Small Town Clinics

TINS©, TIWFDASL© in Da Nawth. I was working my weekends off in a rural hospital’s walk in clinic, and, surprisingly, saw folks who walked (and limped!) in to obtain care for their particular maladies. One snowy weekend, a gentleman limped in, with a complaint of bruising and knee pain after rolling his snowmobile.

Once the nurse had finished her interview of our friend, I entered for my share of the proceedings. I introduced myself, and asked him to tell me what happened.

“Well, Doc,” (No, I’m not a doctor, yet folks persist in addressing me as a physician, notwithstanding the fact that every single time I begin an interview, I introduce myself as ‘Hello, I’m Reltney McFee, a Nurse Practitioner. What can I do for you?’), he began, “Yesterday I rolled my snowmobile down an embankment, and it wound up on my leg, pinning me to the road. I rolled it right in front of a DNR officer, and he and one of my buddies rolled it off me. My knee feels pretty sore, even though I can walk on it. I have another bruise, here on my side, I guess from my Sig 365, that I had in my pocket.”

For those in our studio audience who are not “gun guys”, a Sig 365 is a striker fired semi auto 9 mm handgun, with a 10 round detachable box magazine. It is relatively small sized, being just under 6 inches from muzzle to the back of the slide.

I asked him where his pistol was presently, and he responded, “Well, this is in the hospital, so I left it in my car. That’s what the regs regarding my CPL (concealed pistol license) call for.”

I performed my exam, and we chatted about firearms while I did so. I contributed, “My wife is looking at getting another concealed carry pistol, and she has considered the Sig. What do you think about that?”

“Well, I really like my Sig. It carries well, and I am pretty accurate with it. You read about firing pin drag on the primer, and some guys say that the firing pin may break because of that. I haven’t had any problems myself. Just in case, I carry it with the hammer down on an empty chamber.”

TDW bought a Springfield Armory Hellcat. And loves it!

Another, tangentially related, small town story. Several weeks ago TDW-Mark II and I went on vacation. We set our camper up, and decided that this night was a good choice for pizza. We went to the local pizza place, placed our order, and settled in to wait. It was getting on towards dusk, and I noticed that, as I turned on the lights, there did not appear to be any illumination from the passenger side tail light. Since I did not feel any particular desire to explain to Officer Friendly how this light might have failed, nor my plans to remedy this failure (let alone the conversation that begins, “Well, officer, you see, I have my CPL, and my sidearm is on my right hip. How would you like to proceed?” I have had a couple of friendly roadside conversations about carry sidearm choice, but, wouldn’t it be nice to not encounter Officer Friendly as the traffic stop just after he received a soliloquy regarding his mother’s poor life choices?)

So, the next day, TDW and I set off on our day, and detoured to the Rural Town Truck Dealership. I explained my need to the service advisor, and he said that one of the mechanics could set me right, once the present job was complete.

Cool by me.

I settled in for a spell of a wait, and soon met the mechanic, who identified my bulb type, and led me to the parts counter, there to pay for my bulb.

I typically wear a ball cap, and this one is from Freedom Munitions (no payola, simply a satisfied customer). The parts guy asked me if I worked there, and a conversation about The Ammo Drought ensued. We chatted about caliber, about carry choices, and about setting ammunition by for a “rainy day”.

At the end of the chat, my taillight was repaired, I was NOT charged for the mechanic’s time (despite the fact that I asked what I owed for his time!)

The moral of the story is that, as Commander Zero (http://www.commanderzero.com/)often notes, there are Like Minded Individuals all over the place, if you look carefully.

Neighbors

One fine day, TDW-Mark II and I were at home, doing some sort of chore or another. Our doorbell rang, and I answered it, to find the neighbor girl, a seven year old classmate of Grand Daughter Number Two, standing there with her three year old younger sister, hands clutched one in the other.

“What can I do for you?” I asked.

“My grandpa fell, and he hurt himself, he’s not moving. Can you help us?”

I hollered, “Honey! Emergency at the neighbors!”, and headed out the door, TDW-Mark II watching me turn the corner into their yard.

The girls led me into their home, where I saw an elderly gentleman (now, THAT would be the pot calling the kettle over-the-hill!) prone on the floor, at the foot of the stairs, with a pool of blood about his head. The girls stood by, anxious appearing, until TDW-Mark II appeared, and led them into the kitchen, and attempted to distract them from the front of the house drama.

I asked the gentleman if he was OK, and his answer did not inspire confidence. Looking over the scene, multiple bad scenarios played out in my imagination, all leading to the conclusion that I did not want to manage this scene alone, and I really, reeally wanted EMS here, pronto.

I dialed up dispatch, and abruptly realized that I did not know the house number.

Fortunately, all those years of Street! Medic! Experience! started to pay off, as I realized that the house would have the number displayed prominently on the front. I walked out front to familiarize myself with that little detail. Oh, yes. AND the name of the street one block East of my residence.

You don’t have to say it, I already know. Bad Stretcher Ape! Situational awareness fail!

So, anyhow, I shared my new-found wisdom with dispatch, and summarized what I knew. She assured me that our little town EMS would be on the way, and then proceeded to start into pre arrival care instructions. I played along, until she paused, and I observed, “So, I’m an ER nurse. he is breathing, he is speaking, sort of, and I am reluctant to move him in any way, because it appears that he fell down the stairs.”

“Oh. Right. Well, if things change, call us right back!”

“Yes, ma’am, will do.”

The medics arrive shortly thereafter, and I reported the little that I knew. The one medic was surprised. “You don’t know any of his history?”

“Nope. We’re the neighbors. The little girl came over and got us, when he fell.”

At about that time, the mother returned home, and TDW-Mark II filled her in on what we knew. We turned the kids over to her, said our goodbyes, and departed.

Staging your CAT Tourniquet

I found this, here: https://elmtreeforge.blogspot.com/2021/07/some-good-information-on-setting-up-cat.html Known as “Irons In The Fire blog.

As is likely no surprise, I consider myself a sort of “Surprise, BAD!” guy. Since I might not always have my medic bag right in my hand, well, enter the concept of “everyday carry”.

I have a CAT tourniquet on my belt, well, pretty much all the time that I am wearing pants. Similarly, I have a SWATT tourniquet in my off hand pants cargo pocket, again, pretty much all the time that I am wearing pants.

To date, I have never required a tourniquet, either in a scramble, nor RFN. Still, as Bat Masterton is reputed to have said, “When you need a gun, you really, really need a gun!”, which, given today’s discussion, might be paraphrased as, “When you need a tourniquet, you likely will really, really need a tourniquet. And damned quickly, at that!”

Having stumbled over this video, I felt compelled to pull out my own front line tourniquets, and have a look see.

It develops that my McFee Tourniquet Stowage Plan-Mark I, was one of the featured fails in this video.

Oops!

I guess that makes July, “Medic Bag And First Aid Kit Review, Repack and Revise Month”!

My resume is on Indeed. Read it!

The other day, I received an emailed solicitation to work as a locums. I *have* worked as a locums, and it worked out OK for me at that time. By way of scene setting, I have worked ED and urgent care as a PA, NOT as a neonatal provider of any stripe.

(paraphrased) “Hello from Erewhon Locums Company! With our national reputation for placing the right provider, in the right position, we are looking for a provider to fill the opportunity described below!

Job Highlights: 

• Location: (some other state)
• Specialty: Locum Nurse Practitioner
• 7/18/2021 – Ongoing
• Will Wait for (some other state) License / BC
• Schedule includes day and night hours. Usual shifts 8am-5 pm, 5pm-8am or 24 hours- a combination could be required based on needs of service. Weekends and holidays required as needed. No call required.
• Procedures Required: Intubation, umbilical lines, PICC placement, lumbar puncture, reservoir taps, thoracentesis, exchange transfusion
• EMR System: (Infernal EMR)

Why Erewhon Locums?

• $1,000 referral bonus opportunity
• Personal travel and housing concierge 
• Dedicated support specialist for payroll 
• Experienced credentialing team 

My e mailed reply:

Well, yes, it is a great match, aside from the fact that I’m a PA, not an NP, that I am no sort of neonatal practitioner, none of the procedures listed is in my skillset, and that I will not work in (other state) for any amount of money that you are likely to pay me. 

But, other than that, yeah. Great fit. 

“You’re Gonna Miss This”

Trace Adkins had a song, several years ago, entitled “You’re Going to Miss This”. The narrator recounts telling his adolescent daughter she will miss the security of having her parents around to take care of things. Another verse has him counseling his now adult, now married, now a mother, daughter, that “you’re gonna miss this”, “this” being her cramped apartment with her new husband, later her house with young children.

In the two years before my mother’s death, I remembered that song. During hour plus drives to visit Mom, in her apartment across the state. I told my wife, “ya know, I’m gonna miss this!”, followed by a synopsis of that song.

When, visiting Mom, she had Chris Cuomo (spit!) on her television, the volume set at “11”, likely to accommodate her diminished hearing, I breathed deeply, and thought, “You’re gonna miss this”.

(realize that I supported Mr. Trump, and thought that Mr. Biden ought to be allowed to spend his waning days in the company of his children and grandchildren, spending his Chinese money as he saw fit. Oddly, Mom had a different opinion. Who knew?)

With the above parenthetical comment in mind, when Mom would attempt to drag me into some sort of political debate, such as how Mr. Trump was ill mannered or something similarly important to me (or not. Please, Ghawd! More mean tweets, less food and energy inflation!), I would placidly respond, “Hmmm. Mr. Trump sure elicits controversy, doesn’t he?” And I would remember, “You’re gonna miss this!”

I would take my mother shopping. THAT was entertaining! If you have successfully committed every one of my posts to memory, you will recall my joy at obliviots who would threaten to collide their shopping carts with my children. I, naturally, *did* recall this experience, and noted assholes who appeared entirely willing to knock my century old mother onto her ass. Since that would would have elicited a General Nguyen Ngoc Loan aisle side justice response on my part, and, well, people would talk (And scream. and so forth), I felt that prevention was easier to explain. I redeployed my “Colossus With Bad Attitude” persona, and blocked the aisle upstream of where my mother was shopping. She, of course, required ONE PARTICULAR Brand of baked beans, in one specific size, none other would do. This required considerable searching. After that PITA, well, I’d drive Mom back to her apartment, thinking, “You’re gonna miss this!”

On one visit, I thought that it would be nice if I were to prepare some lasagna for my mother, placed in “unit dose”, single serving plastic containers. Thereby, she could fish one out of the frig, microwave it, and enjoy.

Of course, I did it wrong. She laughed, and asked me, “Do you think that I am some kind of helpless old lady, who cannot even cook?” (Not exactly, but, reports from my sister in law, Donna- Praise Be Upon Her for orchestrating my mother’s household, doctor visits, medications, dog vet appointments, and every other kind of appointment- suggested that burned pans were a foreshadowing of other culinary, and perhaps incendiary, mishaps to come)

Once we had eaten, and I was washing dishes, she asked me, “That was not my recipe, was it? I think I like my recipe better!”

And, I thought, “you’re gonna miss this!”

Trace Adkins was correct.

Memorial Day (yeah, I know it’s the end of June, now)

ref my Memorial Day post of 2020, the above link takes you to the speech Gen. Kelley delivered, and, watching it today, well, I wept.

one commenter quoted George Patton: “Do not weep for these Men, be thankful that such Men lived.”

Two More Tales

Once upon a time, Da City was “The Arsenal of Democracy”, heavily industrialized, and a place where a reasonably hard working high school graduate could graduate, and, within a year, have a solidly middle class lifestyle working in a factory. One auto company had established an industrial complex just outside Da City, and on an island in this complex, had established forges, stamping plants, and coking ovens. Even across the river, the smell had to be experienced to be believed.

I worked with one guy, back on EMS, who had worked, pre-fire department, for one of the private ambulance services. They had caught a run for some emergency or another on this island, and, this being the days of 24 hour shifts, my friend fell asleep, letting his partner, who was driving, take care of things.

He related, “I was awakened when the ambulance stopped. I looked out, at the gas flaring off, and the chemical smell of sulfur heavy in the air. The area aroiund us looked like a hellish war torn moonscape, and I thought, “Oh my f@@king Ghawd! He’s wrecked the ambulance, I’ve died, and this is Hell!”

Another story, from a slightly later time, had me working with Doug and Rob, at a house in the far western area of Da City. We were dispatched to an assault, and met the cops on the scene. Upon entering the house, a gentleman (looking to be something like 6 feet and some change tall, probably running probably 220 pounds) reported that the woman of the house, who, herself, looked to be like 5 feet 2 inches, maybe 120 pounds, had assaulted him, striking him with her fists. He reported that he needed to be “checked out” due to his (non evident) injuries. She interjected that she had not assaulted him, he had, rather, assaulted her (and inflicting no perceptible injury in that process). He responded, loudly, and it was on. The Great West Side Debating Society Quarterly Meeting began.

While “the adults” were yelling etc, I noticed, in corner of the next room a perhaps 5-7 yo little girl, crouched in corner, mouth open, fists clenched as in a silent scream. While cops refereed “the adults”, I crouched down in front of child, attempting to verbally soothe her. One female officer noticed, and came over. I introduced the officer to the child, “This is my friend, Officer Evans. She would like to talk to you for a while. Is that OK? She, and the rest of her friends will keep you safe.”

We disengaged, everybody signed no transport forms, we went in service. As Rob finished the trip sheets, he paused, and commented, “You know, I think we may have just witnessed a watershed moment in that little girl’s life.”

Bastard. I fear that he was right.

First noc I wore fire boots at work: freeway run, on a snowy night.

TINS©, TIWFDASL©, and going to paramedic school in my off time (this was many, many years ago). In the course of this schooling, I spent some time in clinicals, variously in the local ED in a wretched hive of scum and villainy not so very far from Da City, or with one of the advanced life support crews running calls in the self same wretched hive.

It’s generally educational to spend time with other medics, as their organization’s culture, and lore, is likely to be kind of at a tangent to your home outfit. The education may run both ways. In any event, There I was, (studying) Fighting Disease, and Saving Lives in The Wretched Hive, and one of the host medics came on duty, ferrying his “load out” into the ambulance. I noticed that he tucked a pair of fire boots behind his seat, and asked him about them.

It being winter in The Northern Un-Named State, well, we were susceptible to receiving considerable amounts of snow from time to time. I believe the professional meteorological term is “ass loads”. My host noted that this could result in snowy shoes, and therefore wet feet, and that there were few things so miserable as cold, wet feet, in Da Nawth, in winter. Waterproof boots, that reached nigh up to one’s crotch, served admirably to avert this sort of undesirable outcome. I took notes.

Soon, I acquired my very own pair of “Storm King” (old standard) NFPA complaint boots. So, it happened that I wore them to work one snowy evening, and, early in the shift, Doug and I caught a run for “one down” on the expressway.

We pulled up behind the state police cruiser, and saw a figure prone in the snow and slush. The trooper told us that the patient had been struck by an overtaking vehicle, when the overtaking vehicle did not notice that our patient was bent over the lip of the trunk of his STOPPED vehicle, ON THE SHOULDER OF THE DAMNED EXPRESSWAY!

Our patient did not fare well in this exchange. I pulled up my bunker style boots, so that they reached nearly to my crotch, and knelt in the slush. Doug logrolled the man, and I slid the backboard beneath him, and logrolled him my way, so Doug and I could then center him on our spine splint. We buckled him in, collared him, schlepped him into our rig, and beat feet to TSBTCIDC, which happened to be one exit and a coupla turns away.

I remained dry and warm. If I had never worn those boots another day, that night, in that slush, they paid for themselves!

“These are a few of my favorite things!”

Exhibit 1: Cleti seeking work noted excusing them for their call off yesterday. When I did NOT see them, And there is no record of any visit anywhere. And, of course, no symptoms today. (Hangover, anybody?)

Exhibit 2: Jane Doe arrives, reports (complaint). My MA elicits a chief complaint, obtains vital signs, verifies medications, allergies, medical history. Generally, as the MAs with whom I work are smart and on the game, they try to identify what, if anything, Jane Doe has attempted to manage her symptoms with, as well as how long this has afflicted Jane.

Since not uncommonly the interrogatory the MA initiates will get those ol’ neurons a’firing, and other, potentially relevant, information will bubble to the forefront of Jane’s consciousness, I will myself reiterate the allergy-medication-history-symptoms-duration-efforts to remedy these symptoms line of inquiry.

So, when you have twice assured health care professionals that you have NOT employed anything to address your sniffles, for the love of Crom, do NOT interject into my instructions, right after I instruct you to employ any of a dozen over-the-counter nasal steroid sprays, that “I have already tried Flonase!” (or whatever).

It wastes my (indeed, as well as your) time, provides you with the appearance of stupidity, and raises my blood pressure.

Item 3: (Heads Up! This is NOT a ‘sick person’ story!) If any of you have shopped for a vehicle recently, you may have noticed that nearly every vehicle in America that has four wheels and an engine, has a back up camera. My new truck, indeed, does have one.

So, TINS©, there I was at the gas station, looking for a vacant pump. This one fellow pulled away, and I noticed, as I approached the spot that he had vacated, that the woman parked at the next pump behind him had, well, let us say that she had decided to determine how far she could stretch the dispensing hose forward, and still reach her gas inlet.

I pulled in, and backed my full sized truck up, attempting to avoid replicating her hose stretching experiment. Of course, that required that I approach her front bumper closely, a fact that I observed in my (Surprise!) back up camera display. I halted, something like 6-12 inches from her bumper. I exited, and approached the pump to begin my transaction, and she looked me over, and observed, “You got kind of close to my bumper, ya know!”

I smiled, indeed, with a smile that likely even reached my eyes. “Yep. That’s why I have a back up camera, to make sure that I did not get too, too close!”

She looked surprised at that. “You have a back up camera?”

Again, as I started to pump my own gas, “Yep, sure do!”

Uneventfully, she drove away.

(TDW-Mark II observed two things: First, “When she spoke up, I pulled down my visor mirror, so I could keep an armed eye on things”. Secondly, as she and I discussed it later, she observed, “You were nicer than I would have been. I might have observed, ‘Ya know, sweetie, it’s kind of sad that the Rover brought you back here!'”)

Item 4: I have whimsical voices in my head. In this, The Age Of Da Rona, folks seeking entry to our clinic are interviewed. Those who answer affirmatively to any of several inquiries get “drive through” health care. The registrar noted the vehicle, as well as the complaint.

That leads to several whimsical moments. For instance, there is the “GMC sinus” entry. That would be an altogether new variety of sinus affliction.

Then there is the notation of the “Tan Dodge Congestion”. (Hmm. THAT’S a new model name for me!)

Or the “Silver Ram”, leading to the chorus in my head serenading me with

“City sidewalks,

Busy sidewalks,

Dressed in Holiday style,

In the air there’s a feeling of Christmas.

Children laughing, people passing
Meeting smile after smile
And on every street corner you’ll hear
Silver RAM
Silver RAM, It’s Christmas time in the city….”

Finally, Item 5: a comment in response to post at Gun Free Zone blog (https://gunfreezone.net/journalists-are-dumbasses-who-think-that-tv-shows-are-reality/)

Christopher Schwehr

APRIL 23, 2021 AT 2:04 PM

It’s known as FOCUS: Fuck Off ‘Cuz U Stupid.

Dad’s Blood Infusion

So, TINS©, TIWFDASL©…well, while This Is (indeed) No Shit, I was NOT, in this tale, Fighting Disease And Saving Lives. Rather, years ago, I was in The Un-Named Eastern State, visiting the Momette and my father. Dad had had a cardiac arrest something on the order of a year and a half prior, and had, miraculously, recovered entirely intact. Subsequent to that, he was found to have cancer, and THAT had NOT had a miraculous outcome. He had undergone several surgeries, and finally had been referred to hospice.

Let me say this about hospice. These folks, in this corner of that state, were a Gift From Heaven. No shit, honest-to-God, straight up. If I were to be found to have a heart, they certainly warmed it.

Today’s lesson concerns one of Dad’s surgeries. I had taken some time off, and was in The Un-Named Eastern State. Dad had come out of surgery, and we were there to visit him: Mom, My Brother The Accountant, and myself, who, at this point (yeah, my stories sort of jump from one point in time to another, don’t they?) was an actively licensed paramedic, as well as an RN, and nursing supervisor. I had been an ED RN for something on the order of 5 years at the time of this story. In anticipation of there developing a need for me to make a longer term presence in my parents’ home, I had obtained a Nursing license in the Un-Named Eastern State.

So, we were standing at Dad’s bedside, and I noted that he had blood running. As a nurse, we all learn, early on, that from the time that the blood departs the blood bank, until the last drop of hemoglobin rich goodness leaves the bag for your patient’s veins, no more than four hours must elapse. Anything not infused at the four hour mark, will still be in the bag as it is returned to the blood bank.

Idly, I observed that the bag appeared to be half full, and dropping sluggishly. I looked at the blood bank tag, which documented, among other things, the time the infusion had started: approaching three hours previous to my inspection thereof. I inspected the tubing, looking for closed clamps, kinked tubing, or other impediment to flow. On Dad’s hand, just upstream from the IV catheter, I observed a tight bend, something resembling a slight kink in the tubing.

I released the tape, opened the loop a bit, and re taped it, and gave things another looking over.

My mother reproached me. “Reltney, I don’t think you should mess with that. You should call the nurse.”

I was surprised. “Mom, I *AM* a nurse! In fact, I’m even a nurse, in *THIS* state!”

She replied, “Oh, you know what I mean!”