SURPRISE!

So, there I was, fighting disease and saving lives, and my MA came to me, regarding somebody who had arrived for a subsequent Covid inoculation. This soul had informed my MA, AFTER THE INJECTION HAD BEEN ADMINISTERED, that she, the patient, had had a reaction to her first inoculation. She described this reaction as swelling, itching, and feeling ill. This had developed in a couple of hours after the injection.

It turned out that, today, this patient had, indeed, developed swelling, runny nose, cough, and whole body itching within FREAKING MINUTES after her injection. (those of my studio audience who have some sick people experience might recognize these indications as harbingers of anaphylaxis)

Weellll, we administered some IM Benadryl, some IM steroids, a breathing treatment, and close attention from my MA. Several repetitions of vital signs and reassessments later, this lady had seen her breathing improve, her itching subside, her swelling tapered, and the cough and runny nose reduced.

So, pro tip: If you swell up after the first dose of whatever the frack you are being injected with, tell a motherfucker, ya know, like, BEFORE you get the next injection. Personally, my geezerly ass will very, very much appreciate it.

Your View, Is *NOT* The Entirety of The World

So, TINS©, TIWFDASL©, alone as my midlevel walk in clinic shift started. We were supposed to have two of us from opening, but, well, some of us are renowned for strolling in something on the order of 30 minutes late. In addition, there was a third provider slated to come in around 2 hours after opening, and work til close.

To start off with, I had a 5 pack of kids. Well behaved kids (Thanks be to Crom!), but, five at a time nonetheless. All in one room, so, of course, it appeared to whoever else had decided to start their day with a visit to the walk in clinic that I was taking something over an hour with one patient.

One such soul opened her exam room door, around 40 minutes after we had opened our doors for the day, and while I was on Number 3 of 5 in the 5 pack, and asked “how much longer?”

I was charting, and replied, “20-30 minutes”.

She asked, “How come?”, and the MA explained “there are 5 in front of you.”

The questioning patient was surprised. “How can that be? There was nobody here when I arrived!”

The MA answered “I had already roomed them when you had arrived”.

“That’s crazy!” observed the impatient patient.

I was kind of busy. My response was “Yep.”

HALLOWEEN

A long, long time ago, in a county very far away, I was an ER nurse working nights. Indeed, this was so very long ago, that The Plaintiff had not, yet, become The Plaintiff.

It so happened that one Halloween I found myself working. At that time, in that county, we had a dispatch radio in the nurses’ station. After all, in a small hospital, in a very rural county, if you have advance notice of ill tidings, well, sometimes you can gather your selves, and more effectively address the particular ill tidings that are brought to your door.

My shift started at 1900 hours, and day shift had hardly departed when the tones went off dispatching the firefighters, rescue, and sheriff’s department from a couple of townships over. The nature of the call chilled my blood: child pedestrian, pedestrian vs auto on one of the local two lane state highways.

In rural The Un Named Flyover State, traffic on our state highways commonly travels at around 60 mph. Now, KE=1/2 MV². That means that a, oh, say, 3000 pound vehicle at 60 mph runs around 361,040 foot pounds of energy. (By comparison, a 30-06 bullet runs around 3,133 foot pounds, and will kill any large game animal on the North American continent). When this strikes a, say, 80 pound child who abruptly darts out from between parked cars, well, it is catastrophic.

And, it was, indeed, catastrophic. Responding to the call, mothers, fathers, uncles, aunts, sons, daughters: the entirety of the emergency response apparatus in that corner of our county: hell, from couple of surrounding counties, as well: responded, praying, hoping, that somehow they could mitigate this disaster.

It seemed as though the medics spent seconds on the scene. It likely seemed like hours to the horrified family. One second, this child was running along, gleeful and excited at Halloween, eagerly anticipating All! The Candy! that would soon be spread out on the living room floor, and a second later, he was unconscious, broken, in the road.

The county and State Police ran interference, shutting down the expressway to speed the ambulance along it’s way. Our local city cops closed the cross streets, and the medics screamed into our parking lot, where we waited, alerted by the phone call from dispatch.

There were an amazing number of personnel in and about our ER that night. Every floor in the hospital detailed someone to either help, or stand by to see how they could help. The lab was there, cardiopulmonary, and that is not to mention the firefighters from our town, and our cops, in the parking lot, waiting to see if they, too, could help.

The ER doc was not about to half step, and employed every tool at his disposal. But, sometimes Death wins, and we can do nothing to forestall His victory.

We nurses cleaned the child up as best we could, tucking him in with clean linens, and a clean fresh gown. We tried our best to make him appear simply asleep.

The family came into the resuscitation room, and wailed their grief. In that setting, there is really nothing that you can do, nothing of any substance. We stood by, silent witnesses to their heartbreak.

Eventually, they had wept themselves dry. Neighbors assisted the parents from the room, to drive them back home. Later, they would have to plan his funeral, put away his toys, clothing, and things, and come to terms with the forever loss of their little boy.

Halloween would never ever be the same for that family.

A couple of hours later, TDW-Mark I (subsequently The Plaintiff) stopped by. She had taken our two kids then aged 6 and 3, Trick-or-Treating, and they were so darned cute, it finished me. I swept them up into a hug, and likely puzzled them by weeping. Truth be told, I suspect that TDW was surprised, herself. Until one of my partners told her the story of earlier in the night.

My FAVORITE! Things

My FAVORITE! Things

@ When, as part of my assay of History of Present Illness, I ask you how long you have had your (cough, or whatever other symptom motivated you to march you happy butt into my clinic), please, Please, PLEASE do NOT!!! say “a good little while”, or something similarly non responsive to my question. I will simply repeat my question, using the same words, and the same pleasant, inquiring tone, over and over, until you do, indeed, tell me “2 hours” or “2 days’ or “2 weeks” or “2 months” or “2 years”. Simply so you know, IDGAF how long you have had this symptom, on the other hand, it does have some implications for what plan of care I ought to consider in order to, ya know, actually benefit you.

@ Similarly, for the love of Crom, do NOT tell me, in response to my question, “What have you done for (your symptom)?”, that you have “taken over the counter”. Should any of you in “the studio audience” desire to understand just how unhelpful this is, please spend a few minutes on only one freaking aisle of any drug store you wish, and attempt to catalog the dozens of freaking allergy meds therein. By way of illustration, if you have used a nasal steroid, that would be helpful for me to know, since, should that have been unhelpful, I will be required to up my game.

If OTOH, you simply took The Multi Symptom Dreck You Saw Advertised On The TeeWee Last Night, well, I can then recommend some, oh, gee, I dunno…EFFECTIVE OTC medications, instead.

@ I love it when Joe-Bob goes to (St. Elsewhere) yesterday, does NOT pick up his prescribed medications, and swings by my clinic. Because “I’m not any better”.

@ When I direct you to call your family doctor and arrange followup, and you reply, “They always tell me to go to walk in!”

So, you’re telling me that WALK IN prescribes your blood pressure meds, your psych meds, as well as your diabetic meds?

All this is news to me.

@ When I ask, as my review of symptoms, “Have you felt as if you had a fever?”, and you reply, “I don’t have a thermometer”. (how did folks FEEL feverish, before the invention of the precise thermometer by Farenheit in 1714?) Or, alternately, “your nurse just took my temperature, and said I do not have a fever.” (which, of course [a] I already freaking knew, having reviewed the vitals and nursing notes before I walked in the door, as well as [b] NOT answering my freaking question!)

If Only I had Gone to School For This, Or Something!

There has been a spate of RSV going around, lately. RSV, or Respiratory Syncytial Virus, is contagious, via airborne droplets. In small children, it can lead to hospitalize-level-illness, whereas in adults it generally causes “a cold”. The reason younger children can get so ill, is that should the virus elicit swelling of the smaller airways, children, having narrower airways, cannot tolerate as much swelling as adults and older kids, before their ability to move air is compromised. We can test for RSV in the office.

So, from time to time parents bring in their kids, reporting cough, or lack of interest in feeding, or runny nose. Occasionally such a child will test positive for RSV. Occasionally such a child has alarming vital signs. One such child arrived, and the MA truncated her intake, once she noticed retractions and diminished oxygen level in this infant. She trotted out, figuratively grabbed me, and brought me in to see the child.

I saw, myself, the retractions. Retractions occur when the effort of breathing in, is increased to the point that the skin between the ribs, or below the ribs, draws in from that effort. NOT NORMAL!

We administered a nebulizer (“mist”) treatment of a bronchodilator. Subsequently, the retractions had not particularly improved, nor did the oxygenation of this child. I directed the mother that she needed to take her child to the emergency department. She responded that her ride was not present, and there would be a delay as the ride returned.

I recommended EMS at that point. The child appeared to be stable, presently, but I was uninterested in determining how long that would take to go downhill.

The mother responded, “No, I want to wait for my ride.”

It appeared that I had not successfully identified to her the ways that significant delay could make things go horribly wrong. And, waiting for her ride promised to present a significant delay.

Mother was not impressed. Her ride (eventually!) arrived, and everybody went to emergency. Finally.

If You Take Care Of Your People, Your People Will Take Care Of Business

A long, long time ago, in a city so very far away, I was an afternoon shift nursing house supervisor. In the course of my shifts, I would receive call offs from midnights, and attempt to discern that point at which nights would be short, and I would have to attempt to backfill their staffing.

One such evening, I had determined that nights would, indeed, be short. I started on the unit that was short, and called up. The first nurse I spoke with was the recipient of my stock spiel.

“Ms. Smith, golly, have I got an opportunity for you!”

She was amusedly skeptical. “Oh, you do? What sort of opportunity might that be, Mr. McFee?”

“Ma’am, I have the opportunity for you to make eight hours of time and a half, right this very night! What a deal!”

“What might I have to do, to earn this time and a half?”

“Why, simply keep your same assignment, and ride home in the morning glowing in the satisfaction that comes from a job well done!”

“Suppose I don’t have a ride home in the morning? I carpooled with Ms. Diaz, and she is completely uninterested in OT.”

I had an answer to that problem. “In that case, I’ll trot up there with a cab voucher for you!”

She was surprised. “Can you do that?”

“It certainly appears that I can, as I have the cab voucher right here in front of me!”

“But, I did not bring anything to eat later!”

“No problem. What would you like? We have KFC, pizza, Burger Biggie, and others not so far away.”

“But, I did not bring any money!”

“Who asked you for money? You’re working over, I will be sure that you eat, and have a way home. Any other concerns?”

“But, who is going to pay for the food?”

“Not you. Beyond that, not your problem!”

She sighed. “OK, let me call my husband. I’ll get to keep my assignment tonight?”

“Yep! I will so advise the night supervisor!”

“Thank you, Mr. McFee!”

“Ms. Smith, you are welcome. Thank you for being flexible!”

I caught up with the security supervisor, and asked him if one of his officers could make a chow run. I handed him a $20 dollar bill, asked for my change and the receipt, once Ms. Smith had her food.

The next day, I took my receipt to my boss, explained how I had negotiated coverage for night shift, and presented the receipt. She wrote out a petty cash voucher, and sent me to the cashier to get reimbursed.

Cross Country Adventure

So, TINS, I was NOT FDASL. Rather, youngest brother and I were driving a rental truck full of my mother’s earthly possessions back to The Un-Named Maternal State. She had died, and we were consolidating her possessions so as to end paying rental on a storage locker, once we had each kept a few items as keep sakes.

In any event, we had departed early in the afternoon, and therefore were NOT going to make the trip in one go. Gotta admit, the allure of driving through the night, well, had faded with the years. Neither of us were thirty, anymore.

As it started to get to about midnight, Youngest Brother had searched for, found, and reserved a room at a hotel something on the order of 1/3 of our way There. This hotel was described as “near the airport of (fairly large city)”. Now, I have flown a time or several, and have some expectation, expectation that I feel is not unreasonable, that there would be, ya know, SIGNS, announcing the presence of something as large as, oh, gosh, I don’t know, AN AIRPORT. Signs, no less, on the adjacent interstate highway.

Notwithstanding my expectations, I managed to drive a considerable distance past (fairly large city), and began to wonder out loud where the freaking airport, and, with it, our hotel, might be. Youngest Brother did a bit of internet searching, as well as phone map application searching, before he announced that I had managed to drive past it.

Score, ME!

So, we reversed course, and drove back, finally observing a sign announcing the airport, set way, way, way back off the side of the highway, obscured by shrubbery. We only saw it, because, unlighted, another vehicle’s headlights momentarily illuminated it.

I guess that these folks believe that if you do not know how to get tyhere, already, you don’t belong there in the first place!

Once we arrived, Youngest Brother entered, and registered us, obtaining a pair of key cards. We trundled our crap up the elevator, and found the room. This hotel used proximity key cards, and (I supposed) placing the key adjacent to the door locking mechanism would trigger the door to unlock, and we would stumble into sleepy time bliss.

Or not. The lock blinked a persistent red, and there was no whirring as of, say, unlocking, to be heard.

Youngest brother returned to the desk, there to explain the problem to the clerk and elicit a replacement, functioning, key card. He returned to report the following.

He told the clerk that the cards did not function at our lock.

The clerk asked him, deadpan, “Did the light turn green?”

Brother’s answer: “Nope!” (while thinking, ‘Of course it turned green, you idiot. The door popped open, and right now my brother and I are sitting on the sofa, eating our dinner!’)

I suggested an alternative answer. “Yeah, it turned green. And I looked all around, and never did see the butler who is supposed to open the door, turn down my sheets, and unpack my luggage! What sort of low rent establishment are you running here, anyhow?”

We did, in fact, receive a new set of keys, which worked.

THE WISDOM ASSOCIATED WITH HINDSIGHT!

So, the other day, My Best Man and I went to the range together. He had recently acquired a Garand that he had not yet shot, so, by way of introduction, I brought mine, along with some other guns that merited airing out. A good time was had by all, as range time = good times. “Group therapy”, so to speak.

My friend is a bit of a raconteur, so the stories never end. He told several tales regarding the CEO of his employer, and these stories revealed a soul steeped in the tradition of leading from the front, and taking care of your people = taking care of business, which equals, in our line of work, taking care of patients. Well. Taking care of them, well.

From him, with our history, these were tales of high, high praise, indeed. (He is the originator of the observation that “Little Mary Sunshine is *NOT* a force multiplier!”)

Eventually, we had shot everything that we had brought along to shoot, and noted that it had clouded up, with occasional rumbles of thunder to draw our attention. Therefore, we safed the weapons, packed up the ammunition, cased the firearms, and paraded to our vehicles.

Once everything was settled into our vehicles, well, the skies opened. We were at my conservation club range, and so I got the opportunity to exit my vehicle, unlock the gate, open the gate, exit the gate, and relock the gate. This, of course, required that I exit my nice, warm, dry truck, wade through the slough that our driveway had become (soaking my feet in the process. I *HATE* cold, wet feet!), fiddle with the lock, fiddle some more with it as I fail to correctly recall the combination, fiddle with the damned thing YET AGAIN, finally opening it. In the downpour.

As my partner exited the gate, I ran to my own truck, entered it, and realized that I had a poncho therein. I donned the poncho, and attempted to close my door.

As it developed, my truck will *NOT* exit park, and move, until the driver’s door is secured. That required me to remove the poncho from the door, and attempt, several times, to close the damned thing. Finally succeeding, I moved my truck through the gate, and re entered the cataract in order to re lock the gate.

It occurred to me, right about then, that donning my poncho (as well as, oh, I dunno, FREAKING BRINGING MY FREAKING FIRE BOOTS) might have gone a long way towards allowing me to open the gate, close the gate, lock the gate, and then return to my vehicle, without being, you might say, soaked to my damned skin.

Ah, the wisdom associated with hindsight!

Sometimes, The Pucker Could Squeeze Diamonds

So, TINS, TIWFDASL at an urgent care out in Flyover Country. It was a typical afternoon, featuring a parade of sniffles, coughs, and poison ivy. Our clinic was on the south side of the road, east of Middling Sized City, and the Big Time Big Deal Hospital And Trauma Center. In other words, to get the the BTBDHATC, one would exit our driveway, and turn west (that is, LEFT!)

Abruptly, the registrar summoned me. My MA and I walked over, to behold a limp toddler. Very Not Good!

The MA escorted the male carrying the child to an exam room, and began to collect vitals. I examined the child, discovering a heartbeat (Crom be Praised!) and spontaneous respirations. The registrar collected demographic information, and I asked the adult what had happened, prior to arrival.

“Well, he started shaking, and then he stopped. He just wouldn’t wake up, so I brought him here.”

Well, the “wouldn’t wake up” part was still descriptive of the child, and I noted that I would have to call an ambulance immediately, because this could have several causes, none of them good. Indeed, “floppy child” is right up there in my Triage Catalogue Of Very Bad Things.

The adult male paused at this. “I don’t want to send him by ambulance. I’ll take him myself!”

I was surprised. I noted, “So, you *DO* realize that several of the things that caused this, could reappear, and he could stop breathing or his heart could stop. EMS is trained and equipped to deal with those things, should they occur. You, while driving, are not, right?”

He persisted. “I’ll drive him myself”.

We directed him to go there immediately, with no delay nor detour. We explicitly directed him to exit our driveway, TURN FREAKING LEFT (that is, west), and not stop until at the ED.

He stated that he understood, and would do so.

He scooped the child up, and exited the building. I sat down to chart, as well as call BTBDHATC, in order to provide them with forewarning of the sick, sick, sick child coming their way. That is, until my registrar called me, excitedly, to report that this sunovabitch had turned EAST! (exactly away from the hospital) upon exiting our driveway.

WTAF!

I had the clerk print a face sheet, and called emergency dispatch. I related the above information to dispatch, along with my concern that a critically ill child was *NOT* being taken to the ED. I provided the street address we had received, as well as the contact information.

I next called the child protective services emergency number, to report the above. I was assigned a report number, which I charted, and my own name and contact information was taken.

Several hours later I received a telephone call, from a gentleman asserting he was from CPS. I asked him to confirm the report number, the child’s date of birth, name and address of our record. He did confirm all these details.

He queried me about the particulars of the child’s presentation. I supplied the requested information. I asked how the child was. The worker paused, and said, “Well, I am not allowed to provide information regarding an ongoing investigation, particularly one where the child in question has been hospitalized. I’m sorry. “

My response? “Yeah, it’s too bad you couldn’t tell me if the child had been hospitalized or anything. I understand. Thank you.”

Interview Skills

A long, long time ago, in a Galaxy not so very far away, TWWWBTP (The Woman Who Would become The Plaintiff) had graduated LPN school, and was starting her LPN-to-RN studies, and I was seeking a change of employment. I was looking to add ICU to my resume, since the grad school I had my sights on required it. This one hospital was recruiting, and proclaiming that nurses who accepted positions in their ICU, would receive a $10,000 sign on bonus.

I investigated, and learned that one half of this bonus would be paid upon completion of one year of employment, and the second half would be forthcoming after completion of the second year of employment. Sounded good to me, and so I arranged an interview.

Since TWWWBTP, at that point TDW-Mark I, thought that it would be problematic should I accept a job requiring me to drive halfway across the state, as this position would, perhaps she should investigate employment (and schooling) opportunities there, as well.

Sounded good to me.

On the appointed day, she and I arrived for our interviews. I learned of the position, and they told me, “You do know, don’t you, that we require a two year commitment from nurses in order to qualify for this bonus, right?”

I acknowledged that I did, indeed, comprehend this aspect of the arrangement, and stated, “Yep, I expect that I can wait two years before going to grad school!”

They acknowledged my comment, and we proceeded.

So, we concluded our interview, TDW-Mark I and I, and we sat in the lobby, awaiting their offer(s). We were summoned, and received the news: TDW-Mark I was offered a PART TIME, LPN job. As for me, well, I did not receive an offer. They informed me, “We are looking for nurses who want to come here, and settle down here, in our community. With your grad school plans, well, you do not appear to be a good fit for that sort of longevity.”

Cool story. We drove home, TDW-Mark I composing her “Thanks but no thanks” letter in her head, and I remarked, “Ya know, honey, I believe that I have figured out what I did wrong!”

She replied, with some side-eye, “Oh, really? What was that? Other than being truthful about your higher education plans, I mean?”

“Well, you see, I should have walked in there, paused just inside the door, and, James T. Kirk like, spread my arms in an all encompassing gesture, slowly turned, taken in a deep breath, and declaimed, “I…I..feel, I feel as if I have come….HOME! I….I want my children…to grow, TALL, under these…these Blue ! Skies!…I want to spend my days….Breathing! This! Clean! Air! I…I want…my..bones, to rest…to, REST…beneath …these green hills! I…I feel as if…I am…at..HOME!”

I looked over at my bride. She smiled, and responded, “So, you are telling me that you should have lied your ass off, right?”

“Of course, right!”