Random Thoughts III

Story “A”

You may recall my delight at marijuana legalization, correct? Because, “medical marijuana” wasn’t ENOUGH of a cluster f*&k, right? Of course, there is my recurrent delight at the discretion, great judgment, and common courtesy displayed by the genuii who stroll (nay, stumble) about, reefer fumes pouring from every fold of their clothing, if not every pore, in a nigh overpowering display of Poor Life Choices On Parade.

So, TINS©, TIWFDASL© when this braniac arrived, spawn in tow. My poor clerk registered the Named Patient (actually, plural, as in both kids), and then let me know that the chart was ready for me to lay some healing upon them. As if.

So, my first clue that Things Were Not Right, was when the nominally 3 year old child, named Adam, was sitting upright reading some (non picture) book. My second clue was that the nominally 12 year old child, was around 36 inches tall, and appeared to be around 40 pounds. And, did NOT appear critically malnourished.

I asked the reading child, “Please, tell me how old you are?”

The reply was “I’m 12!”

“How old is your brother?”

“Oh, he’s 3!”

I excused myself, and asked my clerk, “Did you know that Adam is 12, and Brady is 3?”

She looked at me, and informed me, “I asked the mother, and asked her twice, which child was which, and who had what birthday. It did not look right to me, but she repeated herself, same birthday both times, for each child. That is what I put down.”

“Well, it is wrong. Please, fix it, and double check it, all over again. Please try to sort out what else she fucked up in registering the kids, please.”

Once the clerk asked the 12 year old for his school id, the mystery was resolved.

My new Life Rule! If you are so stoned that you cannot remember your own gorramned childrens’ birthdays, and you successfully mix the TWO of them up, either stay the Fenomenon home, or WRITE IT DOWN!

Story “B”

Have you heard about Homeopathic Medicine?

“What Is Homeopathy?“

“Homeopathy, also known as homeopathic medicine, is a medical system that was developed in Germany more than 200 years ago. It’s based on two unconventional theories:

*“Like cures like”—the notion that a disease can be cured by a substance that produces similar symptoms in healthy people
*“Law of minimum dose”—the notion that the lower the dose of the medication, the greater its effectiveness. Many homeopathic products are so diluted that no molecules of the original substance remain.

(from: https://nccih.nih.gov/health/homeopathy )

Let’s keep “The Law Of Minimum Dose” in mind for a moment. So, I work in an urgent care clinic in The Un-Named Flyover State. It’s….quirky. Yeah, let’s go with that. So, our cleaners are some folks who are NOT from some national housekeeping chain. I do not know where the owners hired these folks from, but, well, they are, in keeping with the theme of the organization, quirky themselves.

Over the past several weeks, I have been noticing that the hand soap dispensed from pump bottles, has been appearing clearer, and clearer. Similarly, it has seemed less viscous, and less viscous, from week to week.

In keeping with these observations, it has started to require more and more pumps to elicit enough soap to, ya know, WASH MY HANDS!

One of the MA s clued me in to what is happening.

“The cleaners never pour more soap into the dispensers, they just add water. It’s free, unlike the soap that costs.”

I wondered, out loud, “What happens when it is simply only water in the “soap” dispenser?”

She told me, “I dunno, maybe, finally, they’ll buy more soap?”

I corrected her. “NOPE! We will be told, that this is the latest public health innovation! Homeopathic soap!”

Story C

A long time ago, in a county far, far away, I was working as an ER nurse. I overheard one of the clerks engaged in a telephone call.

Now in this agency, at that time, Administration did not want us providing “medical advice” over the phone. I was on board. My stock spiel, when I was trapped into answering some such call, was along the lines of “If you think you have an emergency, you ought to come to the emergency department. If you do not think that you have an emergency, perhaps your problem could wait until (the morning)(Monday), at which time you could arrange for your family doctor to address it. If you do not think that your problem can wait until (the morning)(Monday), well, at this time of night, your only option is to come in to emergency.”

I, myself, often would be the recipient of some query at that point, along the lines of “Well, how do I know if it is an emergency/can wait until Monday?”

My answer would be “You are there, you have sense (Yeah, I was lying through my teeth!), and only you can make that determination. I am not there, and I cannot see what you can see, since you are on the scene, and I am not.”

So, I heard the clerk speaking to some Brain Truster. Attempting to explain, repeatedly, how and why she could not tell him whether his laceration needed stitching. Mr. Telephone was persistent, and I could tell, from my clerk’s responses to him, that he was saying stuff like “Well it’s (insert length here) long, and about (insert depth here) deep, and it’s (insert some indicator of severity, like bleeding or suchlike here), so why can’t you tell me if it needs to be stitched?”

She finally had had her fill of his idiocy. “Sir, what color blouse am I wearing?”

“How the hell would I know what color blouse you are wearing?”

“So, how am I supposed to have any opinion worth anything about your cut?”

The Boiling City Ballet, and Gaps In My Classical Arts Education.

This one time, I was nursing on nights in a Rural ED. TDW-Mark I and our little family were living “Up North” in a small town, outside of a little town outside of a middling sized town that served as the commercial center for that corner of the state. Our small town, let’s call it “Boiling City”, had a bar, a short distance from our no-stop-light town center, and their claim to fame was serving as the region’s titty bar. We locals called it “The Boiling City Ballet”, as a snide reference to the exotic dancers that were it’s main draw.

At this point, I had something like a 15 years of nursing experience, as an ED nurse, ICU nurse, nursing supervisor, all on top of my years on EMS in Da City. I was kind of proud of my “been there- done that” self image.

Remember that thought. As well as the ancient aphorism that “pride goeth before a fall”.

So, TINS©, TIWFDASL©, and registration let me know that there was a patient with a knee injury. I meandered up front, collected the chart, summoned the patient, and invited her to join me in the back. I asked her what had prompted her visit to ER.

“Well, I was doing a pole trick, and landed wrong, and fucked up my knee.”

I goggled at her. “Uh, what?”

She giggled. “I was dancing, I did a pole trick, I landed wrong, and my knee gave out on me!”

BTDT fail on my part. “Uh, what is a ‘pole trick’?”

She filled that gap in my life experience. “I dance at the Roadhouse, out side of Boiling City.”

Ahhh! The formal name for the “Boiling City Ballet”!

“And?” I prompted.

“So, a pole trick is where I do something on the pole, like spin around, and this time I just landed with my foot placed wrong, and my knee started to hurt!”

“Uh, OK. Here, here’s a gown, and I’d get the doc so we can get you examined and x-rayed and everything.”

She was having fun with my norminess. “So, you **DO** know what I do for a living, right?”

“Uh, kind of…”

“So, why do I need a gown? I’ll just whip my pants off, right here and now, just like this…”

I backed out of the room, and shut the door. “No, that’s alright! Just put on the gown, and I’ll get the doc…”

"The Gun Show Loophole!"

One year, my (very successful) brother rented a house in Some Blue Hive State, so his family could summer there. I received an invitation, that should I wrangle the time off of work, and my own transportation, I’d have a spot to stay and join in the merriment.

TDW was interested, and so I arranged vacation, and purchased plane tickets. One car rental later, and we were off!

My brother is an alumnus of an Eastern Sophisticated University, and, therefore, all of his college buddies are, as well. That trends towards them also being of the Blue Hive Borg, where, evidently, “assimilation is Mandatory!”

All these fellows are attorneys, and, generally, pretty smart. No surprise there, right? So, one evening, after consumption of Tax Stamped Beverages, well, one guy (let’s call him Bob, “not-his-real-name”) overheard The Darling Wife regaling me with her recent visit to an Unnamed Flyover State Gun Show, wherein she had purchased an AR pattern rifle, in 6.8 Rem Special. Good News: She was very excited at her selection, describing her new rifle as “Pretty!”. Bad news: Have you PRICED 6.8 Rem Spl ammo lately? Holy Stool, that is expensive ammunition. Not as pricey as H & H .375, or .416 Rigby, I’ll grant you, but pretty spendy against sixty-cent-a-round .223 ammo.

So, Bob told us what his thoughts about that were. That is, if you could characterize him as “thinking” on that subject. “Man, they ought outlaw gun shows! That gun show loophole is awful!”

I know a thing or two about guns, as does The Darling Wife. She had, after all, just the preceding month gone to a gun show, and purchased a rifle. Indeed, in terms of contemporaneous experience based knowledge, she might qualify, within the confines of that house, as a subject matter expert.

Therefore, I asked Bob, “Oh, really? What is the ‘gun show loophole’, and what is the most objectionable part of it, in your view?”

He apparently was not one to let ignorance of the subject get in the way of a good opportunity to let his “woke” flag fly. “Why, it shouldn’t be allowed that simply anyone can just walk right in to a gun show, and just buy any sort of gun that they want, and then just walk right out!”

“Say what?”

He was gonna repeat himself. “Any sort of drunken lout, or mental defective, or terrorist, or mass shooter, can just walk into any gun show, buy any sort of mass murder machine that they want, and waltz out! No background check, no permit, no nothing!”

I turned to My Darling Bride, and said, “Honey, didn’t you just buy a rifle at a gun show a couple of weeks ago? Why don’t you tell Bob, here, how that worked?”

She smiled sweetly at me, and turned to Bob. “Well, I paid my admission, I walked the aisles until I found that rifle. It looked so pretty, I thought that it ought to be my first AR. I negotiated a rice with the seller. He then needed my picture ID, as well as my concealed carry license. He called the National Instant Check System with my information, and got an approval. He recorded the approval serial number, and then I had to complete a form 4473 before we could complete the sale.”

I invited her to be more detailed in her tutorial for Bob. “So, Honey, what’s a ‘Form 4473’?”

“Well, it is a sworn statement, under penalties of both perjury as well as violation of the federal Gun Control Act, that I’m not a felon, fugitive from justice, mentally ill, an illegal alien, have never been convicted of a crime of domestic violence. There’s a couple of other reasons that I could be disqualified, but they are all listed right there on the form. No sale can move forward without that form.”

Bob could not contain his superior expertise any longer. “That’s just wrong! None of that is required!”

I turned to him. “Really? Why don’t you tell us how it went, the last time YOU purchased a gun at a gun show?”

He looked at me, surprised. “I have never bought any sort of gun, ever! I do not own a gun!”

I feigned surprise. “Really? So, just how did you come by your expertise regarding how things really happen in a gun show, such as to contradict my wife’s recent, personal experience in a gun show? Buying a gun, no less?”

“I read it in the New York Times! They said that’s how it works!”

I looked at my wife, and she at me. I continued. “So, let me see if I heard you correctly. You have never bought any gun, ever, anywhere. You read some bullshit in the New York Times, and that is canonical, for some reason. Based on some perhaps third, maybe fourth hand story, that you think you remember reading, in that noted journal of all things firearms, The New York Times, you are in a solid position to tell my adult wife, sitting right here, that things that she, in fact, and in her own direct testimony actually, really, and recently experienced, did not actually experience. Now, that means that you are either telling me my wife will lie, smiling all the while, to your face, or she is so stupid or mentally defective that she cannot tell what she actually did, at a gun show, buying a gun. Now, mind you, she successfully passed the training to qualify for, and the background check to be issued, a license to carry a concealed handgun from The Un-Named Flyover State. So, pray tell, on what basis does your superior intellect and greater knowledge in All Things Gun, lead you to accuse my wife of imbecility, or lying to your face? Please, go slowly, and show your work!”

At this point, Bob had the wit to stammer, and not answer my questions. My brother, wisely, diverted my attention with some query of firearms law esoterica.

So, therefore, I did not break a stein over Bob’s head.

Although, I still wonder if it might have improved either his manners, or his intellect. Or, perhaps, both.

RANDOM THOUGHTS

RANDOM THOUGHT THE FIRST:

I had seen a soul for some malady or another, and had prescribed an antibiotic. In keeping with our usual practice, I had e-prescribed this medication, sending it off to the pharmacy the patient had identified as his preference.

An hour or so later, the receptionist received a phone call FROM THE PATIENT, asserting that the medication was not covered by his insurance.

I receive these calls frequently. Simply so that you know, the mere fact that any particular medication had been covered by one or another of the hundreds and hundreds of different health insurance plans that are out there, by no means establishes that this medication will be subsidized, today. In addition, each individual health insurance plan has it’s own “formulary”, or list of what medications it will subsidize, and to what extent. These formularies differ from Medicare (and among different medicare plans, as well), to Medicaid (and, again, among various flavors of Medicaid), to assorted flavors of private health insurance. Again, formularies vary from one private insurance plan (say, one particular form of Humana insurance), to another (like, one of the insurance products from Blue Cross).

Therefore, it is not uncommon for these calls to come in. Generally, they are from the pharmacist. Then, the pharmacist, who has access to the insurance company’s formulary, can suggest another similar medication that will be subsidized. I will request it, and we all go on about out lives.

When they originate from the patient, it becomes somewhat of a time sink. What, am I gonna tell the patient what the new medication will be, and the dosing regimen, how many doses to dispense, and so forth, so that the patient can communicate this to the pharmacist? (anybody ever hear about, ya know, PRESCRIPTIONS?)

Occasionally, when I have some sort of wild hair up my ass, I am tempted, briefly, to do just that. “Why, thank you for the call, Mr. X! Please tell the pharmacist that I am changing your prescription from Amoxicillin, and instead I will prescribe Mofeen, one pound, and you are to take ad lib and prn until the heat death of the universe! And, you have a nice day!”

My filter has,thus far, worked without fail. I have never told anybody that…out loud.

Instead, what I do, indeed, say, out loud, is “Please invite the pharmacist to phone me, and he and I can discuss it.”

The Second:

I had occasion to phone another physician’s office, in order to have my patient seen that very day. I generally make this sort of call myself, when I need a same day appointment for my patient, because I can either explain all the particulars of the scenario to my MA, who can then repeat it to the other office’s MA, and then have her seek me out when, inevitably, there is some question that I have failed to explain in sufficient detail, or I can do it myself, explaining things once.

I vote for “Once!”

So, TINS©, TIWFDASL©, and on hold/ignore. Eventually, the other office’s scheduler came on the line, and we had our lovely little conversation about my patient’s malady, and why I felt the burning need that this soul be seen TODAY!

Everything proceeded swimmingly, and I noted the time and address of the particular office my patient was to report to. The scheduler asked my name.

“Reltney McFee, PA.”

“How do you spell that?”

“R-E-L-T-N-E-Y, M-C-F-E-E.”

She read back her note: “R-I-A-L-D-M-A-I, M-A-K-A-S-E-E?”

I had not really slept all that well the previous night, and had several people in the waiting room, eagerly awaiting (DYSWIDT?) my attention, so that they could get on with their own days. I quickly calculated that I could get this chucklehead to properly spell my name on the scrap of paper that she would soon discard, or get this patient the hell out of my department, and on to Higher Level Of Care, sooner.

I (unsurprisingly, I wager) went with option “B”.

“Nailed it!”

The Third Random Thought:

My home state, The UnNamed Flyover State, legalized marijuana last year, for recreational purposes. I have spoken, previously, about my rapture at this development. While I have not, completely, cataloged every single way in which I think that this is a fail of epic proportions, perhaps I have revealed just a little bit of my lack of enthusiasm for this development.

A couple of times.

I have noticed in recent months the phenomenon of idiots (er, I MEAN, children of God) evidently wandering through the world stoned. I reached this conclusion because of the numerous folks who stop by my clinic reeking of reefer fumes.

I do not mean, “Hey! If I pay attention, I can detect a waft of a smell, as if of marijuana, somewhere about this person!” Nay, I mean “Dude! Are Cheech and Chong shooting another movie hereabouts?”, or, perhaps, “Is there some sort of Rastafarian festival in town?”

Indeed, occasionally the smoke is eye wateringly intense, yet the purveyors of the fumes appear unaware of the air quality hazard that they present.

I have wondered about that. I suspect one of two things is in operation here. Either they are so stupid, either at baseline, or due to the deleterious effects of marijuana upon their mentation, (maybe, I should embrace the power of “and!”?) that they simply cannot realize what they are spreading in their wake, or else it is some sort of pheromone, at least in their minds, that attracts The Opposite Sex.

Although, to be honest, anybody who would be attracted by the olfactory cues these folks present, I would not romance with your johnston!

Insurance Companies and Purgatory

So, over the holidays, we were at a family gathering when TDW-Mark II’s niece (an adult) departed to go home.

Shortly thereafter she returned to inform us that, due to the poor lighting and TDW-Mark II’s petite vehicle, she, the niece, had inadvertently struck my wife’s vehicle, leaving a dent.

BFD, bent metal, no bent people, all good.

So, we went to our insurance company in order to get the bent sheet metal, unbent. We could, indeed, have our insurance pay for it, since our vehicle was parked, BUT!, we’d have a chargeable accident and likely would see our insurance premiums rise. From the currently affordable, reasonable, “Give us all the money and nobody has to get hurt!” levels we currently enjoy, that is.

THAT sounds attractive!

Or, our niece’s insurance company could foot the bill.

The niece made her report to her insurer, and shortly thereafter I had a conversation with one of their genius, script reading (Thanks, Beans on June 3 ’19), slack jawed, pompous personnel.

It seems that, let us call it “County Garden Auto Insurance”, requires that you take your broken vehicle to one of their adjusters for an estimate. In this area, the freaking capitol of the freaking Un-Named Midwestern State, the (insert pejorative here) adjuster only works freaking Wednesdays, and, into the bargain, Young Ms. Mensa informed me that, since mine is the name on the title, well, I would have to show my happy hairy ass up with the bent vehicle for the estimate.

Well, ya know, I work Wednesdays. 12 hours. Days. I told Ms. Mensa as much. “Ma’am, I will not be attending this estimate. I’m working, my wife will be there acting as my agent.”

“Reltney”, she replied (and, as an aside, I had been previously unaware that she and I were quite that chummy), “You have to be there, since the vehicle in titled in your name.”

“Well, Ma’am, I’ll be working, and so my wife will be there with the vehicle.”

“Reltney, you have to be there!”

“Ma’am, I will not be there. My wife will be acting as my agent.”

“Reltney, you have to be there for the estimate!”

“Ma’am, perhaps you should write this down. My wife will be there, I will not. She will act as my agent, and I will be working.”

“Reltney, if you are going to be hostile, I cannot continue to talk to you. I’m simply trying to tell you how this process goes.”

“That’s fine. So, tell me my options.”

“Sir, it you are going to be hostile, you will have to talk to another agent!”

(My thought, at that point, was along the lines of, “Sugar, if you think that I have been hostile, you really, really have a severe poverty of life experience, that, should you desire, I can remedy!” A thought that went unspoken.)

“Ma’am, I thought you were going to tell me what my options would be? I’m waiting for that information.”

“Please hold!”

(lengthy hold)

“Reltney, your wife can meet with our estimator, but we cannot hand her the check. Can we mail it to you, or to your selected body shop?”

“That will be satisfactory. Mail it to the shop.”

“So, Reltney, what arrangements would you like to make for a rental?”

“Ma’am, we have made satisfactory arrangements for a loaner with our body shop. I suggest that you phone them, and have that conversation with them.”

“I do not understand what you just said, Reltney.”

“Call my shop, you have the name. Talk to Bob. Tell him what you just told me about a rental. Make whatever arrangements you wish with Bob about a rental. Bob will fill me in. “

“Reltney, I do not understand that, but I will notate it in our file.”

(Correctly, I hope, but do not trust…)

“Outstanding. Anything else?”

“No, Reltney, have a nice day.”

And the call ended.

Perhaps, the anticipated cluster…er, hug (HUG! Yeah, THAT’S the ticket!) will provide fodder for a subsequent blog post.

My take home lesson, here, is that there are jobs for the dull witted, and I am fated to spend my time corresponding with them.

Damn it!

Camping with my family

One Labor Day weekend, TDW-Mk I decided we ought to go camping. I was off, the kids were off, and we could all get out for one more weekend before the grind of school and autumn activities sucked us in.

She had reserved a site in the unimproved area of one of the northern state parks, a “rustic’ site. That meant that we got to carry water from one of several faucets serving the campgrounds, as well as go to the bathroom in one of several pit toilets.

The wimmin folk were not favorably impressed.

We were the only ones in our section of the campground as we pulled in, which was of no concern to us. We set up our pop up camper, cooked dinner, cleaned up, and took a walk.

Once we were back at out site, we were inside the camper, organizing for bed time when another party arrived at a site, 2 or 3 away from our own. They were young-ish, and seemed high spirited. Whatever, live and let live.

So, several hours later, TDW and I were chatting quietly, when the noise from the neighbor site picked up considerably. I peeked from our window, and noted what appeared to be bottles of some sort of alcohol in hand, and our “neighbors” sounded to be involved in some sort of loud, animated, an not altogether amicable discussion.

When we heard the sounds of yelling, and breaking glass, I awakened the kids and had them lay on the floor of the camper. TDW called county dispatch on her cell phone, and I settled in next to the door of the camper, curtain ajar and Colt in hand.

One of the party, it appeared, felt the need to do some sort of work on the mirror of one of the trucks, and this seemed to involve attempting to wrench the mirror off of the door without using any tools. That maneuver elicited yet MORE heated words, and things were escalating, which made it convenient that that was the moment that the park ranger, a couple of sheriff’s vehicles, and a city cop arrived.

One of the officers approached out camper, and I took that opportunity to secure the pistol beneath one of the mattresses, seating TDW thereon.

I told the officer what I had heard, and seen, and he assured me that for this party, their camping weekend was over. “We’ll simply sit here, and watch them pack up and depart. We’ll circulate through several times over the rest of the night, and, if they return, they’ll sleep in the sheriff’s office. In the back.”

Then he added, “If you need us, call us back. Have a nice weekend!”

In Review….

I’m an old stretcher ape. Started in EMS a long, long time ago, working in, and for Da Big City. Worked my way through nursing school, and eventually went to grad school, in my capacity of Official Old Fart. I’m chock full of stories, all of which begin with the obligatory disclaimer, followed by the Mark One, Mod Ø preamble: “This is no shit! There I was, fighting disease and saving lives….”

Abbreviations, Acronyms, and Terms Of Art: I tried to assemble all the esoterica in one place, for ready reference/translation to the non-medical readers. Somebody suggested that the link/page of this stuff was inaccessible for one reason or another. Here’s another go at it!

I’ll try to collect all the unusual, non-standard-English phrases and suchlike here, for easy translation.

• BVM: bag-valve-mask. A device for introducing room air into the lungs of a     nonbreathing person, by compressing a bag, pushing the air from that bag through a one way valve into the mouth (and therefore airway) of said person via a mask. Releasing the bag allows it to self inflate, and the patient to exhale, so you can repeat the whole process again. And again. And again…
• Carotid pulse/Artery. Large bore neck artery, main pathway for blood to travel to the brain from the heart. One on each side of the (kinda) front of the neck. High pressure. Lotsa blood flow.
• CLOVER: (from The Urban Dictionary): Clovers believe that they are always doing the right thing, and therefore everyone should wait on them, or are basically oblivious to others’ needs.  Clovers generally believe that if someone does something that irritates them in some way that a law should be made to correct the problem – “There ought to be a law”. A Clover will always side with the police or the government no matter what egregious evil they have committed.
• “da corridor”: the district immediately south of Da University, a sort of wrong-side-of-the-tracks “entertainment” district. An environment rich in overdoses,alcoholism, prostitution and assorted pathology. Commonly, in the spring you would notice new, young, generally female faces among the inhabitants. Towards autumn, most of those faces were absent (Ghawd, I hope that they went home!), and the ones remaining were in no way as fresh, bright eyed, or as healthy looking as they had been around 5 months previously.
• DBCPD (Da Big City police Department)
• HEARN: Hospital Emergency Alert Radio Network, a  VHF. radio channel employed for (surprisingly enough) alerting the hospital of pending arrival, particularly of a priority patient. 
• Kel-Lite: heavy duty, police-style flashlights, useful for illumination, or as a bludgeon
• RFN: Right Fucking Now
• SBTHIDC/SBTCIDC: Second Best Trauma Hospital/Center In Da City.
• “Stat”, “Stat-like”, or “right Stat like”, all equate to “IMMEDIATELY!”
• TBTCIDC: The Best Trauma Center In Da City
• TINS: This is no Shit
• TIWFDASL: There I was, fighting disease and saving lives….
• TLHTTIC: The Little Hospital That Thought It Could
• “To”: (pronounced “toe”, like the digit) short for “ghetto”, as in “Life is tough in the ‘to”
• “Wheedle-Deedle”. The sounds made by an electronic siren. See Also, “Most weird Noises From An Electronic Siren