Wednesday, December 14, 2016

Tuesday, December 6th

The trouble with living inside of a gym in a blizzard is that there are no windows.

OK, so there are other troubles with living inside of a gym in a blizzard. But the no windows thing is a biggie. Because there are also no clocks nearby, and so - unless you check your watch or phone from time to time - you can lose track of time completely. Add to this the occasional short nap, and more surreal experiences, and you've got the perfect recipe for a 100 hour day.

Since Tuesday is a jumble of strange events and curious happenings, I'm just going to share some stories of the day. I can't really say what happened when, but I'll try to keep morning stories in the morning, afternoon in the afternoon, and so on.

One of my early thoughts was that I had taken surprisingly few photos. If you know me well, you know that most of my adventures are overly photographed by me. I'm as heavy on the shutter release as I am wordy on my blog posts...

But on this trip I had not taken many pictures. I left my 'good' camera home, because I remember what military life was like, and figured we'd be moving around a lot, or engaged in taking water and gas and rubber bullets from the "authorities", or various other things that could result in my good camera becoming my lost camera, or my broken camera. I had planned on taking many pictures with my phone, but still didn't document much by way of images. So I figured I'd better get a couple pictures of the blizzard before it ended...

And a couple is literally all I got. The first one is from our drive to camp on the 5th, the second is a shot outside at the AJAMC on Tuesday morning.

At some point Tuesday, word came down simultaneously that the roads were all closed due to the abhorrent weather and road conditions AND that we were expecting an unknown number of people coming to us as overflow from the casino and the sick and weak people from the camp. We were instructed not to drive, but that somebody would be driving mass quantities of people to us.

In true military fashion, most of us smiled and nodded and carried on with what we were doing, and some of us went into panic mode trying to figure out where all the new people would go and what we'd do with the sick, contagious people. We had already set up a little quarantine area because we had a few people coughing up bloody sputum, so we made plans to enlarge that a little. Our Cannon Ball XO, Mel - who was now our AJAMC chaplain and all around good egg - suggested we name it the 'comfort area', as legally we couldn't be quarantining anybody. Most of us liked this idea.

I will tell more about the people I met in a later post. Because I met some truly wonderful people out there.

Anyway, someone came around to collect all of the mats that went with the donated cots to double our sleeping capacity. that wasn't much of a loss for anyone with a cot/mat combo, because we all had our super thick and warm negative temperature sleeping bags that acted like mattresses anyway. I gave brief consideration to donating my cot as well, but I figured I'd just hang on to it until I saw someone who needed it more than me.

Things were coming together nicely, when Margaret came by to find out why we hadn't been gathering information on all of our 'patients'. She was very concerned that we all be able to cover our own butts in case we were sued later. Understandable, I suppose. But since we were basically handing out band-aids and headache meds to people that asked for them, I didn't feel the need to keep super strict records on everyone we saw. As she was telling us of the importance of collecting all of this data, a gal came up with a broken fingernail and wondered if we had any scissors.

I pulled out my trauma shears and gave them to her and she snipped off the offending nail. As she left, I tried to get her name, symptoms, allergies, medications, past medical history, mother's hair color, etc, and that made Margaret laugh. I think she may have relaxed a little bit there, because we had just shown who our 'patient' base was, and there was really no need for data collection on anything but the bad cases.

And we did have a couple of bad cases. One guy who suffered from anxiety found us looking for some help. Fortunately there was a counselor type person who gathered a group of other counselor type people, and I took him over to her and things worked out. We had some blood sugar issues that could have been bad. But mostly we had aches and pains and cuts and blisters.

At another point in the day, a bus had arrived with sixty or so people from...somewhere... Casino maybe? Anyway, the bus got stuck in a snowbank coming in to the parking lot, so a herd of us went out to help push it loose.

As we walked into the frigid, cold, blowy type day, I noticed some people hooking the side of the bus to a big pickup, ostensibly to pull it sideways off of the bank(?) I dunno. I just gave them some space in case the chains snapped. When that didn't work, we were all instructed to go to the back of the bus and prepare to push.

So we tromped our way around to the back of the bus and waited.
And waited.
And waited.

Then someone up front yelled for us to get out of the way, because the bus was going to try and go backwards to get another run at the parking lot.

So we all moved back and watched...

When that didn't work they told us to get ready to push, as the pickup truck had now moved to the front of the bus and was being hooked up to pull.

When that didn't work, they told us to come around to the front of the bus and try pushing it back into the street. So we all moved around to the front of the bus and waited.
And waited.
And waited.

It was when they decided that we should go to the back of the bus and push that I decided that things were getting silly and I was getting cold. So I headed back inside to warm up a little, and found several others had preceded me. More would join us from outside as we talked about all the new people that had arrived.

Eventually the bus was freed. I don't know how, because it happened while most of us were inside. But I'd like to believe it was the power of our positive bus moving thoughts that helped the most.

One of the local business owners came in to tell us that he was bringing Chili and fry bread for everybody at supper time. This was met with loud and appreciative cheering, and I think I can safely say we were almost all looking forward to seven o'clock. (1900 in military time.)

At some point between the bus and supper, Margaret came over to ask if I had any dressings for an IV.

"Do we have IV equipment?" I asked.
"I do." she said.
"Do we have someone that needs an IV?" I asked.
"The dog over by the door is sick and needs fluids, so I'm going to start an IV on it."

I slow blinked a few times.

"Really?" I asked.
Margaret just looked at me with impatience and again asked if I had any dressings for an IV.

I gave her my package of 3x3's and a roll of Coban. I wondered to myself if she was going to try for a vein, or just do a fluid push in the scruff of the neck like I had done with Shoba when she was dehydrated. But I didn't ask, because Margaret was obviously tired of my questions.

As she headed off excitedly, Tammy got up to follow. She wanted to keep an eye on things since the whole "starting an IV on a dog" thing seemed a little hinky to us.

It was not too much later that we had... an "incident".

Here is what I saw.

I was sitting on my cot, talking with a couple other people when suddenly there was a commotion over by the door.

Margaret was holding someone and yelling for people to take their medical supplies away. She was very obviously pissed by the tone of her voice.

I stood up to see better and saw that Margaret was holding Tammy's arm behind her back, and her (Margaret's) other arm around Tammy's neck. As I started to head over to see what the heck was going on, Margaret then put Tammy in a headlock and was yanking her around, trying to wrestle her to the floor.

I ran over, but others had already stepped in and removed Margaret from Tammy. They were quickly separated. Ari the CO and Clark the Sgt. Major were there in a flash and talking to each woman individually. As I walked by Ari talking with Margaret I heard him say something to the effect that what she had just done could be prosecuted as battery... I just wanted to get to Tammy and make sure she was ok.

I saw that she was talking with Clark and another witness, and so assessed from a distance. Her neck was red, but she seemed to be breathing fine. So I decided not to barge in and just let things get taken care of.

Eventually I was able to talk with the other girl that saw the whole thing and got the rest of the story.

Apparently, there was a vet tech type person willing to try the stick on the dog, but she was pretty frazzled and missed. So Margaret stepped in to save the day. But apparently Margaret didn't have any experience with medical procedures on dogs, and Tammy didn't think it was a good idea to let Margaret experiment on this dog. Some words were exchanged, and Tammy reached over and moved the IV kit out of Margaret's reach. This threat to her authority set Margaret off, and you know the rest.

Well... I was a tad perturbed by this. Margaret had rubbed me the wrong way from pretty much the moment I had met her. I had figured that she could be "in charge" as long as she wanted if it made her feel better, because we weren't going to be there long enough for any of that to really matter. But she had just attacked one of MY medics.

OK, so I was technically not in charge of any medics or anything. But the Cannon Ball medics had been together for awhile now, and I was feeling quite protective of the little group of friends I was in. So when Tammy got attacked, I got mad.

I made it a point to seek out both Ari and Clark and let them know that there was simply no way on God's green earth that I was following any orders from Margaret anymore. I told them that there were other medics that felt the same, and told them that if they should choose to keep her as "Chief Medical Officer", then I would question their leadership as well. And since we were all volunteers and there was no actual chain of command, I was more than willing to take all of the medical supplies I had gathered and head up to the camp.

Other medics also stepped up to voice their displeasure with what had happened. At one point, Ari came over and asked me two questions.

Would I be able to work under Margaret just for another night?

No. Absolutely not. She is unstable and at this point a danger to herself and others. She should not be near an actual patient.

Would I be willing to step up and lead medical if they removed her?

Umm... yes? But only if they didn't have anyone better.

I didn't want to be a boss. I just wanted to be available to help people as the need arose. I wanted to eat and make sure all of 'my' people got food. I wanted to sleep and make sure all of 'my' people had beds. I wanted to keep everyone calm and cheery without the threat of being attacked by a "Type A" self appointed leader.

Medic Tiffany made a joke about the Lord of the Flies. It was sadly funny because it was certainly starting to play out like that. If we stayed for much longer, things were going to devolve quickly.

Eventually they called all of us medics to a meeting. I went with some trepidation. If they kept Margaret, a bunch of us were out of there. I also didn't want to be boss. I was hoping they'd just tell everyone to chill, since we'd all be leaving in the morning anyway.

At the meeting, they told us that Margaret was no longer in command (good news) and that David the RN was our new Chief Medical Officer (GREAT news)

David and I were talking later, and he felt the same way I did. If we were going to be stuck there for weeks, then yes - we'd need a better command structure. But for a night or two... just help people that need it and chill.

I went back to my cot relieved. Word soon came down that the chili and fry bread had arrived. Another grateful whoop rose up, and people started lining up for hot chow. I stood off to the side to make sure everyone got some food, and was pleased when they made the announcement for elders to go up and eat first in the traditional Lakota/Dakota/Nakota way. I was joined by Chaplain Mel, and we had a fun talk about our beloved Marine Corps.  As we spoke, a new group of people came in, and I resigned myself to not getting any chili or fry bread because I wanted to make sure the travelers coming in from the cold got some hot food. Besides, I had parts of the MRE left to eat, so it wasn't like I was going to starve or anything. I went back out to see if there was anything left when the line died down and remarkably there was some chili still in the pot! I grabbed a piece of fry bread to go with it, and went back to my cot to eat.

I cannot describe the epigastric joy I experienced with that meal. There simply aren't words that would do justice to the flavor sensations that were held in that little bowl. You should be jealous you were not there. (Unless you were there - then - Holy Carp! Was that good chili or what!?!)

After dinner there was a program going on with a native guy and his wife telling a story about two birds in a race. Tortoise and the Hare, Dakota style. They had recruited a couple of vets to play the parts of the birds, and made a good show of it. That was really fun to watch.

After that, they began a drum song and a round dance, where people joined hands and danced in a circle. As I was watching that, a gentleman came over looking for a doc. I answered, because it was one of the three names I had agreed to answer to.

He told me that he has a seizure disorder and that his meds were in his gear in Kenel, a small town about seventeen miles away. Then he told me that he hadn't taken any of his meds for a few days. He was worried that he might have a seizure and wanted us to be aware of it so he didn't freak anyone out if it happened.

I thought perhaps we could scrounge for someone that took the same meds, but how to go about finding those? This, I decided, was a job for our NEW CHIEF MEDICAL OFFICER!

He was dancing in the circle dance when I approached him and gently tugged on his sleeve. He smiled and made a space for me to join in the dance. This would have been fine had I not met the gentlemen off his meds. So I told him I needed to talk to him away from the circle.

After filling him in on the situation, we went to talk to Clark and Ari. Knowing that finding the same meds in the same doses as this guy was unlikely, I volunteered to drive down to Kenel to get it. Clark was a little hesitant, but I gave him my credentials, Arctic driving courses in the Marines (Which were basically just driving around Ft. McCoy in the wintertime - but hey, it got me a military license to drive in Norway!) 100,000 miles as an over the road truck driver, and I promised him that we'd go slow and turn around if it got too bad.

He agreed on the condition that I take a co-driver. So I asked Kiyoshi if he wanted to come along, because he's good company and I knew I could count on him if something went wrong. We also took the 'patient', as we were going to the Kenel community center and finding his gear amongst a lot of other gear. I figured he'd be able to find it, and with my luck, we'd just bring back some other vets gear.

The roads weren't good, but they were so very much improved from our adventure driving on Monday! So much so that I was actually up to 40 MPH for some stretches! The wind was still blowing snow into near whiteout conditions, but not as fiercely as the day before. We also noticed that the sky had cleared up, and we could see starts through the swirling maelstrom on the ground. The conversation was delightful, as our 'patient' had been a career mechanic in the Navy, and kept us entertained with stories of fixing all sorts of engines. I don't know about Kiyoshi, but most of his technical talk was pretty much lost on me. But it was still good to hear. From a medical standpoint, I could maintain observation on him even though my eyes were on the road. As long as he was speaking clearly, no seizure! From a veteran standpoint, it was fun to hear his military stories. Kiyoshi did a great job of keeping the conversation going most of the time, which I was thankful for when I needed to be ultra focused on the road a few times. It was a very pleasant trip down to Kenel.

We found the community center gym without too much difficulty, and upon entering found a well organized, albeit small, group of people. They welcomed us, offered us bed space and food, and in all did a great job of being hosts in their space! We explained that we were just stopping by for some gear and meds, and when we returned from finding our patients belongings, they had packed a bag with fried chicken and sodas for our return trip.

We had been there all of fifteen minutes, but were still sent off with food and hugs. It was very nice.

The trip back was pretty good, as we neared the AJAMC, the winds were finally starting to slow down a bit as well. I had no doubts that we'd be able to clear out in the morning.

The gym was dark when we returned, and Clark seemed glad to see us back in one piece.  I went to the bathroom and when I came back saw our patient and his friend and some others gathering near the door.

Turns out they were getting on a bus to head back to Kenel to join up with the rest of their crew. I'm still trying to find a way to convince myself that our whole trip wasn't for nothing. Although to be fair, it was a good road trip with excellent company, so I'll hold on to those memories for the take away.

In the "medical room" was another seizure patient that had intentionally refused to take his meds. He was being tended to by the aroma therapist doctor, and Dave the RN CMO was trying to find medics that could stay awake and monitor him. I begged off, as I was exhausted and was going to need to drive a lot the next day. Thankfully, oh so thankfully, Medic Tiffany stepped up to volunteer, as she was going to be a passenger in her vehicle. So I finally said my goodnights.

I was heading across the dining room when a guy half carrying a stumbling woman approached. We got her into the medical room as well, learning that she was diabetic. Well, being a newly minted diabetic myself, I just happened to have my glucometer in my gear. So I went back into the dark gym to pillage through my things until I found it.

With a clean needle, we checked her blood sugar and it came back at 100. This is not particularly low, but she was symptomatic. Fortunately, she was also being tended by our LPN's, so my presence there was superfluous. I said goodnight again and was again stopped in the middle of the dining hall. This time for introductions to an ACTUAL MD! He asked for an update and I told him all that I knew, which wasn't much because I had been searching for my glucometer. I told him her blood sugar was 100, but she was still kind of loopy. They were getting her food and juice. Then he asked me if I was a paramedic. I told him I had been, and he asked me what I thought had happened.

I said with a smile that even when I was a medic, we weren't allowed to diagnose. He smiled back and said "Still... what do you think?"

So I told him that 100 might not be low for a normal person, but she's diabetic, stressed, maybe not eating well, maybe not taking her meds. So maybe 100 is low for her if she's used to 300 or 400.

He smiled again and said "I agree."

He asked me if I had insulin. Which confused me for a moment because A) I was stupid tired by this point, and B) I'm not insulin dependent, so I thought he was talking about having her insulin. And why would I have her insulin? I just met her five minutes ago.

Then it dawned on me what he was talking about, so I told him I had none, and he seemed ok with that. He was laid back and unperturbed, which I like in a doctor. I was glad he was there, even though I'd never see him again.

Blessedly, I made it back to my cot without further interruptions, and flopped down to sleep right after kicking off my boots, coat and hat.

It had been a long, weird day. The plan was to be up at 0530 to depart the AJAMC by 0800. I set my alarm for 0545 just in case I slept through reveille. It was 1 o'clock (zero 100)when I finally shut my eyes on the day. 

More Later

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