And Now For Something Completely Different

Well, THOSE were some dark stories! And, now for something completely different.

TDW got a kitten from a friend, whom we named Max.

It developed that Max would laze away the afternoon, gazing out the window. After a while, he started to do this sort of “click-click-click” noise, and move from one window to the next, as if following something. Investigation revealed that this something was another cat, who eventually demonstrated that she had had kittens in our window wells. TDW eventually noted that the kittens were eating the dry cat food that she had been putting our for the new cat, who we dubbed Momma Kitty, and we soon retrieved the kittens: Momma Kitty escaped our clutches.

When we got the kittens inside, we locked them in the second bathroom, providing a crate where they could hide, water and food, and litter boxes. We would enter a couple of times a day to clean up the mess, refresh the water, refresh the food, and attempt to play with them, trying to socialize them into their new lives as house cats.

Took some doing. The one kitten would sit in a corner and snarl at us with all the gravitas a 6 ounce kitten could muster. She was named Henrietta, after the chickenhawk character in the Foghorn Leghorn cartoons.

Another kitten would gnaw at our fingers, then rush to lick and pat the same finger, reminiscent of the big blue “Sullie” character in the “Monsters Inc.” cartoon. A third kitten would lay, tranquilly, in our arms, allowing us to pet her and provide neck scritches, purring all the while. She was named Olivia (as in olive branch, the historic symbol of peace).

The final sister was named Dynamite, since she would nearly explode into a fury of claws and fangs upon any approach. She has since calmed down, although she is not altogether sure about the whole “hold still while Ipet you” thing, and would rather get going after a brief interval of tolerating our petting.

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“State Employment Agency”. Yeah: About That….

Years ago, I was unemployed. Since I was unemployed, I registered for (surprisingly enough) unemployment insurance payments. THAT necessitated that I register with the state, for assistance obtaining employment.

THAT was a treat! As it developed the folks at the “find this guy a job” office, did not appear to comprehend that I was an RN. Ya know, Registered Nurse. College and everything like that. They persisted in pointing out that they had PLENTY of Nurse’s Aid jobs. “Uh, yeah, about that. I am licensed here in the Great State of The Un Named Fly Over State, as a Registered Nurse. Nurse aids report to the LPNs that work with, and supervise, them. My job is, among other things, when I am working, is to supervise the LPNs. Howzabout you find me a job like THAT, hmm?”.

You might imagine that I did not rely upon them to find me my next job.

Trying to facilitate my return to gainful employment, I observed that I also held licensure as a Physician Assistant. “Oh, yes! Isn’t that like a medical assistant? We have jobs for those!”

Sigh. Another explanation of the collegiate effort required in order to qualify to sit for the board examination. As well as the different responsibilities appertaining to medical assistants, versus physician assistants.

I found employment as a midlevel, through a locums agency. Fat lot of help the unemployment folks were.

Never Fuck Around With A Brooklyn Boy

My Dad was from Brooklyn, He told me, when I was a lad, “Never fuck around with a Brooklyn Boy!”

That is sound advice.

I used to work with a guy who, one time, when his wife was ill, and he was the only income in their two income household, fell behind on some bills. He is an ex street medic, himself, and, well, not in the “shit” business: he did not talk shit, he would not take shit.

So TINS, this one tine he received a call from one creditor, who, once my friend had explained that he, the creditor, would not be receiving money in the near future, and would indeed be paid, once the finances in the household were approaching stabilty, responded (the creditor), “Oh, so you do not think that I can find you?”

My friend paused, and counseled this asshole. “Well, no, I do not think about that issue, one way or the other. But, now that you have brought it up, it is my opinion that, should your luck be exceedingly poor, you just might, indeed, find me. Have a nice day!”

My friend never saw that jackwagon, ever.

Years and years ago, I fell behind on my mortgage. (something about unemployment…) I was in touch with my lender, thinking that absence of surprise would be to my advantage.

Wrong.

I asked about any sort of program for an unemployed soul, whereby I could make partial payments, and have the arrearage added to later payments.

Nope.

Could I miss a couple of payments, and have them added to the tail end of my mortgage? I would continue to pay interest.

Nope.

Well, after buying groceries, and sucklike, gotta tell you that there simply was NOT the money to pay the house payment.

So, one day, a month or two into this niceness, I received a phone call from the mortgage company. The mortgage company asshole on the other end of the line advised me, “We are going to come out to inspect the house.”

“Why are you telling me this? You can drive by any time that you like.”

“Uh, no. We will come in and inspect the house.”

(my response)”Uh, no, you are not. You might make an appointment to come out, when I am home, and it is possible that I might escort one of your personnel to view selected portions of my house, but you are not simply going to ‘come in and inspect the house’. Not going to happen.”

(Mortgage Asshole) “You think you can stop us?”

(me) “Interesting that you should ask that question. Yeah, I know that I can stop you. If you do, indeed, plan to simply waltz in here without my permission, send orphaned bachelors, because whoever you send to walk on in, will be carried out.”

“Is that a threat?”

(me) “Nope, that is a prediction. Let’s consider this: you have just now threatened to have stranger or strangers break into my occupied home, and I have told you that that sort of activity will end poorly, for everyone. You threatened me with a B and E, I told you what my response will be. Your move.”

Oddly, nobody came over to “inspect” the house. What a surprise.

Snippets VIII

THAT LOOK WHEN the pregnant patient whom I am interviewing, trying not to get high myself as she emanates reefer fumes, asks me, “Is amoxicillin safe for my baby?” (This after I had diagnosed her UTI, and was in the middle of prescribing amoxicillin to treat same)

ANOTHER DAY, ANOTHER CHILD OF GHAWD relating that their malfunction is “I have a sinus infection”. I perform my usual review of systems, featuring denial of fever/chills, and no at home treatment over the 3 days of illness that drove this soul to my clinic.

Physical exam did NOT reveal any positive findings, except for mucus coursing down the back of this soul’s throat. I provided my assessment, and my basis for that assessment, including “…if you had a bacterial sinusitis, you would have leaped off the table and yelled at me when I tapped on your sinuses!”

This soul replied, “Oh, well, I NEVER get sinus tenderness with my sinus infections!”

Not being in a mood to argue, I smiled, did NOT observe that marked sinus tenderness is one of the CARDINAL signs of bacterial sinusitis, and said, “Here’s your augmentin prescription. Have a pleasant day!”

A FEW WEEKS AGO, TDW-Mark II had a migraine, and it took it’s sweet time resolving. I had to work, and came home to find my bride upright and preparing some soup (this being an improvement). I asked how her day had gone.

“Well”, she began, “the migraine was unpleasant, like they always are. This time, every time I woke up from my multiple naps, there were six cats perched on the bed, as if they were on watch. You know, if one or two others had joined them, I was going to call you and insist that you come home!”

Fortunately, her furry caregivers determined that, the next day, she only required 4 in attendance at any one time, and so, she recovered, as the cats weaned her off from a high level of feline supervision.

ONE DAY, my MA asked (it seemed to me, from out of the blue), “What do you want on your tombstone?”

I spread my hands, fingers wide, and stated, “Like this , with fewer fingers.”

She smiled. “Wow, kinda harsh! I meant on your pizza. THAT escalated quickly!”

Dressing For Success

One time, my family gathered at a restaurant in Greektown, celebrating one occasion or another. This was in Downtown Da City, and, at this time, there had developed the phenomenon of flash mobs, wherein high spirited youths would apparently spontaneously congregate at one location or another, and in the course of the festivities, civilians, otherwise uninvolved with the group, would be assaulted and robbed.

TDW-Mark II and I spoke of such an event, and the potential for same to develop when our children, and grandchildren were at hand, and decided that this Would Be A Very Bad Thing. We selected our wardrobes accordingly.

It turns out that my son in law, my daughter, and my brother, all feel similarly about this sort of thing, for, when I counseled my sister in law, a very nice (and very naive) soul that, “If a group of folks all enter this restaurant all at once, I will tell you to take the children into the kitchen of the restaurant, and keep them there. Under no circumstances are you, or any of the children, to re enter the dining room, unless one of us physically arrives to escort you out!”

She protested, “But, we aren’t allowed into the kitchen!”

I showed her my wolf grin. “If I tell you to do so, I guarantee that nobody will say a word about you and the children being in the kitchen. The noise will be way, way too loud for you to hear them, if they were to do so!”

She looked puzzled. My son in law explained. “Mary, if Brenda grabs the kids and beelines to the kitchen, two things: do not be left behind, and do NOT get between her and the kitchen door!”

“Why is that?”

“If you are between Brenda and the kitchen door, and one of the ‘celebrants’ starts into the kitchen, he will be shot. Do not be in the way.”

Mary turned back to me. “Why would they try to go into the kitchen?”

I wolf grinned her way, again. “Because I had failed to kill them.”

My son in law chimed in, “I will have missed them, too!”

TDW-Mark II joined in. “Me, most likely I will have run out of ammunition. I do not plan to miss!”

My brother observed, “And, I will police up the stragglers, if any!”

Looking aghast, Mary declaimed, “You cannot believe that anybody would try to hurt somebody at random! I just do not believe such a thing could happen!”

TDW responded, “You just keep on believing that. In the meantime, if The Stretcher Ape tells you to get into the kitchen with the kids, do so right fucking now, pretty please?”

Abandonment, and Trust Issues…

A while ago I had an MA assigned to me. She was (is) capable, focused, intelligent, and engaged; she maintained awareness of what else was occurring in the department, and reacted promptly and appropriately. (She was the protagonist of the tale of the early morning floppy child)

As things developed, she had an opportunity to transition to a day shift, Monday to Friday, 9 am to 5 pm, work-no-weekends-or-holidays job (in contrast to our present work-til-9-pm, every other weekend, every other holiday scenario). And! Get a raise in pay!

Naw, I cannot see why she would entertain such an opportunity for a single second, either.

So, of course, I teased her. “Oh, I see how you are! You would rather spend time with your husband, with your children! Oh, yes, I suppose all that is just fine for you, but what about ME?”

As you might expect, she started her new job, and, occasionally, took some overtime, working with me from time to time. Of course, each time I would tease her. “Oh, I see! Now that you are dead to me, NOW you come back, just as I was resolving my grief at your cruel abandonment of me!”

My partner joined in, observing, “You know, if you came back to work in this department again, you could never break up with him ever again! He has been an embittered husk of a man, since you left!”

(This is the same partner who observed, when I once wore a fleece prominently displaying the fact that it was an item from the National Rifle Association, by means of the 2 inch tall initials “NRA” over the left breast, let me know, “You know, they spelled your name wrong on your coat!”)(My name is “Tom”)

We reached a lull one overtime night, and I renewed my teasing. “You know, I taught you everything I know, while I was standing on one foot, and you abandon me! Oh, yes, you have a ‘HUSBAND’, and you have your ‘CHILDREN’, you have dreams, and plans for your life, but, what about MEE?!?”

She chuckled.

Serendipitous Connections.

Among the maladies that motivates folks to come visit me in the clinic, is that their infant has diaper rash, also known as diaper dermatitis. Should this persist past, say, 3-5 days, there is an increased likelihood of Candida (you may recognize it as yeast) joining in to add to the discomfort. Yeast (Candida) is commonly found in stool, and, well, with infants, stool in the diaper is a common occurrence. If there is diaper rash, susceptibility to candida climbs.

So, microorganisms really, really like a particular set of conditions in order to grow and proliferate. Generally, that includes warmth (like you might find beneath a diaper, for example), moisture (which just MIGHT be found, beneath a well fitted, and perhaps, oh, gosh, let’s spitball here: wet! diaper) as well as darkness, so that those pesky UV rays do not disturb the microorganism’s DNA, as well as that nasty old sunlight not drying out the area of operations.

This being The Un-Named Fly Over State, and deer hunting being nigh unto the State Religion, once you get into the outer ring of Big City Suburbs, most folks recognize the existence of a program known as Quality Deer Management (QDM). The premise is that, should the landowner provide for high quality food (acorns, or suchlike), access to water (ponds do nicely for this), shelter (like deer tend to find in a woodlot), AND you avoid hunting young bucks, then you tend to hunt, and harvest, larger, healthier bucks in later years simply because you provided an environment conducive to such bucks reaching maturity, in an environment providing them with their needs.

Therefore, when I suggest that parents who attempt to provide an environment that DOES NOT provide these elements to the germs in their child’s diaper, the child is likely to have fewer episodes of diaper rash, of shorter duration, and less likely to require my attention. That means, naked babies (generally in the kitchen, on the linoleum), kept meticulously clean using bland soaps and tepid water, with their (the babies) bottoms protected from the irritant effects of urine and stool by such means as petroleum jelly. That means, to those steeped in such things (like your Mark 1, Mod Ø deer hunter), that concerned parents do THE OPPOSITE of what QDM practitioners do for deer. Take you kid’s germs, and dry ’em out, blast them with sunlight, cool them out, and let Nature, and your child’s immune system, take care of business.

Serendipitous connections.

Tales From The Nightshift

So, TINS©, TIWFDASL© one night in The Maternal State, years and years and years ago. My father had taken ill, and of the three of us boys (the attorney, the contractor, and me, the nurse), it seemed that I was the best fit for the job of helping Mom take care of our Dad.

Well, that, and I was the one who did not have a family.

So, in order to keep my house and my vehicle, my creditors agreed that it would be nice if I were to continue receiving a paycheck, while I was 800 miles from home, and taking a voluntary leave of absence from my employment. So, I became a travel nurse!

This one night, I was working midnights at Some Suburban Megalopolis Hospital’s ED. It was way, way late, and we had cleared all the souls from our beds, and were engaging in my favorite slack time occupation, Story Hour.

So, one nurse was recounting how her boyfriend was failing to meet performance/behavioral expectations in one way or another. The other nurses (all women) responded, in a sort of choir, with murmurs of affirmation for the reporter. Except for one particular nurse.

This woman’s speech was rich with the cadence and harmonies of Da Islands, with a Caribbean note permeating her pronouncements.

“Aw, naw, ghurl! Ya no haveta put up with dem shenanigans! He gotta go, out de doah!”

The chorus affirmed this pronouncement.

The protagonist in our little Greek tragedy continued with her lamentations of Mr. Unworthy’s misdeeds, and our Caribbean Correspondent again provided her assessment: “Out de doah!”

Again, the call of more misdeeds, again the response from the congregation: “Oh, naw! Out De Doah!”

It devolved into a documentary of The Misdeeds Of Men, and along about that time, I found something I ought to be doing. At the other end of the department.

Two more snippets

FICKLE CATS::

When I am in bed, they snuggle up against me: likely due to the warmth from my electric blanket. I can pet them, and they do not beat feet, alarmed, at my approach. They purr, and roll into my petting. On the table in the cat room, similarly, I can pet them, and they purr like miniature motorcycles.

Elsewhere in the house, I approach them, and they elope as if I were the Cat Attacking Golem, or something. Of course, when they are on the counter, or the dining room table while we are eating, I do chastise them: “Are you on MY counter? Bad Cat!” accompanied with a sort of interpretive dance, which most closely resembles an effort to shoo away angry, invisible, hornets.

ANOTHE STORY FROM THE STREET

So, TINS, TIWFDASL….well, no. I was at home, long ago and far away, when The Plaintiff (aka TDW-Mark 1) and I were still in wedded bliss. In the very rural county in which we lived, EMS was provided by a sort of tiered response: in the event of an emergency, dispatch would alert the sheriff’s deputies on patrol, and tone out the nearest fire department to send their rescue. The ambulance would depart from the hospital in The County Seat, and the crew would make their way to the scene. There, the three agencies would address the problem, and then, response complete, resume whatever they had been previously been doing.

I volunteered for the local rescue, since, I figured, I would want SOMEONE to respond when/if we had our own emergency, therefore it seemed reasonable to carry a pager and respond when some neighbor had THEIR emergency.

Let me interject that I had a scanner at home, and so I (and TDW-Mark 1) could monitor the goings on in the Fire/Police/EMS world. Or, our corner thereof.

So, one evening I was home. The pager went off, and I responded to the fire hall. Another firefighter arrived, and we were off.

We arrived to find a sedan crumpled amongst the trees lining the side of County Road Whatever. The deputies had already triaged the scene, and pointed out one soul who was not making much sense. As I approached, my differential diagnosis expanded from head injury, to head injury, or intoxicated, or combinations of the above. This was elicited by the prominent odors of ethanol emanating from my subject.

Well, when you have a soul who was involved in a collision, as this guy had been, who is not able to navigate or articulate, as this fellow was not, one must wonder if the collision had cracked his coconut (not, strictly speaking, a medical term, you know…), and that was why he had his articulation and locomotion difficulties, or was he intoxicated into dystaxia/dyarthria, or (perhaps worst of all potential scenarios) was the intoxication obscuring his intracranial bleed, or something similarly dire?

I, paramedic and RN that I was at the time, was elected to ride in the back as Mr. Ethanol Odor was transported to hospital assessment and management. Of course, he was spine boarded. Of course, he disapproved. Of course, he protested, loudly and profanely, about our handling of him, as well as the fact that he desired to depart our company and be on about his business (not an exact quote).

I recall providing report by radio, his soliloquy in the background. He was describing my character flaws, and errors in my upbringing, at volume. As an exact quote, he suggested the my shortcomings included, “Assholes! M@74erf&25ers! Dickheads!” (I suppose he included my partners in this assessment, come to think about it.)

I unkeyed for a moment, prior to concluding my report, and, rekeying the radio, observed, as he renewed his Short Course On Character Disorders, “As you can tell, patient in no evident respiratory distress!”

I arrived home to find TDW-Mark 1, chuckling. “No distress, huh? Have you told your mother hello for him?”

Material From “An Away Game”

From Eaton Rapids Joe’s eponymous blog, a thought for all of us sick folks out and about:

Sunday, January 8, 2023

Strep Throat

Anecdotal evidence suggests that there is a lot of Strep Throat locally right now.

Strep Throat often follows colds and other viral infections. It is primarily an opportunistic infection that takes advantage of the fact that frequent coughing and throat clearing irritates the throat and removes some of the protective layer of mucous.

If you read “symptoms” on the internet you will find countless repetitions of the words “…the back of the throat looks beefy…” While this may be totally clear to medical students it was not clear to me. I am made of meat. All of my inside parts look “beefy”.

After way too much digging, what they mean is that the normal, whitish, filmy covering over the back of your tongue, upper mouth and throat is gone. The Strep bacteria displaced it.

Strep is nothing to screw around with if it doesn’t clear up in a day or two. It can infect your heart valves and/or kidneys.

Posted by Eaton Rapids Joe at 8:12 AM

MY COMMENT:

Simply to make things more interesting, technically, the strep does not, itself, “infect” kidneys or heart. Some varieties of strep B produce a toxin that elicits a sort of autoimmune response, “rheumatic fever”, which is readily prevented by antibiotics. Take note! The abx really do NOTHING for the sore throat (which, of course, is why we all see our doctors in the first place), rather, they protect us against a potential consequence of infection with certain varieties of Strep B which may trigger that response.

Should one develop rheumatic fever, (which itself may be life changing), that may be followed by rheumatic heart disease, which can be a BFD (Big Freaking Deal), with scarring of the valves, leading to narrowing thereof, and requiring increased effort from your heart to force blood through them, leading to heart failure. This, also, is generally prevented by antibiotics (abx).