Communication Breakdown

So, TINS©, TDW-Mark II had set out, because TSIL-Mark II (The Sister In Law-Mark II) had undergone surgery of some sort, and required assistance in the couple of weeks post operation. TDW does not work outside the home, and I flatter myself that I am sort of self sufficient. So, off she went.

Her journey to Another Fly Over State was unremarkable. She arrived, and notified me of this fact. I cooked up a batch of food, ensuring a supply of left overs for my work day repast. I laundered clothing and suchlike, and folded and hung same. I washed the dishes, and then put them away. I went to work, came home, played with the cats, and generally bummed around.

Just like I was a grown up, and had, oh, heck, maybe, done all this stuff before, right?

So, one evening I had changed into pajamas, hanging my pants and shirt up on the hook in the closet. My routine is that I will, the next morning, retrieve said pants and shirt, and transfer all my whatnot from old clothing, into the pockets of new clothing.

Well, when I do so, and leave my cellphone in my pants pocket, and retire to another room altogether to watch “Battleship New Jersey” videos (highly recommended, BTW!), or The History Guy videos (another enthusiastic Thumbs Up! Recommendation!), well, I cannot hear the ringer on my phone. Since I am not youthful, and do not have a pristine medical record, and, as well, TDW-Mark II is a bit of a worry wart, well, when I do not answer my phone, nor the texts, and this continues for something like a half an hour, well, she gets excited and calls a friend of ours, who also lives in town, requesting that he meander over and verify that I am not folded up on the floor, with the cats poking me and asking when I will arise, and feed them. Or something.

So, much to my surprise, our friend rang my doorbell at something like 2200 hours, and explained the preceding paragraph to me. I retrieved my phone, and promptly called TDW, and reassured her that I was NOT a crumpled heap of geezerhood at the bottom of the stairs.

The ringing in my ear, from the chastisement I subsequently received, has nearly resolved, as I write these words.

Smoking is Bad, M’kay?

Several times a week I get the opportunity to “cheerlead” one soul or another along the path that ends with not smoking. Some folks are receptive, and they get the full orchestration. Others, not so much, and they get the admonition, “So, smoking is not health promoting behavior, is it? There, I’m done yelling at you about smoking!”

Those who appear receptive get told, among other things, that The Plaintiff smokes, She is a nurse, so it cannot be that she does not know the effects of smoking. And, if you ignore the fact that she married ME, and divorced me, well, ignoring those two errors of judgment, she is pretty smart. Finally, she has never been any sort of shrinking violet. As a mother, I enthusiastically applaud that sort of strength of character.

As The Plaintiff, well, not so much.

I move on to observe that this set of facts (see previous paragraph) tells me that stopping smoking is a monumental task, complex and demanding much of those who would make that journey.

Then, I observe that I worked, full time, in my Nursing school years. Spent two years on around 2 hours sleep a day, in my AD program.

Pretty worthwhile. Mighty difficult.

I conclude by observing that worthwhile things are seldom easy (cf. Raising children), and that easy things are seldom worthwhile (see: video games).

Occasionally, I will see some soul who was on the receiving end of that spiel, several months later, and some of those folks will tell me”I have really cut down, and am trying to finally quit, because of what you told me!”

Sometimes, you get to think that you have, indeed, made a difference!

FPC: Phenomenal Phone Company

A long, long time ago, in a state capitol city not so very far from here, I was seated in the basement of The Enormous Hospital System Mothership, where She Who Would Become TDW-Mark II was undergoing surgery of some sort. I was seated next to, well, let’s simply call him my father in law.

At this point in the celebrations, the divorce from The Plaintiff had concluded, and she and I had a week-on-and-week-off child custody arrangement. My adolescent children had cell phones, and had both me and their mother on speed dial.

So, Number Three Son had occasion to call me, but I could not make out what he had to say, and my attempts to re connect with him were for naught.

I did not know if this was generic adolescent ‘gotta call dad’, or something emergent. That latter was very unlikely, but, after all, I have kinda spent my life in the “this is sort of an emergency” business, and therefore considering that possibility is an occupational hazard. Therefore, since I was NOT at home, and, should my children need me, their ability to communicate that to me in a timely manner was mission critical, well, The Phone Company, and their inability to connect a freaking call something like 12 blocks from the freaking state freaking capitol, well, to understate the thing, I found it unsatisfactory.

Father In Law offered the use of his phone, on Another Carrier. I entered the number of my son, hit “connect”, and, par miracle’!, just like that, I was speaking to my son!

We concluded our conversation, since it was a generic “ought to call dad” call, and I asked Father In Law if I could make one more call. He assented.

I then called “customer service” (spit!) of The Phone Company. I explained my problem, and how this was not acceptable. Phone Company Minion asked my location, and I described myself as being one floor down from street level, in waiting lounge of Enormous Hospital System Mothership. Minion then regaled me with a bit of RF theory, to wit: “You cannot reasonably expect a cell phone to have a reliable signal when you are underground!”

I asked Minion, do you have caller id?

Affirmative.

Could you tell me the originating telephone number for this call we are having, right now?

He read back Father In Law’s phone number.

Is that a Phone Company number? If not, what carrier services that number.

Why do you ask?, responded the Minion.

“Because, that is the carrier who is henceforth going to be receiving checks from me approximating $200/month, because my phone, my childrens’ phones, and the phone of every mo$%#r f@!%&er who will stand still long enough to hear this story, will be giving their business to this carrier, whose phone I presently hold in my hand, in this basement, as you and I converse!”

Having said that, I realized that there is no satisfying way to slam down a cell phone. I miss plain old wired phones.

Gotta Scratch That Itch!

A week or two ago, my MA returned from her lunch, and showed me her parking lot find: a couple of dirty syringes, with bent needles. “I found them on the ground behind my tire”, she related.

My thoughts were, ‘what sort of fool, even among the universe of fools who inject drugs, leaves a freaking needle on the ground in a parking lot, where children come and go on their way to their own physician appointments?’

@

So, just the other day, TDW-Mark II needed to recharge her cash card. Off to her bank we went. The gentleman attending to her transaction appeared to be somewhere in his twenties, whereas I, myself, am approaching 70 (and so closely approaching 70, that 70 has started to tap his brakes, and slow down, in hopes that I would not admire his bumper so closely anymore!).

TDW was making conversation with this gentleman, and he was owning that this sort of transaction was unfamiliar to him. TDW then up and chirps, “It must be hard on poor elderly people, who don’t have computers, or know how to use them! That whole smart phone, and computer banking thing can be rough on the elderly!”

I looked at her for a moment, and spoke up. “Am I not standing right here? You CAN see me, right? Really? I. Am. Right. Here!”

Moar! Random Thoughts!

The other day, I saw some soul, who was vexed by an itchy rash. I interviewed said soul, examined, and prescribed a steroid cream to soothe the rash. My instructions, in the prescription, were “Apply thin layer to rash twice a day”

Later that day, my MA fielded a call from the pharmacy inquiring where the rash was? (as in, I suppose, where on the patient’s body). I therefore had to complete the thought that I was charting on a completely different patient, find the chart for the patient, open that chart, review my note from several hours ago, and answer the query.

Foolishly, I had assumed (…yeah, I know. AssU-ME.) that “the rash” was specific enough, but, it seems, no…

In a similar vein, I continue to receive prior authorization requests. This is maddening, because (a) I typically attempt to prescribe the exact same thing previously prescribed. For, say, asthmatics, that means I attempt to prescribe the-flavor-of-the-month of albuterol inhalers. In addition, (b) years and years ago our Fly Over State Legislature passed legislation mandating substitution of generic, equivalent, medications unless the brand is specified, with the specific instruction of “dispense as written”. Silly me, I had supposed that when I prescribed albuterol, which is the generic name, that this generic substitution law would allow the pharmacist, who has access to the “menu special of the day” that the insurance company will subsidize, could then think, so to speak, “Hmm. McFee wants albuterol, but the insurance company will only subsidize Youcallwehaul brand of albuterol inhaler. Howzabout I simply fix that, and dispense the Youcallwehaul inhaler, just as if it were not a BRAND of ALBUTEROL, but, indeed could be considered equivalent to the generic albuterol inhaler that Our Hero had indeed prescribed?”

Had that occurred, I would not get a paper note spending pages and pages to tell me that the Useless Insurance Company Inc., would not pay for the generic inhaler, but would, rather, pay for the Youcallwehaul inhaler, no doubt reflecting the proud legacy of pharmaceutical excellence that has characterized the Pashmir Valley since January of 2022!

And receive that note several days AFTER my patient encounter.

All the while telling me that they would not pay for a non preferred inhaler until two other inhalers had been employed, and had failed.

So, that means that my patient has NOT had their freaking inhaler for (lessee, now: Friday visit, Monday denial, Thursday, if they are attentive (scoff!), mailing date for the voluminous tutorial on the pharmaceutical excellence of Bagwan’s Pharmacy And Weapons Factory, which I finally see, perhaps as soon as a full week after my patient encounter.) So, something like 8 days, more or less.

Let’s paw through the old chart, and review previous prescribed inhalers, shan’t we? Lessee, there is Ventolin, and then there was that time this soul received…Ventolin, and, of course, the last time when one of my colleagues prescribed…..er, Ventolin. So, imagine my surprise when I prescribed (lessee: what was that stuff?)…Oh, yes. Ventolin!

And I receive the previously described voluminous correspondence detailing why the Behemoth Insurance Company would not pay for the prescription of….er, Ventolin.

I really try to embrace the suck, but geez, ya know…

TASK STACKING

Eaton Rapids Joe, proprietor of the eponymous blog, must have been an engineer in a previous life. (and, I must have been dyslexic in my previous life, as the previous 5 words, pre-auto correct, read “enbgineer in a previous lidfe.”. Sheesh! I scare me!)

In any event, I seem to recall he once explained the concept of “tolerance stacking”. As I recall, however imperfectly, the concept might translate into, say, a rifle trigger pack, wherein one would take Part One, at it’s maximal permissible dimension(s), and add it to Part Two, similarly pushing the boundaries of out-of-spec-large, and add that assembly to Part Three, (ditto), until, finally, you had, say, a trigger pack, each part in spec, yet the assembly would not function, or else would not fit into the firearm at all.

Not so very long ago, I was reminded of that when TDW-Mark II assigned me (or, maybe, I was voluntold….) the task of cleaning the piles from the dining room table. I confronted the concept of “task stacking”.

To be honest, I had several probably 12-18 inch tall piles (more about that, in a moment…) of papers, magazines (the literary kind), boxes, and assorted whatnot, that (a) I had NOT addressed appropriately, (b) in any sort of timely manner, and (c) that TDW had, at long last, grown weary of seeing.

Along the way, may I observe that I share my home with several cats? And that cats are Agents Of Entropy? My appraisal is that cats are genetically incapable of viewing an organized stack, of whatever sort of stuff, and of whatever degree of righteous organization, without feeling the overwhelming need to Tear! It! Down!.

Of course, having several days off in a row, I was, well, “willing” probably overstates my enthusiasm for this task. Still, it will do. So, I was “willing” to address this problem, but I needed to have a space to take the stack-du-jour, in order to unstack it, triage each component, and then address same.

That meant establishing subsidiary stacks, one of trash (simple: stack same in the…wait for it!…trash can!), one of things to be shredded, and one of other, kind of valuable, things. That last stack would then be the subject of a re-triage, and once suitably thinned, put away.

This process was to be repeated, until the dining room table had my computer, and one (SMALL) stack of whatever needed to be addressed in the next couple of days. And, nothing else of my bullshit.

Well, in order to accomplish THAT task, I had to clear the table in the kitchen, that had, itself, become home to (yes, he admitted, embarrassingly) several stacks of things awaiting disposition to the garage, the trash, or other longer term, somewhat organized, rest.

The trash component, here, was simpler, due to being closer to the trash can, after all. The put-this-crap-away-somewhere-not-the-kitchen-table task, elicited it’s own task-stack, as my imaginings of organized stowage in the basement, required that there be horizontal surfaces, in that basement, that were unoccupied.

Do you, as well, see a pattern here?

So, I thinned the herd of bullshit in the basement, and changed the trash can. I imposed some modest organization in that basement, and then found homes, however transiently, for the keep-this-crap-just-not-on-the-kitchen-table items.

I shredded much of the shred-able stuff, and changed the trash can. Again.

I eventually had emptied the kitchen table, which I then re-filled with dining room table stuff.

Rinse and repeat.

So, it turns out that I am not the only pile challenged soul. I get several days off in a row, that follows a stretch of many 12 and 10 and 8 hour shifts. When I am in the midst of my duty week, well, my ambitions do not particularly exceed “get up and get around”, “get to work”, and do the above in accordance with my employer’s expectations (that is, on time). So, being a geezer, after a 12 hour shift, I get home, graze a bit, and turn in.

I had requested TDW to thin the herd of home chores, so that I might kill of the remainder on my first day off, then to laze away the rest of my stretch of off days.

Hard fail. She injured her foot (neither of us has any clue how. It hurts, that limits her mobility, and that mobility is kind of mission critical to things like putting away the dishes, moving the laundry along, and so forth. In addition to nurse-maiding an ailing dog and ailing cat)(can’t say we don’t know how to have good times!)

Being the loving husband that I am, I offered to heat and deliver some supper to her.

Task stack. Be nice if I washed my hands.

Which would be helped by access to the sink.

Which would be facilitated by loading the dirty dishes into the dishwasher, thereby emptying the sink.

Which would be easier, from a no-two-objects-may-occupy-the-same-space perspective, it the dishwasher were to be emptied, and the clean dishes put away.

Which, aesthetically, ought to be performed by clean hands.

Which required soap and water, currently unavailable due to the mosh pit of our sink.

Which inspired my present blog post.

After the dish part of the foregoing had been accomplished.

Finishing the dining room table is Tomorrow’s Task.

SNIPPETS

To be honest, y’all, I present snippets when the fountain of (I certainly hope…) entertaining stories has run a bit slowly, or I have collected several thought fragments which do not inspire an entire blog post. So, with that in mind, here is my latest installment of snippets.

Conversation with a child of Ghawd: “What makes your cough worse?” “What do you mean, ‘worse’?” (never mind: I now know that the answer is “nothing”.)

My mornings: I set the alarm for 0700, in order to get up, get around, and get to work. Kitty wants to play, at 0600.

I wonder if it would save me a lot of pointless conversation should I get a tattoo on my non dominant arm, saying, “Good talk! Here’s your Z-Pak! Have a nice day!”

Triaging one night as an RN, chucklehead enters bitching nonstop, “Stupid hospital! Stupid doctors! Stupid…” “Yes, ma’am, and I am likely the dumbest one here!” “But, you’re a nurse! You cannot be a nurse, and be stupid!” “Yet, ma’am, here I am, as are you! Now, what brought to us tonight?”

”I am going to prescribe an antibiotic for you. What pharmacy do you use?” “I don’t use any pharmacy. I never get sick.” (sigh) “So, what pharmacy are you going to go to, when you do go looking for your antibiotic?”

Overheard conversation among the MA staff: “So, he and I used to ride the bus together!” (I interject) “Is THAT what you kids call it, nowadays?”

When your MA starts report with, “So this guy, almost a year ago…”, you know that whatever follows is very likely to be some sort of cluster.

One day, I will snap, and I will write the following off work note: “Cletus was seen today in clinic. He is released to return to work after the heat death of the universe.”

Small Town Policing

So, once upon a time, my bad example led TDW-Mark II (The Darling Wife-Mark Two) to obtain her own concealed pistol license. She spent some time at the range with me, and eventually decided that she would carry a Springfield Armory XD pistol in 9 millimeter.

As these stories of mine develop, she was driving about our little town, and one observant police officer noted that she had a brake light out. He pulled her over to explain to her his observation.

Being a good doobie, she announced as part of her opening conversational gambit, “I am a CPL holder, and I have it here in my purse on the floor of the passenger side of the car!”

He acknowledged this tidbit, and invited her to carefully produce her license, registration, and CPL license itself.

She did so, and the officer walked back to his vehicle to run her plates and license.

He returned, and returned her cards to her. “So,” he asked, “What made you select the XD for your carry gun? My wife just took her CPL class, and is considering her own choice of pistol.”

TDW recounted her experience with my array of pistols, finding them overly large for her hands (Glock, Browning High Power), or not enough ammunition in the magazine for her preference (Revolver, Colt Government Model). “When I picked up the XD in the gunshop, it felt just right in my hand, and when I shot it, I did pretty good with it!”

They soon concluded their conversation, and she returned home, excited about her contact. “We simply had a nice conversation about concealed carry, and women’s choices in pistols, and why this or that pistol might be more or less suitable. It was kind of nice!”

Entry number 4,385 in my Catalog Of Why I Love Small Towns.

Nursing School Lessons

NURSING SCHOOL LESSONS

So, TINS, TIWFDASL, years and years and years ago. I was in nursing school clinicals, and working for EMS in Da City. This was so long ago, that HIV/AIDS was not even on the horizon.

One day in clinicals, I was cleaning up an incontinent patient, and my instructor motioned me outside once I was done and the patient tucked in to a nice clean bed, and he, himself, was clean and dry and in a clean gown.

She began: “Mr. McFee, You did very well keeping the patient covered so that he would not get chilled as you bathed him. There is, however, one item I ought to call to your attention.”

“Yes, ma’am? What is that?”

“I noticed that you were wearing gloves. That concerns me, because your patient might feel insulted at your wearing gloves for personal care.”

I responded, “So, you are telling me that the fact that I am wearing gloves to clean a patient who has been incontinent, of stool at that, might be seen as insulting?”

“Yes, Mr. McFee, that is exactly what I am telling you.”

“Well, ma’am, I worked last night, on the ambulance. I spent the night crawling in and out of cars, and over broken glass, removing injured people. I probably have a thousand little cuts on my hands alone. I am pretty certain that any patient of mine will get over their hurt feelings way before I recover from Hepatitis B. But, you are the instructor, and I am the student. Let’s write down your directions for me in this matter, and make a couple of copies. We’ll both sign each copy. That way you will have a copy, establishing what you directed me to do, I will have a copy and therefore cannot claim that you never told me to do what you told me, and there will be no questions moving forward what I am to do.”

She looked aghast. “I am not going to write that down! No way!”

I smiled. “Thanks for the counseling session. I will certainly keep your words in mind, moving forward!”

Kitten Tales, Part VII

So, TINS…. OK, this is not another firehouse/”sea story”. I was lolling around the house one evening, and TDW-Mark II came to me, cradling our petite, mostly white (well, most of the time…) cat, Trixie. Said cat appeared to have settled herself, right side first, into an ash pile.

This was concerning, since when the kittens had first joined our household, four of them had taken to exploring our heatilator style fireplace. Said explorations were made considerably easier (for the kittens) due to the fact that one of the grates, in place specifically to prevent such explorations, had become loose. TDW-Mark II had (a) noticed that the kittens were not accounted for, and, after a frenzied search, (b) had noticed that one of the older cats, Max, had, pointer style, settled in in front of one of the fireplace warm air outlets. When she (TDW) investigated Max’s pointing, she discovered four grimy, meowing, kittens, noses pressed against the grate.

She removed that grate, and extricated the kittens. They were brushed off, and pranced away, none the worse for wear. Since I believe that too much of a good thing is just about enough, we expoxied the offending grate back in place, replaced the unscrewed-so-we-could-extricate-kittens grate, and placed the fireplace screen in a closet, and backed a piece of furniture against the opening for the fireplace, after placing a large sheet of cardboard over the opening.

Remember that cardboard bit.

So, Trixie’s ashen demeanor elicited some concern that other cats might have taken up spelunking. A hurried cat census revealed that everybody was accounted for, and the only problems remaining were cleaning Trixie, and more effectively securing the fireplace.

Inspection revealed that the cardboard had been bowed, producing a kitten sized sort of funnel devolving into the fireplace. Well, THAT was a permanent fix! Worked fine, as well!

Second things first. I retrieved a sheet of plywood (now, kiddies, once upon a time, mere mortals could afford this thing called “lumber”. Indeed it was so inexpensive that folks built entire houses out of the stuff! In a manner similar to the query, how did Californians light their houses prior to using candles? Electricity!) I placed this sheet in front of the fireplace, between the cardboard and the opening, and wedged it in place with that furniture I spoke of 3 paragraphs ago.

TDW-Mark II had determined that Trixie T. Cat had a bath in her future. Golly, I was so, so, soooo looking forward to that!

Fortunately, Trixie had previously decided that she needed to supervise my med passes, as well as my shaving and my tooth brushing. In the process, she would bat at the stream of water coming from the faucet, then licking her paw as if in surprise at that wet stuff appearing thereon. And, repeat. So, the water-running-in-the-sink thing did not concern her. She was even relatively copacetic with the run-warm-water-over-the-kitten part.

Not such a fan of the baby-shampoo-on-the-kitten part. Pro Tip! If you have occasion to bathe a cat, even such a placid cat as Trixie, bathe said cat with DROPLETS of baby shampoo, NOT streams. That latter initiative will lead to a prolonged period of cat rinsing, and, well, cats have a limited desire to play in the water. Particularly when said water is all over them. Trixie rapidly reached the part of our tale wherein she declaimed “Let me the fook out of here! I. AM. DONE. HERE!”

That is the bad news. The good news is that she articulated this complaint with pushing at us with her paws, claws retracted. Good on’er for the retracted part!

Soon, we had rinsed the shampoo from her, and wrapped her up in a bath towel, halfway drying her. Another towel, and she was as dry as we were going to get her.

We released her, and she walked away, pausing from time to time to shake one leg or another, as if to shake the remaining water off. She still looked bedraggled, but considerable less sooty.

By the following morning, between her own cleaning efforts, and grooming from her siblings, she was nearly entirely clean. And dry.