I simply offered her a semi-warm house to crash in, on a comfy sofa, and offered some cookies that well, I was pretty proud of (it was the first time I had ever baked cookies from scratch). I followed her around like a little lost but star struck puppy all day in Baltimore. If it had not been for her, I probably would never have even actually gone to Baltimore. The minute she arrived at my house and we said our hellos it was like she was a friend I had had for many years. She was kind enough to make sure I got introduced to all the "big names" we ran into. And again, while they knew who she was right away, I was not greeted with any less enthusiasm. And by golly I may only have 2 blog followers, but I felt like I was on top of the world several times on Friday. For the first time ever I felt like I was actually involved in something that was changing the EMS world that I have chosen to be a part of.

So thank you to all of the folks who include, but are not limited to (sorry if I forgot anyone), the following: Epi_junky (April Aaling), UKmedic999 (Mark Glensourse), thehappymedic(Justin Schorr), Tony Oliverio, Jared Scott, geekymedic, setla (Thaddeus Setla), Ambulance Driver (Kelly Grayson), ckempt (Chris Kaiser), natemt_b (Nate) and so many others. Thank you again fro making me feel part of such a large thing!

ponderings on my career...

The news tonight of a paramedic killed simply because he was doing his job has really hit me hard. I can't imagine, trying to help a suicidal pt, trying to convince them that life is worth living, to have them attack you and ultimately kill you.

I have been in EMS for about 7 years. I have not seen many gruesome things, I have not run many "bad" calls. I consider myself blessed for this. It keeps me loving this job, being the "sparky medic". I am far from burnout at this point thanks to this. The down side is when I do get one of those career or life alterating calls how will I do? Will I be prepared? Will I know what to do? Will I make the right decisions? I guess I truly won't know until it happens.

For now I do what I feel needs done for my patient. I am thankful for the docs here who are very cool with us smudging that medical command line. I do however find myself reviewing my protocols after many calls, especially if I find myself second guessing if I should have given that drug I was hesitant to or if I should have done more or less. I always try to err on the patient safety side. This has kept me out of court and still with a job this long. I am still hungry for more knowledge, for more experience. Knowledge is easy to find, even more so now that I have expanded into the blogger world and made some amazing contacts at EMS Today this year in Baltimore. The experience side still leaves me hungry for more. I want to experience more, heck I'd even settle for observing more. Anyone interested in having a medic ride along?? Hit me up and let me know!

my worst EMS nightmare

I mentioned a few posts back that my worst EMS nightmare to date had happened, but at the time I was unable to talk about it. At this point everyone in the local EMS community knows about it, so I suppose it's ok now.

I often do ALS tranports out of the emergency room that I work in. We typically either call one of our own medics in or one of the 3 of us on shift will go, but only for the ALS transports out of our own ER. This was the case the night of "the incident". I took a very stable trauma pt with a head bleed to a trauma center about an hour away. The local BLS transport company sent 2 people on their ambulance. They and I loaded my gear on their truck and we got the patient situated and off we went. The call went without any complications. Upon leaving the trauma center, one of BLS employees offered me to ride shotgun, and I happily accepted. We had an uneventful trip back, put my gear back and finished the rest of my shift, no problems yet again. I got home the next morning and got ready for bed. I had no sooner got situated in my PJs in my comfy bed when my cell rings and I looked at caller ID to see the bossman calling me (this is a rarity, especially using his own phone). He began questioning me about the transport I took, which gear set I used and any procedures or tratments I may have performed during said transport. I explained I only monitored the pt on the cardiac monitor and vital signs, no other treatment or procedures were needed. I was then advised that there were narcotics missing from the gear I had used, and thatthey had been accounted for at the begining of my shift but when day shift was doing their rig check it was discovered that 3 vials of narcs were missing. I immediately got out of bed, got dressed and headed back into work. I eded up spending about 4 hours with my boss, police and simply just waiting. I gave a written statement to my boss, one to police and was interviewed by local police, video tapes were reviewed of both facilities to ensure the theft didnt happen while the ambulance was unattended.

The end line of the story is that while suspicion was high, it couldnt be proven. I was never considered the culprit, and my boss had my back 100%.
Since then the way we store, count, and track our narcs has changed and I have become even more anal retentive about my narcotics.

I'll admit it, I'm a cardiac chicken...

McDreamy Partner goes out for a chest pain in the middle of nowhere in the middle of a blizzard, you guessed it, guy was having an inferior MI. McDP brings pt to the local hospital due to road conditions, we can at least stabalize and get thrombolytics on board, pt found to be having an inferior as well as a RVI...the docs originally decide to admit to CCU here until they can get him transferred to Big City Hospital for a cath. Third Partner says he has connections and can arrange for state DOT plow trucks to lead the way all the way to Big City for the ambulance, so everything gets arranged and the question is asked, which of us wants to go with the local FD ambulance with this guy. There are 3 of us, we all have the same education, 2 of us with less experience, I admit, I was chicken, I didnt want to take this unstable pt in a major snowstorm, partner 2 says the last AMI he had in the last snow storm coded on him in the town square and he is still shell shocked (I DID transport that one in the midst of the last snowstorm) and so we talked partner 3 into going, after all, he has more experience....

I would have taken it if no other choice....but I guess my thought was it was in the patient's best interest for the most experienced medic to go, right??

I still tend to get a little gun shy with cardiac patients, even after 2 1/2 years of being a paramedic.....it doesn't seem to matter how many ACLS or 12-lead classes I sit through....Any helpful advice is welcome.....

want to pull my hair out!

well, last week I had my "worst EMS nightmare" happen to me. I can't really say anymore than that right now, but I can say it resulted in us having a few policy changes and hopefully some bigger, better changes for us, the hospital I work for and for our patients. I am also happy to say that I am glad to have the boss that I do. He probably doesnt realize just how much he is respected. Heck, I look up to him as not only a boss, but a great paramedic. And I am very appreciative for the co-workers who, although can give a hard time, helped me through the last week.

ILYGM!!

Whats your EMS opinion?

Well, work has been pretty calm. I had a few days to think about my last few serious calls. I am constantly reminded that I do know what I am doing, although I don't always feel like it. I had an interesting OD call the other day that I wasn't really sure if I did the appropriate thing. Although I have been working in PA for over a year I still sometime revert to the protocols that were engrained in my mind originally (which would be WV...which limit a provider). I was dispatched for a male in his 30s who took an unknown amount of Seroquel. Upon my assessment my pt states he took several different kind of pills, at least 3 different colored pills. The EMTs had gathered pill bottles for me before rendevousing with me and all the bottle they had were Seroquel, all stating the pills were either white or yellow. The pt reported taking several large pink pills as well, the wife stated maybe some Lamictal.
Pt was initially A&Ox4 and stated he felt high, loopy, and nauseated. He attempted to induce vomiting before calling 911, no luck. In PA ALS providers do not carry or administer charcoal, some BLS units do and can give it with approval of medical command. BLS put pt on oxygen and called for ALS. Throughout tx pt became slower to respond to questions and began to get sleepy. Pt could be aroused by a gantle shake to the shoulder but was unable to stay awake for long periods of time and when he talked his speech became more and more slurred, his oxygen saturations also began to decrease as did his respirations. I ended up giving 1 mg Narcan, just to see if it might help, his oxygen saturations came up but he still remained with slurre speech and sleepiness.

When I got back I talked to one of my medic partners who has been a round for a while and she said she wouldnt have even given the 1 mg in case he became violent...

What do you all think?

off day...

So I have to say Im officially having an "off" day. My shift tonight started out BUSY. We as the medics didnt have any calls, but the ER was swamped, and on divert for at least 6 hours. Things eventually calmed down and I was really getting into the game I was playing onmy laptop when the tones sound for an unconscious male, and it was my turn to take a call. As I am enroute further from dispatch is possible cardiac arrest. I keep waiting for the ambulance to mark up, and I wait, and I wait, and I wait. I request PD while Im enroute to the scene (fearing I will be left attempting a code by myself, I assume they can at least provide some man power). I arrive to find a rather large man in his 30s in cardiac arrest with 2 obviously distraught female bystanders.
Long story short: I get a bystander to help me with CPR for 5-7 min until another medic and PD and BLS crews show up. Pt is DRT, in asystole. I attempted an intubation, get no breath sounds but get gurgling, and then stomach distention. So I try a King, no distention this time but only gurgling and no air movement in lungs, so I try the fix all of airway devices, the S.A.L.T.....and still NOTHING, only copious amounts of vomit! My medic partner takes a look and sinks a tube....WTH?!?!?

We get to the ED and of course the doc calls it within 2 min. Then they start examining the body and they find track marks that I would never have seen in a house lit by one 30 watt bulb lamp and they find ice, yes ice cubes, down this guys pants (I had heard of this but never experienced it for myself....) So who knows??

It really affected me that I was unable to get the airway on this pt. I have no idea what, if anything, I was doing improperly and would it have made a difference? Oh, and of course it didnt cross my mind to give narcan a shot....I have been a medic for 29 months now and I still feel so insecure at times....

never gets easier

I have been a part of the EMS world for over 6 years now, and today I realized some things just never get easier. I currently work in a hospital based system, which means we get the opportunity rotate though triage for 4 hours every 12 hour shift. Today I am working a 16 and somehow wrangled 8 hours in triage. (It's really not too bad some days) Well, my fellow paramedic brought in a cardiac arrest who was a rather young pt, in their 30s. The call came in as a seizure but upon BLS arrival it was a cardiac arrest. The crews did their best but was unable to resuscitate. His buddy rode in on the ambulance with him, but family was completely unaware of what was going on. About 30 min after he was called in the ER family showed up, were shown to the consult room and the doctor went to talk to them, you could here the cries and screams of grief clear out in the waiting room. It never gets any easier at the point. I can handle a pt not making it, I have done it several times, but when the family can't handle it or handles it badly it is like daggars to my heart...

love notes from the nurses

If you can't read it, it says:
"Tiny insects brains can solve big problems"
then handwritten below says:
"See? Even the medics can accomplish something!"


This was a love note from one of my favorite RNs here at work that I came back to after a call tonight.

It's such a shame that she will soon be leaving the dark side of the ER for dayshift. I am definitly going to miss her love notes and her humor!! Thanks Sue!!!