“The Nerve Pill”

So, TINS©, TIWFDASL© in Da City one Dark and Stormy Night. My partner was driving and, therefore, I was blessed with the opportunity to interact with the diseased and injured of Da City, at length. My Very! Favorite! Thing! Ever!

This one gentleman was seated upon the squad bench, and I had reached the part of my interview wherein I inquired after medications presently among those employed by the named patient, namely, da dude in da ambulance.

“So, Sir, do you take any medications?”

He gazed thoughtfully into the distance, or such distance as the module of an ambulance provided, and responded, “Uh, no, not really.”

Internally, the Voices Inside My Head raged over this reply. “ ‘Not Really’? Whaduhfug! How can a question, with an anticipated answer of ‘Yes’, or ‘No’, be so freaking complicated? Dude! This is a ‘Yes’ answer, because you do, indeed, take freaking medications daily, or the answer is ‘No’, because you do not! Even a simpleton such as I can sort this one out!”

What got past my Thought/Speech Filter, was the following: “Uh, does your doctor expect that you are taking medications?”

The response was, “Uh, I guess so, I suppose that he does.”

“What sort of medication might it be, that your doctor thinks that you are taking, but you are NOT taking?”

“Oh, that ‘nerve pill’”

“The ‘nerve pill’? Why did you stop taking your ‘nerve pill’?”

He looked at me, dead in the eye, and, with a straight face, told me, “Because the voices in my head told me that I did not need them any more!”

Let me tell you, the rest of THAT trip to the hospital was not relaxing!

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Alimony

Some back story. When TDWM1 (The Darling Wife Mark 1) and I had met up, she was a single mother of two children, working full time and going to nursing school. And, yes, she was successfully pulling that off. Once it was plain that our relationship was going places, well, I invited her to give up her apartment, move in with me, and let me support everybody. I made as much money in one OT shift, as she made as a nursing aid over an entire week. Or two. I told her, “You can always make a buck. You will not get a second chance to make that grade.”

She accepted my offer, completed Nursing school, got licensed, and we lived happily ever after. Or, at least, several years, happily (or so I thought).

So, fast forward to The Divorce. Let me admit, early in my tale, that she could have been way, way WAY more wretched than she elected to be. For example, had she alleged (falsely, but nonetheless she could have alleged…) that I had threatened her, well, a personal protective order was routine in such events, and until I successfully proved to the judge’s satisfaction that I had NOT threatened anyone, well, all my firearms would have to find new, happy homes. That is one example of wretchedness that she passed by.

On the other hand, getting back to my story, TINS ©, TIWFDASL ©…well, OK. There I was in a courthouse conference room with The Plaintiff (en route to transitioning from TDWM1 to The Wretched EX), her attorney, my attorney and me. Her attorney had just finished describing one of their demands, that I pay The Plaintiff alimony, and I quote, “So that Ms. Stretcher Ape can complete her Bachelor Degree in Nursing, so she can support her children better.”

I looked at my attorney, and he shrugged. With that signal, I dove in.

“Uh, Ma’am? why does your client require alimony in order to complete her BSN?”

“Mr. Stretcher Ape, it seems only fair. After all, she worked to put you through PA school, didn’t she?”

I contemplated this gambit. “You know, you have a point. I think we all agree that we all want fairness. You *do* realize that, while she was earning her associate nursing degree, I paid all of the household expenses for her, the children, and myself, right?”

Every at the table nodded, some more warily than others.

“So, since I contributed $1000 every month from my student loans to the family budget, while I was in graduate school, full time, isn’t it reasonable to expect your client to make a similar contribution toward her own education?”

Again nods, some wary.

“And, since I worked night shifts, 12 hours each, every night that I could, during our month long semester breaks, and every holiday shift that I could sneak in, as well isn’t it fair to expect Ms. Stretcher Ape to do likewise?”

The attorney nodded. I continued. “So, if we review my W2 forms, which I am sure our friends at the Friend of the Court have supplied you with, you can see that I contributed around $30,000 every year from my night shift earnings, as well as another $12,000 from my student loans. Isn’t it fair to expect a similar contribution from your client?”

The Plaintiff’s attorney started to bluster, but I held up a hand. “I’m not done yet. Now, you are suggesting all this effort should be directed toward earning her BSN, so that, as you term it, she could provide better for our children, right? This will add up to thousands of hours when your client could be mothering our children, and thousands of dollars in tuition, books, fees, and associated expenses, money that could be spent to the benefit of our children, right? All so that your client can earn a BSN, and earn more money, correct?”

The opposing attorney nodded. “Well, I, myself have a BSN. I am presently employed as an RN, and I can tell you, for a fact, that your client will earn twenty five cents an hour premium, as the holder of a degree in Nursing at the 4 year level! That means that, conservatively, her education investment will have paid for itself in (mumble, mumble, scribble, scribble) somewhere between ten to forty years, depending upon where she takes her classes.”

Opposing counsel leapt to her feet. “I do not believe that the earnings increase that comes with a BSN is so paltry!”

I leaned back, and smiled. “Madam, you have my pay stubs. They reflect that my employer, the largest hospital system in this part of the state, pays twenty five cents an hour. Most hospitals do not pay any sort of premium for that degree.”

Across the table, they leaned into each other, and held a hurried, whispered, conference.

I interjected. “May I make a counter offer? One that you likely will see again, like in court?”

Warily, I received nods of assent.

“Well, since I am a MAN, and a MAN wants what is best for his children I propose that, rather than spend thousands of hours in academics, hours when she could be mothering our children, and rather than spending tens of thousands of dollars, money that could be spent to the advantage of our children, that your client instead spend that time, spend that money, for the betterment of our children. And, since I am a MAN, and, being a MAN, I want to do what is best for our children, for my part, I will offer to pay her, annually, in one lump sum, in addition to whatever other money I am directed to pay, the five hundred dollars annually that she will forgo should she defer her education.”

I sat back.

THAT was the last I heard of alimony!

Why Do People Get Shot In Da City? (or) A Tale Of Four Stupids

TINS©, TIWFDASL© in Da City, as a medic. (Kinda where this entire series of stories began, right?) Every night my partner and I would respond to somewhere around 12-20 runs in the course of a twelve hour shift, seven shifts in each two week pay period. Let’s call each typical night 12 runs. It makes the math simpler. Nearly every shift, there’d be one shooting, sometimes we would catch a couple or four shootings, occasionally no one would be shot among our patients.

So, after over 6 1/2 years, back of the envelope math reveals that I responded to something on the order of 14 000 calls, maybe 2 000 shootings. I developed my own opinions on why it is that folks get shot in Da City.

First in the list, most popular, if you have your heart set on being shot, is engaging in the unlicensed retail narcotics trade. If you prefer, in order to accommodate delicate 21st century sensibilities, we can refer to folks so occupied as “Undocumented Pharmacists”. These entrepreneurial souls were commonly among the shoot-ees in my ambulance. As regards their numbers among the shooters, well, I lack direct data, but it seems reasonable to conclude that these folks were not shot by the Amish, nor by employees of competing internet startups; for one thing, there was no internet in these dark times. Rather, it seems likely that the perpetrators of these shootings were attempting to dissuade competitors from marketing in what the shooters thought of as their markets.

Secondly are alcoholics or those who associate commonly with alcoholics. Patient census wise, this was also a “popular” option should one seek to be shot. Well, for certain meanings of “popular”, that is.

Third in line (and likely showing some overlap in our Venn Diagram of morbidity with the first two groups), are those folks who owe some third party sizable amounts of money, and have allowed this third party to have some lack of confidence in either the timeliness of repayment, the completeness of repayment, or some combination of the above. And, I do not mean MasterCard or Quicken Mortgages. They only shoot you in the wallet.

Next up in our list of popular triggers, so to speak, of being shot, is represented by Lotharios who romance somebody, that somebody else believes is THEIR love interest exclusively. That aggrieved somebody else may seek redress ballistically.

Last in measurable terms is the innocent victims of random violence.

An over arching theme among the above, is the report of the shoot-ee, that “There I was, minding my own business, and these two dudes, they shot me for no reason!” This is akin to the classic report by the family of deceased home invaders, immortalized in recent months on television news, as “He dindu nuffin! Ain’t no cause to shoot im! He just breakin in, dat ain’t no deaf penalty crime!” (checked for typos)

Also associated with this is the lament that the decedent was studying to be an aeronautical engineer, transplant surgeon, minister, or was studying music so that, once his rap career was successfully concluded, he could find a second career being a choir director, given his love for choir as a yout.

In summary, may I remind one and all of John Farnam’s dicta, which I repeat to my family ad nauseum. In my iteration, it is referred to as “Avoid the Four Stupids!”, or in more detail: “don’t go to stupid places, at stupid times of day, to do stupid things, with stupid people.” This includes by reference the mantra that “Nothing good happens after midnight!” Mr Farnum’s own formulation reads as follows:

(a) Don’t go to stupid places. (b) Don’t associate with stupid people.

(c) Don’t do stupid things. (d) Be in bed by 10.00pm (your own bed!).

(e) Have a “normal” appearance. (f) Don’t fail the attitude test! (http://defense-training.com/2018/where-is-safety)

 

(So, I suppose that makes for Six Stupids: “Don’t go to stupid places, at stupid times of day, to do stupid things, with stupid people. Don’t look stupid, don’t act stupid”)

Another Triage Tale

Another ER night shift, another exciting opportunity to triage.

So, TINS, TIWFDASL, and another lucky soul ambled in to have his disease fought and his life saved from the scourge, the morbid threat, the life changing consequences of having contracted….THE SNIFFLES!

I sought to elicit his chief complaint, history of present illness, review of systems, daily medications, and medication allergies. His answer to the last, stopped me in my tracks.

“I’m allergic to everything.”

I did another literal, physical double take. “Pardon?”

“I’m allergic to everything!”

“Uh, sir? Are you telling me that you have never, ever, in your entire life, taken a medication that failed to make you ill? Every single time? Without exception?”

“Yep.”

“Every time? Not once did a medication fail to make you ill? Every single one you have ever taken?”

“Yep.”

“I’ll make sure the doctor knows that.”

Nursing Story The Third

Another day found me triaging. As always, TINS, TIWFDASL, and my next lucky contestant sat down. Again, with the chief complaint, history of present illness, review of systems, vitals, allergies medications and personal medical history.

As I wound up my interview, I asked, as I typically did, “Do you have any questions?”

Of course, my correspondent replied, “Yeah. Is the doctor gonna give me any medicine with any side effects?”

“Sir, why do you ask?”

I found out why he had asked. “Well, I don’t want no medicine with no side effects!” (No, he did not appear to be a Rhodes Scholar).

I performed a literal, real, physical double take. “Excuse me?”

“Because I don’t want no medicine with no side effects!”

Being an old fire department medic, I commonly repeat back what I had just heard, in order to assure that I had heard what I had thought I had heard. This time, I needed it.

“So, you’re telling me that if anybody, anywhere, ever, anytime, had had any side effect from any medication, whatsoever, then you do not want to take that medication? Did I get that correct?”

“You did. I won’t take no medicine with no side effects!”

I told him, “I’ll make sure that the doctor understands your concern,” and ushered him back into the waiting room.

Nursing Story The Second

Again, TINS, TIWFDASL in some other ER, in some other little town. The night of THIS story, I had a patient assignment, and one of my patients was the subject of a an order that he receive an IV (infusion of sterile fluid) and a blood draw. Typically, these are performed simultaneously, as very few folks really enjoy a second needle stick in order to obtain the blood that you did not obtain the first time you subjected them to a needle stick, to start the IV. I thought, Easy-Peasy, no problem, I can do this, just like the thousand and twelve other times I had done this very thing.

I gathered the supplies I would require, and approached the patient, launching in to my stock spiel. “Hello, sir, I’m Reltney McFee, one of the nurses, and I here to start an IV and draw some blood. Please, say your name.”

He said his name, the name I was expecting, and asked, “What’s an IV?”

I explained, “Well, sir, I stick a small needle into your vein right here on your forearm, and slide it out, leaving a small plastic tube in the vein. I connect this here tubing to the hub of that plastic tube, and administer sterile fluid to help you feel better. You should feel the benefits in under a half an hour.”

“Will it hurt?”

My internal dialogue, effective squelched by my functioning thought/speech filter, ran along the lines of either “I’m fixing to stick you with this here pointy thing, and you wonder if it’ll hurt? Naw, hell naw, I won’t feel a thing!”, or “Yep. Hurt like a motherfucker. I don’t think you will completely pass out, but, just in case, I’ll get some towels when your bowels and bladder release from the pain, OK?”. Due to that filtering, I said, “Sort of, for a minute.”

He then asked me, “Doc, hurry up!”

I corrected him. Not every male with a stethoscope is a physician. “Sir, I’m a nurse, not a doctor. I’ll be as gentle as I can be.”

He was not listening, it appeared. “Oh, doc, doc, doc! Hurry up!”

I set my stuff down, and faced him. “Ok, here is how this works. I can, if you wish, do this really fast. Or, as an alternative, I can do this once, correctly. Which of these sounds better to you?”

“Uhhh, once sounds better!”

“Very good choice. Now, maybe you would allow me to do this, just like I’ve done it several thousand times before, OK?”

“Uh, OK.” And he stuck out his arm.

So, I applied the venous tourniquet, prepped the site, set up my blood draw tubes, readied my adapter, tore my tape and prepared my site dressing, one puncture, blood flash, and steadied the hub as I withdrew the needle. Attach adapter, obtain blood, remove adapter, attach tubing, secure tubing connection, tape hub, apply site dressing, create and tape down “tug loop” in IV tubing, set IV drip rate, and collect my trash and blood and off I go. Send blood, chart IV start, done.

Like I said, Easy-Peasy!

Nursing Stories The First

So, TINS, TIWFDASL in an ER in a little hospital in Da City. The night of this particular tale, I was in triage, and so found myself interviewing this febrile, coughing, achy, miserable soul.

We had conversed about his medication allergies, which medications he regularly took, his own medical history, and were beginning to chat about the events that had led him conclude that a visit to ER was the prudent way to spend his evening.

He had already cataloged the fever, cough, and myalgias culminating in our lovely little chat, when he shared with me the fact that, “Doc, I’m so sick that I cannot even smoke!”

I had spent a rather busy night in triage, and was kinda lacking in sympathy. In addition, my “Thought/Speech Filter” was in need of some preventive maintenance. I replied, “You do know, sir, that in some ways, that could be regarded as a clue?”

Fortunately, this gentleman had a very robust sense of humor. His chuckled reply confirmed it: “I know, right?”