Mirror mirror on the wall.

Over the last few months, I've had a steady stream of students on the ambulance with me. At first I thought to my self "What in blazes can I teach these people - I know squat and am far too new myself! Eeeek!" Having someone watching you, questioning your every move is quite daunting! And with the rapid pace that the Paramedic profession moves on, often they have had more recent and up to date training than me!

But, after the first few days I started to relax a bit. Even enjoy it. Having 3 people on a truck is certainly more fun and relaxing than just two! Those extra pair of hands, however inexperienced, always come in handy.

However, throughout the whole experience of different students, all at different levels, it has highlighted to me just how much I still need to learn, re-learn and keep learning! On a number of occasions something has come up, a question asked, an odd situation occurred, and where as before I'd have limited time to absorb what has gone on before being punted to the next job, I now have people asking me the most important question we as Paramedics can ask....

Why did that happen?

The enquiring mind. Vital for our job. Not only in the here and now of a job so we can predict what is likely to happen and prepare for it but, as I am continually being reminded, after the job. As I have been training I've had a bit more freedom to spend more time at hospital to debrief my students after jobs. It's allowed me not only to help them understand what went on but to give ME time to absorb it, to question what I did and to think how I may have done it better. Yes, I've been reflecting!

I know the R word can be scary for some people. Thankfully having gone through the university route into the Paramedic world I was exposed to this often alien concept from the off. Not that I enjoyed it, bloody essays! However, now that it is less formal, now I'm not being marked, I'm realising that I'm doing it more and more. I probably should write some of it down in a slightly more formal manner, keeps the HPC (Regulatory body for Paramedics in the UK) off my back! Particularly when a student asks me something which I'm sure I know, but do go and look up just to be sure. (Pleased to say that most of the time my poor grey cells have actually remembered the right things!)

So, what started out as a scary, daunting prospect has turned into a really positive experience. It's keeping me on my toes, keeping me reflecting and keeping me asking "Why?"

For those of you who are students, bombard your tutors / mentors / trainers or what ever you call them with as many questions as you can. Keep them thinking.

For everyone else, if you get the opportunity to take on a student, jump at the chance. It is not only good for them but it WILL help improve your practice as well!

Singing the same song in the same key

As a Paramedic, you are entrusted with a lot of responsibility. You are given lots of shiny toys, a fair number of drugs, even more if you become a PP (Paramedic Practitioner) or CCP (Critical Care Paramedic), and are let loose on the general public who, on the whole, will let you do almost anything to them when you turn up in your shiny ambulance.

This leaves us with a need to ensure we practice properly and are doing things because patients NEED them doing, not BECAUSE WE CAN do them. It means we have to be evidence based practitioners and ensure we are doing everything in the patients best interest.

Now, most Paramedics I know are ethical and sensible with their treatments, although I do know of some who cannulate "because they can". My question to them is "Why? How is you sticking a needle in them in a dirty out-of-hospital setting benefiting that patient?" Quite often they have no intention of giving them anything iv, and I think this is wrong. I do know of a service where some medics can take pre-hospital blooded when they cannulate to prevent a second invasive procedure, which is brill. However I have heard that some are using this as a justification TO cannulate. This I don't agree with. There are other practices done "because that's just the way we do things here" and other such phrases, and things done because it's easier.

I also know of some services where they have told medics to do / not to do certain things that fly in the face of all the published evidence for best practice. We as employees then have to follow these poor practices even when we know it isn't in the patients best interest.

So, where do we stand as Paramedics? As a fairly new medic (although recently I've looked around and started to feel more of an old hand on station than a newbie!) I still find it difficult to question practices of those who have been in the job for longer than me. I still see people doing things and want to stop or correct them but don't do it, and as such I feel I'm failing in my duty to give everyone my 100% best.

But as a whole, I feel we as Paramedics are not united as one. We have multiple unions who fight amongst themselves, the services we work for all seem to sing from different hymn sheets, and even within the same service there can be many people singing in VERY different keys. There are guidelines, protocols and evidence which all contradict each other. Yet as practitioners we are supposed to know what to do?

While I'm not specifically here to promote the College of Paramedics (Yes I know this is the second post in a row where I've gone on about them, I promise I won't on the next post!), I do firmly believe in them as a potential unifying force that all UK Paramedics should be getting behind. Only by uniting and getting one voice can we as a group of health care professionals begin to influence practice on a grander scale, to get one voice saying to all UK ambulance trusts "oi, let's get x y z standardised across all services", to have once voice TO all Paramedics guiding and advising us as a whole, and taking a lead in collating, disseminating and even producing research relevant to our profession and using it to guide practice. I know its more expense but I do feel that we need it and is ask any of you out there who are not members to seriously consider signing up.

On a personal note, I believe that we all as Paramedics also need to be prepared to do what we know is right and challenge that which we believe to be wrong, even if it is uncomfortable to do so. After all, its in out patients best interest and that's why we are here isn't it??

Who are we?

Paramedics.

We are a funny old bunch really. But recently I’ve been thinking, what exactly IS a Paramedic? And from things I’ve read from the College of Paramedics and other sources, this question is one that is coming up again and again.

It’s difficult to define really. When you stop to think what we actually do, then try to explain it, nothing seems to come close. Some will say “a Paramedic is like a Technician only they can cannulate, intubate and give more drugs”. Is that what we are? A Technician with extended skills? Personally, and I mean no disrespect to Technicians, I think that isn’t a very good description and sells us short. Besides, with the way the profession is moving I don’t think you can sum up what we are just by the mechanical skills we perform and drugs we are licensed to give!

Another description I hear a lot is “Jack of all trades, master of none”. While this hints at our need to have some knowledge about all and sundry in the medical world since we never know what we are going to come up against, again I think this sells us short. Master of none? I’d argue that there is one trade we are masters of – Pre-Hospital.

I’d say we are “Pre-Hospital Specialists”. While this may seem a bit vague, I think it is true. The pre-hospital world is a very strange, sometimes dangerous place. It is not just “here is a patient, please make them better”. While many doctors, nurses and other health professionals can deal with the medical side of our patients, dealing with the complex medical needs of the patient in ever changing environments with little or no backup, while being conscious of your own safety, and dealing with the often tricky extractions from said environments to your ambulance and then to wherever is appropriate for the patient... well that is a whole different ball game and one we are right in the middle of.

Much, if not a very large percentage of our job is not all about the medical knowledge, the things we do medically to patients, but about talking to people, dealing with their emotions, dealing with the people around them, problem solving, negotiating. It is hard, and often draining work but it is what we must do if we are going to truly help our patients.

Of course, there needs to be firm underpinning knowledge and skills to go along with the talking and dealing with people. A Paramedic who can’t walk in and recognise the “big sick” patient who needs rapid treatment & transport (drug of choice –DIESEL) is not very good at all. But increasingly we are not just dealing with the big sick patients. We have to be able to deal with the not-so-sick and all their complex needs as much as the big sick.

A blog post that really captures the essence of what we do is one from the Legendary Insomniac Medic and can be found here http://insomniacmedic.blogspot.com/2009/08/proof-of-creationism.html - And really, if God had that much trouble with us, will we ever be able to get a good definition of what we are?

In the ever changing dynamics of the NHS I feel it is important that we as Paramedics keep a sense of self. We need to make sure that what we do is recognised and appreciated by the wider health care community. We need to shout about what we are good at, make people realise we are no longer just stretcher taxies with first aiders on, but also to recognise what we are not good at and ask for help. In a little plug, I also feel that we need to get behind our professional body, the College of Paramedics, as without a strong professional body, how can we as Paramedics stand up and say “Hey, this is what we think and we do actually know what we are talking about”. Any medic who may happen to read this and is not a member, please do join. It’s not that expensive at all and they are gathering momentum. If we get over half the 17500 Paramedics in the UK as members, they can apply to be the Royal College of Paramedic – and that will provide even more clout!

So, next time someone asks you “what is a Paramedic”, pause for a second before you answer. If you really think about it, I’d say we are unique, special, highly adaptable members of the health care community who have to be able to deal with anything life can throw at us in a calm, professional manner with the highest levels of patient care and treatment available. We are Pre-Hospital Specialists.

NM.

Going to hell?

Pride.

Apparently its one of the 7 deadly sins (according to some). So, is it wrong that I am:

Proud to wear the uniform that I do. To put it on each day and know I’m doing something good with my life?

Proud to be trusted by complete strangers to come into their lives at their most vulnerable and try and help them as best I can?

Proud to help people in whatever little way I can, from a simple smile, a lift off the floor when they are stuck, to much more in depth medical interventions and life saving treatments?


Well, if it is wrong, then I’m going to hell because I know I am proud to be a Paramedic!

NewbieMedic

Who cares?

My heart sank as the familiar vibrating sensation got me and my crewmate out of our seats. Our radios had buzzed indicating we had a job.

"This one will be sick" I said to my fairly new crew mate.

"How can you tell?" they asked.

"Simple. We have less than 30 minutes of our shift left!"

We climb into the vehicle and my fears mount.

"Yep, gonna be a sick one. Just look at that address..."

Any job at a care home / nursing home tends to fill me with dread. And this one was no exception. Sure enough, more information buzzes down to our computer as we start to roll out the garage.

"Looks like you might be right" my crew mate says to me. I take one look, press the "999" button turning my big yellow custard box into a flashing yellow custard box and do my best to personally destroy the ozone layer as I make significant haste towards this job.

What had made me go like a rocket was a few notes in the description box "BP 66/33. Oxygen levels low". For anyone non-medical reading this, your Blood Pressure (BP) really should have the top number (the systolic) above 90. If it is not, then vital organs, such as kidneys and the brain, start having issues getting blood to them. This is bad.

As we pull up and get out, met by an aroma of rather hot breaks, I suggest we take the bed and all the trimmings in. Normally I take in my medic bag, O2 and a defibrillator anyway, but for this job I actually thought I was going to need them.

We start rolling the loaded bed towards the entrance when a lady appeared to show us in. I'll admit this did surprise me as I am more than used to having to wait for 5 or so minutes to get in / find someone who knows what is going on. Perhaps this was one of the better care homes in the area. How wrong was I.

We squeeze our trolley bed into the room that clearly had not been designed with getting patients in/out in mind, and are met by a nurse.

"Hello there. What's happened?"

"This is Edna" I look over and see this elderly bag of skin and bones sat up in bed looking not well. "Edna's had diarrhoea for the last 3 days. Now her blood pressure is low. So are her oxygen levels. And she's not really responding that well either"

"Ok, what are her obs?" I ask as I start trying to find a radial pulse, pop my sats probe (a device that measures the oxygen content of your blood) on her finger and indicate to my crew mate to do a temperature and check the ladies sugar levels.

"The last BP was 66/33 and her sats were 83%"

I look at the ladies badge. Yep, it does say nurse.

"So, why is she still sat up?" I ask. A blank look is my reply. "And do you have oxygen in this place?"

"Oh yes" the nurse replies.

"Any reason it is not on this patient then?" I ask.

"Er.... I don't know" they sheepishly reply,

"Well may I suggest that if a patient has a low blood pressure you lie them flat at least, and perhaps raise their legs if you can. And if they have low oxygen levels you actually give them oxygen?" There is a distinct bitterness in my voice at this point. Not entirely sure she realised how annoyed I was at her. "Do we have any notes for this patient? Any sort of medical history?"

"There should be some notes in her file".

"Then may I suggest you go and get us a copy of these notes as this would actually be useful". I may have over stressed the word actually, but I think she got the message as she left.

The radial pulse was all but non existent. A manual BP showed about 75/40. Better than what we had been told, but not by much. This still was a very sick patient. Temperature was slightly raised, so perhaps there was an infection on board. A quick listen to the lungs; nothing significant in there. Sugar levels fine. Pulse slightly quick. Oxygen levels initially a bit low had now come up since we had actually put oxygen on this poor lady.

I look at my crew mate. "Trolley, ambulance, scarper me thinks".

"I agree!" they reply. Considering they had been on the road less than 6 months, they certainly had more of a grasp of the severity of the situation than the "Nurse" did.

We move her over carefully. It wasn't hard, to be honest I could have blown her over. There literally was nothing over her. I turn around to put some bits back in my bag...

"I don't think she's breathing"

In the immortal words of James May, Cock.

I turn round. No obvious chest movement. Quick listen.... a beating heart but no sounds of breathing. I dive in the oxygen bag and pull out a bag valve mask (BVM) used to ventilate people, plug in the oxygen and pass it to my crewmate who was already at the head. As she starts to ventilate the patient, I grab the defibrillator and start sticking on the pads - once breathing stops, the heart often isn't far behind!

"She's breathing again". Sure enough, there was clear chest rise, not being caused by my crewmate.

"Let’s move before she goes again" I suggest, with which we grab all our bits (no staff around to help of course) and start rolling towards our ambulance. On route we bump into the nurse.

"One of our colleagues is coming with you. He has all the notes". Nice to be asked if this is ok! But at least we will get the notes.

On board the ambulance I pop a needle into the lady, which I must be honest I didn't expect to work as old people have veins that like going POP when they even see a needle. But, having not cannulated a patient for well over a month, first go and in it went. I connected up a bag of fluids, raised the patients legs, both in the hope of getting her blood pressure up a bit so that her brain and other vital organs would get a better blood supply. We shot to hospital, handed over to the staff in resus and left her there. I have no idea if she made it through the night, but I have my suspicions.

The thing that struck me about this job was the nursing home. Now, before I continue I should point out that, as a paramedic, tend to only see the less good nursing / care homes. The ones that are not looking after their patients. This is why we keep getting called. The better ones look after their patients and so we don't see them much. This may have warped my view slightly....

When we get older and frailer, we may end up in a state where we struggle to care for ourselves (there are some that think I can't do that now!). At this point we may well end up in a care home or, if we need extra looking after and have more medical needs, a nursing home. In these supposed sanctuaries we should be properly looked after until the day we pass away. However what I saw with Edna was a poor little old lady, suffering, skin and bones, not well cared for at all. And she is not alone. The number of homes I go into where patients all look so uncared for is scary. And it breaks my heart every time. Many of these patients are paying very good money for these places and they are being totally let down. Yet nothing seems to be done.

Not wishing to start a euthanasia debate, but we do appear to look after our beloved pets better than our elderly. They are either nursed back to health or, should they be suffering, put down. Yet our elderly are stuffed into these homes, with staff that are highly questionable and only care about their pay cheque and going home, and are left to suffer, usually prolonged by modern medicine trying to keep them alive, until they finally pass on.

I don't want to moan, I really don't. But this issue really gets to me every time I enter one of these "pre-mortuaries" (I did not make this phrase up but I do find it scarily accurate). We should be honouring our elderly. They should have prize place in our society. We should be ensuring their care is above reproach, top class, never faltering. So I ask anyone who has actually stopped to read this to do one thing:

Never be afraid to highlight a problem in one of these places. Be you a visitor to your relative or a visitor in green coming to take another poor person to hospital. If you have even the slightest doubt that the care may not be up to scratch, tell someone. If you are working, there should be reporting mechanisms. If you are a visitor either talk to the management, or if you are worried your relative's care may suffer because of it, go through your local social services and they should be able to help. Only by highlighting your concerns every single time can a body of evidence be put together to make changes happen. It may not be easy. It may make you late off work occasionally. But these people often can't stick up for themselves. We must be their advocates. We must be their voice.

Thanks for reading

NewbieMedic.

Keeping up to date

As a Paramedic, I am responsible for ensuring I keep myself up to date with all the latests guidelines, practices and to make sure I keep my skills up and prove that I can still do those things that I was taught many moons ago. This is part of my profession and part of being a professional, taking responsibility for ones "upkeep".

However, this is not easy. Yes, you can read journals. Yes, you can keep reflective accounts of jobs you do etc to help learn what you have done and how you could improve it. But, and I don't know if I am alone in this (which is one of the reasons I blog - to see if I am alone or if others are in the same boat and how they deal with it!), I do find that my trust is not hugely supportive of on going training and development. I also feel there are limited courses out there in commercial world specifically designed for the Paramedic market, and many of these courses are not cheap either!

Now, don't get me wrong, but I think trusts (well my trust at least) are trying. Rota's now have (or are getting) training days built into them. There does seem to be more of a push towards yearly reviews for staff and individual training plans. They are trying to get more training staff available more of the time to more staff, which is all good. However, as soon as the pressure levels increase and the trust is over worked *poof* away goes the training. Certainly, in the trust I am in, we seem to be "under pressure" more and more these days, and I guess it is the same for many with the wanting us to do more for less. But is this really an excuse? While I am not going to go into the intubation debate here (I'll save that for another post!) even though it is recognised that Paramedics don't get as much exposure to this skill as is desirable, there is little that trusts seem to be doing to address this. One trust I know of has even stopped training intubation to all it's new Paramedics - so instead of trying to find a solution to the training they have just removed it which, given we are in the 21st century and wanting to move the profession forward (well I know I do and I am sure I am not alone!) this only seems to be a step backwards.

As for external course, yes you have things like PHTLS and ALS but really these are Doctor courses and while they are relevant for Paramedics in the whole, they have not been designed FOR the paramedic. If I am honest, I'd love to see some courses with us in mind being developed between the College of Paramedics and HPC. In my little brain I can see a huge market here - perhaps a course that you could do where you can have simulation manikins and practice intubating (to reduce the aparent skill fade and thus stave off the skill removal), prove compitence in managing cardiac arrests or truama or any number of scenarios, perhaps some theory and even an exam. Perhaps even make this a mandatory course which you need to do every 2 years and produce the certificate when re-registering with the HPC. Some people reading this (assuming anyone does) may think I am crazy, and in part this may be true. But surely, something like this, designed for paramedics, making sure we keep skills up to date, proving that we still know stuff can only help to improve the profession. It would ensure we keep ourselves up to date. It would ensure we do still remember things and are regularly tested on them, not only proving to ourselves that and our peers that we can remember it but proving to the public that paramedics are not just a group who have done training once but are constantly being re-tested to protect them. Yes, I know this in part is what CPD (Continual Professional Development) is about, along with folders, but wouldn't it be good to have specific courses targeted at paramedics with this in mind?

Ah well. Until such time as these sort of courses appear I shall keep doing whatever training I can get out of my trust, probably some additional courses on top (if my bank balance will allow!) and perhaps a conference or two. Will definately keep reading blogs and listening to the Ambulance Matters podcast - http://ambulancematters.com - (strongly recommend this to people!) as this seems to be quite a good way of reflecting...

Oh, and if anyone has any great learning resources, any tips or tricks, or any courses they'd recommend, I'd be really interested to hear. I want to become a good paramedic and I know I am right at the beginning of this journey. Like I have said before, anyone who thinks "I'm now registered. I've got there" is in for a shock as there is always more to learn. And if anyone fancies setting up some Paramedic Training Courses designed by paramedics, for paramedics, let me know!

Who wants trauma?

What is it with Trauma? You've probably heard similar comments as I have...

"Went to this wicked job last night"
"Oh, what happened"
"Well it was this proper trauma job...."

I have heard people talk, even rave about trauma jobs, "proper jobs", jobs where people are significantly injured and it takes a lot of effort to save them. So many people, and often new people particularly, seem to be transfixed on these jobs, some I'd say even look forward to them.

And, to a point, I understand their "attraction" - the fact you have to use your skills, think on your feet, actually use all that training you once did, cannulation, the needle chest decompression (sticking a needle in the chest to relieve a potentially fatal pressure build up), giving fluids, working alongside HEMS. It's a proper job. The sort we all trained for.

But, is this right? We are a profession that exists to care, to help the sick and injured. So how can we WANT a trauma job when that requires someone to be seriously injured? In fact, any "proper" job where someone is unwell enough for them to require full blown paramedic interventions, drugs etc surely is a bad thing? After all, we want people to be well do we not? Surely a day with no patients would mean a day where everyone is well and not injured??

It seems to be a contradiction - liking the trauma jobs (or other such hard working jobs) yet wanting to make people better. A bit of a moral nightmare. And this got me thinking....

I can't speak for everyone, but I don't want people to be injured or sick just so I can use a skill I haven't done in a while. Some of the least used skills are ones that I don't want to use (they mostly involve very unwell kids / babies - which is why I don't want to use them!). However, I think we all can agree that a day with no illness / injury is not something we are likely to see. And so, I'd rather be somewhere where I can help those who most need it.

It's still morally shaky. Still not sure how I feel about trauma. I wouldn't say I "enjoy" a trauma job, again there is a sick and injured human being at the centre of all of it - someone's son/daughter, brother/sister - but as a job, whatever the outcome I find it brings the best out of people. There is definite teamwork, there's a yearning to do the best, do it well and do it quickly. We all pull together and fight together for the same outcome, and it is this shared experience, this teamwork that I think I enjoy.

So, judge me if you will, but I do like a proper job, trauma or otherwise, but not because I like guts and gore or really sick people, but that as a job it's one that brings the best out in people and you really work as a team. But I'd still rather I was never needed.

It's not easy being green.

So, there you are. Fresh out of training school / university / whatever route you have entered the mad world of EMS. You are all keen. Full of knowledge and enthusiasm and wanting to put that into good use. You know what you should be doing. You want to get out there and do it. Do the best for your patients no matter what.

Then you meet them. Those who "remember the days when". Those who want to just take every patient to hospital. Those who think machines are evil. Those who think that there is no point asking too many questions as they never listen at hospital. Those who never take anything into a job because "it'll just be rubbish anyway".

And here comes the dilemma. You have to work with these people. You are a very small fish in their very large pond. How far do you go to get along? What will you sacrifice so as not to become "that bloody uni student"??

Will you sit idly by while they do things you know to no longer be best practice?

When you attend, will you still take in all the bags because YOU want to make sure you are not caught out?

Will you try and leave people at home when it is the best option for you or will you be pressured into taking them to hospital "to cover your arse"?

When you are driving, will you "turn those lights and sirens off, its a load of bull and we don't need them on"?

Will you continue to listen to the chest or will your stethoscope become another bit of kit gathering dust in your bag?

When a patient would benefit from a drug that while not essential right now you can give, but it will involve cannulating, will you spend the time to make the patient feel that bit better slightly quicker or "just take them to hospital. They'll do that there"

Will you keep your keenness or be sucked into the cynical, anti-management, anti-work world of the old school?

Now, don't get me wrong, I think the old school have huge amounts of experience to teach us newbie’s. They have coped and done the job with less equipment, facilities and drugs for years. Their hunches about patients are quite often spot on. They know how to deal with PEOPLE, something that can sometimes be lacking with newbie’s. But it's about extracting the good from the bad and learning from it.

A wiser person than I once said "You can learn something from everyone you work with, either something you want to incorporate into your way of working, or something you don't. Treat every shift as a learning opportunity".

I'd like to think that throughout my training I have tried to do this but I know that there have been times when, working with certain individuals, I may not have done as much as I'd like because I didn't want grief. Now, I'm a little more confident (not that much tho!) and take what I want into jobs, deal with patients the way I want to and try not to slip into bad habits. Yet a recent incident has made me realise that I have a long way to go still. I'm still very new in the grand scheme of things and could be working with these people for years to come. And a 12h shift is a long time to work with someone who really dislikes you.

Thankfully, with words of encouragement from numerous people I am happier with what I am doing. While I have noted the comments made about me, I haven't really changed my practice. I'm just more aware of it.

If EMS is to change, to improve, to move forward, we have to make sure that we do not let those who would anchor us in the "I'm just an ambulance man with a van" era succeed in bringing us down. While we must respect their views, learn what we can from them, we need to be mindful that EMS is developing and we can help that development. We are the future.

Best not tell them that tho, seems to p*** them off!

NewbieMedic

Me and my blog

Well, here goes nothing. Me. Blogging. Bizarre. I suppose it would be best to start by saying who I am and why I have started to blog.

Who am I? Well for now at least, this shall be, in part, a mystery. Anonymity provides a certain level of protection, not only for myself but also for those patients who I may end up blogging about. Anonymity also provides a level of freedom to open up without any fear of reprisals from management, colleagues, friends or anyone. Needless to say, all details of patients, colleagues and anyone else involved will be anatomised to protect confidentiality. So, to an extent, the blog will be works of fiction based loosely on fact.

However, to understand why I am blogging some sort of background into who I am may provide a frame of reference as to where I am coming from. I am a registered Paramedic working within a large NHS Ambulance trust. I have been with them for a while but only been a Paramedic for a little over a year. Before joining the trust I also had experience working in an A+E department for a number of years, something I am very thankful of to this day.

However, even with my background of working in the health care field of a good few years, I still feel very new. VERY new. I have been a Paramedic for a year but still feel like I am just out of my box, shiny and new and sent out to deal with anything and everything. A bit daunting to say the least.

And it is this feeling of newness that has prompted me to start this blog. I don't know if anyone will read it. I don't know if anyone will care about my ramblings. But it is a way for me to mull over those feelings inside me, to put down all thoughts thoughts that are rattling around my brain and to try and make sense of it all. Even if one other person reads any of my blog and thinks "thank God I am not the only one who feels totally out of their depth" then it will be worth it.

I don't expect this blog to be a "hit" like many others I read. I am not looking for stardom or to be thought of as a "hero" - If I were then I'd be in the wrong job to start with. But I do hope that writing things down, getting them on paper (well, on screen) will give me a better chance to reflect on what I do, and to try and become a better medic for it.

And so, with this brief intro into to who and why, I begin blogging. See ya around!

NewbieMedic