Thanks to all that have helped!!!

Wednesday, July 16, 2014

Grief Mops

I realized a sad truth very early into my career in EMS. It can best be summed up by a quote from the movie "Bringing Out the Dead." Nicholas Cage's character is describing his role as a paramedic

" I realized that my training was useful in less than ten percent of the calls, and saving lives was rarer than that. After a while, I grew to understand that my role was less about saving lives than about bearing witness. I was a grief mop. It was enough that I simply turned up."
Bringing Out the Dead is a perfect example of a paramedic who is "burnt out" in public safety terms, in medical terms Frank Pierce (Nic Cage's character) is a classic, albeit highly dramatized for the film, case of PTSD. He had ran too many calls, had tried to wring out that grief mop one too many times. The years of hiding his feelings coupled with the lack of that adrenaline rush that comes with a save to give his life meaning, he is left to battle his demons. His particular demon was named "Rose," an asthmatic he was unable to save, becomes the standard barer for all those perceived losses he is unable to mourn. We call it being "Burnt Out," the inability to have any empathy. It's not that we don't care about our patients, we just simply cannot take any more, our mop is soaked and there is no way to wring it out.

The role of Public Safety falls into this category all too many times. The combined amount of human suffering and tragedy that we are exposed to is only compounded by the perceived machismo of the position. Showing emotion is often viewed as a sign of weakness and is preyed upon by the collective group. As always, there are exceptions, most often pediatrics. It seems to be the only time when emotion is not weakness, but expected. The same isn't true for the countless other tragedies, for those you are expected to "suck it up and move on."

For years, I followed this formula. Pushing all the fear and guilt of the "lost" saves into a dark recess of my mind. I would find outlets where I could, dark humor and nightmares were my two normal weapons to combat the feelings when they crept up. Insomnia became constant, only to be quelled by medication (both self and prescribed).


My "Rose" came in the form of a 10 year old boy. He happened to be wearing the same shoes I had just bought my son. Prior to this run, I had been comfortable as seeing my patients as their respective conditions. I could trick my brain into seeing a broken bone, a stroke, a heart attack as just that, the person who had suffered these ailments didn't exist. That wasn't your father, that was a full arrest who needed to be intubated and medicated. I followed my protocols and treated each problem in order of it's severity and life threat...until this child. I jumped into my normal role, he was a cardiac arrest that was more than likely caused  by a respiratory problem. I needed to get him intubate and oxygenated...I inserted my laryngoscope blade and looked up to get my tube, that's when those Thomas the Tank Engine shoes came into view...I continued on my mission. I had been successful and had a return of circulation. I was walking on air...I had a save. One who had an actual chance of walking out of the hospital. Yet, his shoes stuck in my mind, I would relive this run over and over again, every night he would meet me in my sleep. I thought if I went to see him, to see that he was getting better it would help quell this temporary problem. I met his mother, I saw him on the ventilator with my tube still in his trachea, providing that all important oxygen. Yet, this only worsened the nightmares. It all came to a head when I heard the news of him dying. He was to be released, and suddenly took a turn for the worse. His death marked my first experience with that flood of emotion breaking loose from the dam I had built. Years upon years of tragedy I had held in broke loose with a force I had never experienced.

I took more and more ambien, trying to knock myself out and patch this hole...and it worked for a little while. The problem is, self medication never works. We need to change this broken dynamic. We need to realize that in our field there are no walls, we are alone in a sea of human suffering. We have been called to be islands of refuge in this storm, and we need to let their be strength in showing emotion.

I'll end this diatribe with this thought. We all have a calling. For those of us who chose to run towards the chaos instead of away from it, we have to realize that it comes with a price, more often that price is our own piece of mind. So take on that grief, be the mop, but before you become saturated, turn to your friends, your coworkers, and show that their is untold strength in empathy and emotion.

Monday, July 7, 2014

Update on Life...Glad to be back

Well, after a long hiatus I'm finally back online. We have been having some issues with our internet connection, so after several phone calls AT&T finally got the issue handled. I just wanted to stop in and give you an update on things around the Prosthetic Medic household.

First things first, I'm very excited to say that the schedule for 2014's Stanford Medicine X conference is out, and I will be speaking Saturday Sept 6th. I'm still working out the speech and trying to decide between the two topics I've been writing on. I've got a few more days before my initial outline has to be turned in, so I've got to make a decision soon.

Next up, Kate has taken a job with Bullitt County EMS and couldn't be happier. She loves working in a 911 system and I'm very excited for her to finally find a service that feels like home to her.

Lastly, I have taken a job with Amazon in Sheperdsville, Kentucky. I am so excited to move to my next step in this crazy experiment of life. I will be working there as an Onsite Medical Representative. Basically, I'll be providing basic medical care and helping to manage their  cases. I'm very excited to be joining the Amazon team and try my hand at Industrial Medicine. It will be quite the change from working on the ambulance, but after proving that I can still do that job, I think working in this setting will be better for me physically. I will probably try to find a part time job on a truck somewhere, just to keep my skills up, but I'm ready for the change.

I'll be back in a night or two to write about something with some more substance, so for now, that's all thats going on in our little corner of the internet.

Later,

PM

Tuesday, June 3, 2014

I'll give you a hand....just need an XBOX Kinect and a 3d Printer

While mindlessly browsing Facebook today I came across a very interesting article. For the low price of $45 we are now capable of printing a mechanical 3d hand that is, according to many users, better than any mech hand on the market made by the major prosthetic companies.

This got me thinking...With the push in 3D printing technology, the ever strengthening materials, and the constant battle to obtain a prosthetic from insurance companies...Why aren't the big prosthetic companies making a huge push for Insurance Fairness for Amputees? With the lack of access to reliable and high performance prosthetic equipment, mankind is doing what it has always done when faced with a problem...We are adapting. Now with the Open Hand Project, and countless others, hand amputees have more options than ever.

To add to the dilemma, 3D printed sockets are now available for upper extremity and below knee amputees, how long till every class of amp is included. With very little knowledge in the AutoCAD program and a Microsoft Kinect camera from an XBOX, you can now 3d scan in your own limb, design a socket to fit, and soon, attach this socket to your own home printed limb....It boils down to this. The Apathy of the manufacturers is going to put them out of business. They are too blinded by their own success to look down and see the patients on whom their limbs reside, and rely on. Why would I jump through the hoops and red tape for a prosthetic, when I can design one just for what I want it to do from the comfort of my own living room? Unless this lack of response is reversed and pressure placed on the correct sources (ie Congress, not the people designing the limbs they couldn't receive through traditional means) then they are going to put themselves out of business.

Most people putting their prosthetic designs on the internet for 3D printing aren't doing so to make a quick dollar, no, they are doing so because they can see the insanity of denying a person a limb that could give them back a quality of life that is similar, if not better, than they had prior to their amputation. We need to join forces, there are 2 million of us in the United States, not to mention the tens of thousands of employees that are working for the big name prosthetic makers.

If you are reading this, please send this to your prosthetist, your doctors, your prosthetic company, whomever you think may benefit from prosthetic parity. The time is now...

Friday, May 30, 2014

Stanford Speech and Steampunk Prosthetics




If you missed it, above is the link to my Ignite Speech and QA at Stanford Medicine X's School for Design Course. David Ruthven and I had the opportunity to speak about Designing for the Physical Environment. I focused my ignite speech on Prosthetic design. The biggest problem is lack of Patient Centered Designs. For a refresher:

Patient Centered Designs are generally customizable and retain some patient individuality. In the Prosthetic world you need to look no further than the Socket. The patient interface that connects to the prosthesis itself. These are designed for each patient, molded to fit their limb, and often some form of individual design added to make it feel like "mine." As an example:
      
 This is my first socket. Notice the "Jackass Jolly Roger" a great way to individualize a socket

In Contrast, the prosthetic itself is a cookie cutter design that is the same for each patient. No options on colors or exterior design. Otto Bock has helped with making the individual settings customizable to speed up or slow down, add resistance or take it away, or preset settings for specific sports and activities. However, for appearance you, have no options. 
Until Now...I was forced to eat my words by the guys at Digital EFX Wraps 
( http://www.digitalefxwraps.com ) 
They have taken the idea of wrapping a car with a vinyl design and applied to prosthetics. I am the second person to have the opportunity to have my prosthetic customized to a design I chose. I went for an Industrial/Steampunk look. It fits my personality...the great part is they can do anything. I've already been dreaming up my next cover, probably a mixture of anatomy and machine.


I'm so excited at what this will do for amputees and bringing amputation to the forefront of peoples minds. I love that my prosthetic is a piece of art. Let me know what you think. If you want one...message me and I'll get you in contact with Dallas at Digital EFX. Lets get this viral...spread the word!!!

Monday, May 12, 2014

Dancing with the Amputee Star...

I've avoided watching Dancing with the Stars. I have successfully avoided watching not only this season, but most seasons. Sure, I've seen an episode here and there, but for the most part, I'm simply not interested. That being said, tonight there's not much to watch and I found myself watching Amy Purdy's dance. She was amazing, for those who aren't familiar. Amy Purdy is a Paraolympian Snow Boarder who happens to be a bilateral below knee amputee. What struck me the most was the buildup to her dancing, and her decision to perform the quick-step with her "blades." Blades are the running legs most people are familiar with seeing, and for some reason the image most people associate with prosthetics.









Amy Purdy on "Cheetah" running blades



What I noticed is that she had several other pairs of prosthetic feet to choose from, in addition to the running blades. I realize that she is a gold medal winning Olympian and has several sponsors who are willing to pay for these prosthesis. I found myself getting upset. No, not upset, down right mad. Not at Amy Purdy, mind you, at the fact that in order to receive the prosthesis you need to live you have to either 1.)Be independently wealthy, 2.) Be extraordinary and have sponsors who want you to wear their prosthesis, 3.) Fight tooth and nail with insurance companies to "maybe" get a prosthetic...not the best one to let you live life again, no just a prosthetic.

I nearly found myself in the 3rd category, but thanks to those of you who read this blog, and, as I was described by Dr Larry Chu at Stanford Medicine X, being persistently disruptive for a positive change in the amputee community, I was able to pressure an insurance company into covering a prosthetic they deemed "Experimental." By the way, Experimental is an insurance term for prosthetic technology that has been around since the 1990's, being the microprocessor controlled prosthesis. There are nearly 2 million people with some sort of limb loss currently, not everyone of these amputees would benefit from this technology, but for those that would, it is a life changing prosthetic.

Imagine this...for an insurance premium of around 5 cents per person, microprocessor controlled prosthesis would be covered for those who meet the standard. That would be possibly hundreds of thousands of people able to return to a more active lifestyle and many of them would return to work.

Now for contrast, lets apply insurance companies logic to other areas of healthcare. Could you imagine an insurance company denying a pacemaker that a cardiologist wants to implant? How about denying the hardware for a hip replacement? Yes, these happen in rare occasions, but under normal circumstance these devices are implanted and covered. Now, realize that these are also prosthetics. A pacemaker is a prosthetic that assumes the function that the heart has lost the ability to perform, a hip replacement places a prosthetic ball and socket joint that resumes function of a joint that lost it's ability to perform the normal function. Now, why does implantation inside the body make these more important than a hand, knee, ankle, or other prosthetic device? I wish I had an answer...that's why we need Insurance Fairness for Amputees.

Oh well,

I will step down off of my soap box for tonight and hope this has given you something to consider.


Until Next Time ...PM

Friday, May 9, 2014

Happy Anniversary!!!!

Yesterday was the 3 year anniversary of my life changing fall. This week has seen a spike in my anxiety, while it has been rough, it was not unexpected. I have experienced the same problems for the past 2 years, so the increase in symptoms this year, while unexpected, were not preventable. The amazing part was that, on the actual day of the fall, I had a wonderful day. This is due to Kate and I celebrating our 1 year wedding anniversary. We made the decision to change the outlook of that terrible day into a very positive one, and I must say...it worked.

On to the updates,

I had the wonderful opportunity to speak to the Moving Forward Limb Loss support group a few weeks ago. It was a wonderful experience and I look forward to further meetings with those wonderful people. You can watch the speech here Moving Forward Speech

I spoke about one of my least favorite cliches..."Playing the hand you're dealt." We all have heard this euphemism before. A negative event happens, and inevitably you're met with at least one person telling you to play the hand you're dealt. I happen to disagree strongly with this though process. Playing the hand your dealt, leaves you in the situation. I say, instead of playing the hand you're dealt, why not change your cards. Life is not a poker game, No, life is more a game of Go Fish. You can ask your neighbor for help, and luckily, you can help your neighbor as well. Playing the hand you're dealt would have left me with a fused knee and ankle, and miserable.

In a few weeks, I will be travelling to Stanford University to speak to the School of Medicine. I will be giving an Ignite! style speech with a power point to back up my points. I will be posting a video of this once it's available.

I am happy to say that, while I'm not where I want to be in life, I am finally optimistic again. It has taken 3 years, but I feel like I'm finally getting back to who I am. I have finally mourned my loss of both my leg and previous identity. I have came out on the other side with a determination I wasn't aware I was capable of...I now understand the battles I have been through will be platform I stand on to help others either get through their battles or avoid them completely.

I'll be updating again soon,

Until next time.

PM

Friday, April 18, 2014

Louisville Metro and Open Doors

On Tuesday I attempted to take the Louisville Metro EMS physical agility test. For an overview here is what the test consists of...
100' Serpentine Carry: Carry an approximately 80 pound hose bundle 100 feet
zigzagging through cones spaced 5 feet apart
you have 1min 10sec to complete

Enter through the window of a standard size car window and then exit 
through the same window

The following tasks are performed continuously, you have 5min 30 sec to
complete these tasks

Enter the driver side of the ambulance, touch the radio, emergency
equipment, gas and brake pedals then exit

Open the rear compartment and remove the stretcher with 2 med bags placed
on the bed. Move the stretcher next to the fire tower

Carry the med bags (approx 33 pounds) to the 3rd floor (although their paperwork
says 3rd floor they made me go to the 4th)

Once on the 4th floor put the bags down and pick up the 80 pound hose bundle and
carry back to the stretcher.

Put the stretcher with hose bundle back in the ambulance

Return to the 4th floor, retrieve the med bags and place them on the floor of the
ambulance (end of test)

As stated above, I had 5 min and 30 sec to finish this task. I completed the skill in 5 min and 57 seconds. 27 seconds over my allotted time. I had asked prior to testing for another minute or 2 to complete the tasks as an accommodation under the Americans with Disabilities Act. I was denied this accommodation and therefore failed the exam. To say I was bummed was an understatement. I was crushed. Thankfully, I have a very supportive group of friends and family, who helped me realize that considering I climbed effectively 8 stories in under 6 minutes as an amputee. That's not to shabby. 

I did email the HR rep for LMEMS and brought to his attention that although their departmental paperwork said we would be tested by going to the 3rd floor, we were instructed on test day to go to the 4th. Had I went to the 3rd floor as on the paper they gave us I very well may have passed. The rep responded that since I didn't say anything before my test then I forfeited all rights to complain. So, that's it. My future with LMEMS is over. I can retest in 6 months if I chose too, but I think this ship has sailed. That leaves me with a decision to make. Do I continue on in EMS or do I try a new path? I think I've made that decision. I may take a part time job on the ambulance, just because I really do enjoy patient care, and I am good as a medic, but in the long run EMS is just too hard on our bodies. Most people in this field end their career with a back injury. The days of making it 20 or 25 years are quickly coming to an end. An ever expanding population of bariatric (obese) patients is increasing the rate of injury on duty, and ending careers almost quicker than we can replace those left by the wayside. 

I have decided that I will continue in some function in medicine. I may teach paramedics, I may go back to nursing school, who knows where my path will lead. One thing is for sure. I am turning my focus. For the next few years my focus will be on helping Kate go to school and continue to push for Insurance Fairness for Amputees. I am going to try to focus on a national level instead of state level. My number one priority will be Kate. She has supported me throughout this insane journey we have been on. Up till now, the focus has been squarely on me, it's her turn for center stage. I will continue to write, do the occasional speaking engagement, and always mentor others (amputees and EMS). 

So, with that said, please continue to follow along. I have decided to stop trying to open this closed door and search for a door that is open. 

Until next time, 

PM