Are We Ever, Really, Off Duty?

Are you ever off duty?

I had spent some time praying at The Altar of The Overtime Fairy, and with the proceeds had decided to take The Long Suffering Wife on a cruise. Now, one of her idiosyncrasies is that she is allergic–VIOLENTLY, anaphylaxis, throat swelling, red faced allergic, to tree nuts. Remember that. It will return to feature prominently in this “war story”.

The cruise line we selected had gotten our business previously. The personnel are unfailingly pleasant, professional, attentive, and on their game. The food is excellent, the accommodations are pleasant, the cabin stewards are magicians who ghost in and make the beds and change the linen without our seeing them. There are reasons that we are repeat customers.

We select the formal dining room each time. There are large tables, so we get acquainted with fellow cruisers, the food is outstanding: as good as, and generally superior to our own home cooking. On this cruise we joined two folks from Minnesota, a contractor and his girlfriend, and two other couples, the men both volunteer firefighters from a small town in Canada.

Firefighters are part storyteller, as am I (surprising, no?). It develops that our other two companions were storytellers, as well. So, mealtimes were fun, great food, round robins of telling tales, and no workaday cares.

Now, it seems that, for some reason, we had failed to make clear to the serving staff my wife’s allergy to nuts. (likely, because we had failed to, ya know, TELL THEM!, or something.) So, one evening, when my wife took her first bite of the chicken that she had ordered, she chewed it for a moment, then spat it out, turning to me with a peculiar look on her face.

I asked her what was the matter, and she told me, “I don’t know, but my mouth is burning as if I had just eaten a nut.”

From the corner of my eye, I noticed our firefighter companions in still life, forks immobile in mid air, as Mrs. Stretcher Ape and I had our conversation. I asked her how her breathing was, and she told me that was fine, but that the burning was concerning. I agreed.

She keeps an epi pen in her purse, which, of course, presently was in our cabin. She did have benadryl on her person, and I directed her to take two, right now. She did so, and we all watched her for a moment. I then directed her to give me a third capsule of benadryl, which I opened, and poured onto her palm, directing her to “lick that up, now!”

One of the firefighters shuffled his chair back a bit, as if clearing for lift off, and asked me if I needed any help. Our contractor friend, with whom we had gone on shore excursions, observed that I was an ex medic, ex ED nurse, and presently a Physician’s Assistant. I looked at the firefighter,  perched on the literal edge of his seat, and his partner, similarly (not so very) relaxed, and said, “It looks like things are OK for now, but I’m anticipating the possibility of that changing. Let’s give it 20 minutes to see how things develop. Thanks for the back up.”

I turned my attention back to my wife, and pasted a fake, but encouraging, smile on my face. “How you doing, Honey?”

She thought for a second, and answered, “OK so far.”

The waiter had noticed our diorama like table, and the absence of conversation, and walked over to see if he could assist us. I briefed him on the foregoing, and our suspicion that the chicken may have been cross contaminated with some sort of nut in some manner. Alarmed, he told us he’d look into it and be right back.

He was. Along with the Maitre D’. Both assured us that there were no nuts whatsoever in the recipe for my wife’s selection, although it was possible that there were some nut oils remaining on the surface upon which the chicken had been prepared. Effusively, they both asked after my wife’s well being, and apologized for this occurrence.

By this point, she reported that the burning was receding, and no swelling nor shortness of breath, as well as no itching was present.

I noticed that everybody else at the table, finally, resumed their meals.

Once I was convinced that her symptoms were, in face, receding, and appeared likely to continue doing so, we retired to our cabin for the night. She, and I, thanked our companions for their vigilance, and reassured everyone that it appeared that her reaction was on the way to being resolved.

So, the question: are we ever REALLY off duty?

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Patient Care Is Everywhere!

I had the opportunity, a couple of years ago, to speak with an police officer who 
personified the “Protect and Serve” mindset. An elderly, very confused 
gentleman, with a baseline mentation deficit, was brought in to the hospital 
at the instigation of the officer. 

Having been dispatched for a "welfare check", he found this soul confused, 
and in the officer's estimation, "looked sick." We evaluated the patient, and 
tried to (start to) fix his medical issues.  While waiting for the lab results, the 
officer and I chatted. The officer related to me that he was an officer, 
“not for the attorney with a 150,000 dollar car and a nice house: he doesn’t 
need me. That guy, over there: he depends on me to do the right thing. 
He is why I took that oath.” 

Once we had finished caring for the gentleman, and were ready to discharge 
him, another officer from this same (yeah, rural) department came and took 
him home, seeing him safely into his apartment.

Another occasion, same rural police department, same officer. This time he  
accompanied an EMS transport. This soul was in custody, so the officer parked 
himself outside the room, to keep an eye on his charge. During their stay, in 
the room across the hallway, was a child, who was very dubious about the 
entire "going to the hospital" thing. This officer was approached by the fearful 
child, who momentarily had his fears overcome with curiosity about a 
live-and-in-person police officer. This officer was very engaged with the child, 
producing wide eyed interest as the boy lectured the officer on the ins and outs 
of frogs, and minutiae of their lives in the wild. He (the officer) offered a few frog 
insights of his own, and the two of them had an animated conversation there in 
my ED hallway. 

The rest of my encounter with the boy was made considerably smoother, when 
the officer asked the boy, "Are you behaving for my friend Reltney?  Yeah, he 
may be a doctor (well, a PA at this point, but, ya know...), but he's pretty nice.  
Give him a chance, wontcha?"

My point? There has been come conversation of “Officer as social worker” 
becoming part of the police toolbox. This theme is not new, although it used 
to be called "walking the beat, and knowing your beat". Some officers, who 
are each a credit to their profession, have been employing that tool for a 
long time. And, in some regards, to steal a phrase from the American 
Nurses' Association, "Patient Care is Everywhere!"  Some of the practitioners 
are not formally licensed in health professions. And, some of us simply see 
it as being a good neighbor. 

Small Town Hospital Fun And Games

 

TINS. TIWFDASL in a small rural ER somewhere, and the local EMS had brought in Sumdood who had sustained some sort of injury, that necessitated placing him on a long backboard, and cutting off his clothing. Said Dood subsequently, and contrary to my exhortations, removed his backboard straps, ripped out his IV, exited the cot, and started trying to assault another patient. I overhead paged “security stat to ER” (try not to hurt yourselves laughing), and the reporting officer ran back in, and took down my crazy, naked, lunatic wannabe fellow patient assailant.

Mr Naked was trying to cold cock the cop, the cop was trying to cuff Mr. Naked, and it looked to me as if more hands were needed, on The Good Guy’s side. I grabbed Mr. Naked’s off hand, and it was on.

So, the three of us were rolling around on the floor. Neither the officer nor I was making much progress, because Mr. Naked was sweaty and (shockingly enough) uncooperative. In addition, and simply making my day so very much better, he was bleeding enthusiastically from the site from which he had ripped his IV. Nice.

One of the nurse aides came over, and asked, “Is there something I can do to help?”

I replied: “Go over to the phone, dial 9 to get an outside line, dial 911, and tell the nice dispatcher that you are at Rural Community Hospital ED, and you have an officer in trouble. Repeat that, over and over, without stopping, until you hear the sirens. Now. Now would be very, very good!”

Long about this time, one of the (male) floor nurses, having determined from the overhead page that This Was Likely To Be Bad, had gotten another floor nurse to watch his patients, and trotted into the fun and games. So, by the time that the first backup officer had arrived, there were FOUR of us rolling around on the floor. In the blood. And sweat. And, every bit as much fun as it sounds to those of us who really, really do not like to exchange bodily fluids in the middle of the ER. On the floor.

Well, it soon developed into a Public Safety Roll Call. Every officer in our rural county screeched to a stop in our parking lot. There were city cops, there were county deputies, State Police officers rolled in. I even think that the county’s Department Of Natural Resources officer joined in the festivities. EMS showed up, firefighters clumped in.

Mr Naked was subdued, and cuffed. The offices went to pick him up by his cuffs and feet, and I suggested that they were much less likely to hurt their backs, should our friends from EMS place him on a backboard, and transport him to the pokey in their truck.

On the way out of the door, the ER physician asked the medics to pause a moment, and the doc asked the patient if he, the patient, desired to be evaluated for any injury or illness. Mr. Naked responded with an oration on the peculiar mating habits of the physician’s mother. We took that to mean, “Why, Doctor, how thoughtful! No, thank you very much, but these nice officers and I have made other arrangements! Y’all have a nice evening!” (or, something like that)

I retired to the nursing station, to write a nursing note that looked like a Take Home Essay Final on “Emergency Nursing in The 20th Century: Issues and Answers”. It ran on the order of 2500 words, and I made certain that this narrative was filed where I could find it should the need arise.

So, out of the blue, maybe 5 years later, I received a phone call from the Prosecutor’s Office for Rural County. I was asked if I remembered Mr. Naked Guy. I replied that I did, indeed, remember Mr. Naked Guy. I was asked if I could recall the events that I just finished recounting, in slightly altered fashion, above. Why, yes, I replied, I certainly could.

She continued. It seemed that Mr. Naked Guy was now out of jail, and was alleging that the responding officers had employed excessive force in subduing him. Did I recall anything that might relate to Mr. Naked Guy’s allegations?

I asked her if she had read my nursing notes? She had not.

“Ma’am, why don’t you read my nurse’s notes, and, if you have any more questions after that, call me back.”

She told me that she would do so.

I never heard another word.

Teamwork!

This one time, after departing Da City’s employ, I worked for a hospital in Da City. After several adventures as a staff nurse, I was promoted to supervisor.

The way things worked, was the staff nurses attempted to untangle the problems that developed,and then punted the resistant ones to me. So, one evening I received a phone call from one of the floor nurses, relating that Mr. Man was due some coumadin (a blood thinner, used post blood clot, among other indications), and she had none in her medication drawer to administer to him.

Thinking, “This is why I get the big buck!”, I asked her, “Have you looked on the counter, and checked the medication record?”

Yes to both, no accounting for the coumadin either place.

“Did you call pharmacy, and request that they run some up to you?”

Again, yes, she had. Her explanation of why Our Friends In Pharmacy had not delivered the medication, was intriguing. “They said that it had been in the drawer when they swapped them out this morning, and they were not going to send any more up, until tomorrow.”

Puzzled, I asked, “Did they explain how your patient was going to get his medication in that circumstance?”

“Nope, simply said that they would not deliver any more.”

“Let me look around. I’ll be right up!”

I arrived on the floor, and, sure enough, no lonely coumadin on the counter in the med room, nor on the counter in the nursing station.

I called Our Friends in Pharmacy, and asked the pharmacist about the missing coumadin.

“It was there this morning, I’m not gonna send any more. Everybody knows that the nurses take meds from the drawer, I’m tired of it!”

It had been a kind of grueling night for me, and I was not in the mood. “So, let me see if I’m hearing you correctly: you are telling me that you have personal knowledge of nurses diverting medication from patients for personal use, did I hear that right?”

His reply? “Yeah, everybody knows it. It goes on all the time!”

I set my trap. “So, what have you done about this information?”

“Nothing. Everybody knows about it, nobody’s gonna do anything!”

“So, you are telling me that you have personal knowledge of medication diversions, and you have done nothing about this knowledge, did I get that right?”

“Yeah, nobody’s gonna do anything about it, so, yeah, right.”

“What do you suppose the Board of Pharmacy would think of this revelation? Tell you what, why don’t I write them a letter, documenting this conversation, and you can find out, in person, what they think of a pharmacist who has personal knowledge of medication diversion, and takes no action to end it. That ought to be very educational, don’t you think? In fact, if you are here, with the needed coumadin, before I finish that letter, perhaps I will not have to send it at all! Maybe, I could write a letter telling the hospital administrator how wonderful it is to work with pharmacists who are so very, very collegial. Bye-bye, now!”

I asked the nurse, standing next to me, if I could borrow her pen and have a sheet of paper. “What for?”

“Got a letter to write!”

“What sort of letter?”

I told her, “That depends on whether or not we see your favorite pharmacist up here with your coumadin in the next few minutes, or not!”

I heard the pounding of footsteps on the stairs, and heard his wheezing before he even reached the stairway door.

I love it when we all work together to help our patients!

I Hate Late Night Phone Calls

Many years ago, I was working midnights in a small ER in northern Michigan. One night, around 0300, the phone rang. I answered it to find my wife on the other end. Her opening conversational gambit certainly caught my attention.

“Honey, it’s me. Don’t panic.”

Sounded like good advice to me. “OK, I’m not panicking. What might make me consider panicking?”

“Well, when you hear on the scanner that the sheriff is sending a car out here, I thought you’d get worried.”

Hmmm, the hospital still has coffee. Why would the sheriff send a car out to my home, populated by my wife and (presumably) sleeping children? I asked, “Why is the sheriff on the way out there?”

She responded, as if telling me about the dog getting into the trash, “There is a guy on the porch.”

Remember the guy-on-the-porch story I told y’all recently? Yeah, I certainly did. I was beginning to very much NOT like the direction this conversation was taking, so I asked her, “What gun do you have?”

“I don’t.”

This required remedy. “I’ll wait while you fix that.”

My normally clear thinking bride seemed somewhat slow this morning. “Huh?”

“Go get a gun, right now. I’ll wait.”

“What? Why would I get a gun?”

“Because I think it would be a good thing if you had something more compelling than your girlish good looks and winning personality should Mr. Porch decide that now was the time to enter, and lay hands on you and the children. Go. Now.”

Evidently Mr. Porch had decided that he did not, really, need to enter THIS house on THIS night, because this porch guy had elected to wander off before the sheriff’s deputy arrived, and before The Darling Wife felt the need for a little show-and-tell. No loud noises, nobody got hurt, Score! Score, and SCORE!

My Youngest Son Gets Dunked (or) Why I Will Never Be Constipated

We were living in An Un-Named Bedroom Suburb of Cohoville, and discovered Road End Parks. This capitalizes upon the fact that the county/township right of way extends into the lake bed, and therefore, an area roughly 25-50 feet wide continued along the roadway into the lake, and belonged to the township/county. When you have some property that wide, you can park a couple of vehicles at “the curb”, and fence off maybe 50-75 feet of the easement, and you have a nice little parklet, which the fudgies are unlikely to know about. If your idea of summer fun does not run to drunken aquatic revelry, well, you are all set.

I was working nights at Erewhon Community Hospital (“Both Nowhere, AND Backwards!”), years and years ago. The Plaintiff, in her pre-Plaintiff days, worked days. Therefore, summer days provided an opportunity for me to Be The Dad, and bundle our brood off to the lake for fun and sun.

If you have read my tales of rollicking good times, you know that I have plenty of experience with The Prophet Murphy, and his laws. Having worked the street,  I  feel well prepared for minor childhood misfortunes. Before setting out on our beach trip, I had carefully checked the contents of my personal medic bag, placed a lifeguard style whistle on a lanyard around my neck, set my truck’s amateur radio to readily access the local 911 center (this was in pre-cell-phone days), and waited the usual complete hour after lunch.

Arriving at the beach, we reviewed the McFee Family Immediate Action Drills, carried picnic gear and loads of whatnot to the beach, and so began our casual, layback day of fun and sun in beautiful Northern Michigan. The big kids played in the water, keeping well within earshot, and the little boys had big fun scooping sand and splashing away.

This worked out alright, at first, as the older kids waded some distance out into the lake, and the little boys stayed within ten feet of the beach. I settled there, toes in the sand, camouflaged with a book that I really had no intention of even looking at. I even began to relax. BIG mistake.

The local lake, in Michigan’s Northern Lower Peninsula, is not really deep in any meaningful sense of the word for quite some distance out from the shore. I had assumed that, keeping eagle eyed watch from the beach, nothing could develop that I couldn’t handle. Two year old David, Number Three Son, was having Big Fun with his brothers and sister, navigating just fine in the knee deep (to him) water. Next thing I knew, a wavelet from a distant boat lapped at his knees, and he fell, face first, into the water.

He immediately came back up, only to go back, face first, into the lake.

Police officers who have been in exchanges of gunfire report that time slows way down in life or death situations. Boy, have they got that business right! One second, I’m fat, dumb, and happy, soaking up sun at the beach, the next second my two-year-old son is floating inert, face down in the lake. The second immediately following found me with my feet wet, almost before I became aware of Number One Son, 11 year old Adam, at arms length from David, calling “Dave? Dave? Dave?!?”

Adam knew this was not right, but had not yet sufficiently organized himself to act upon this insight. I directed him to “PICK DAVE UP!” all the while reviewing these sort of videotapes running in my head. First Edition, I would pick David from Adam’s hands, race to my truck, call the Paramedics (“Paramedics? I want a Freaking Helicopter!”) on my Ham radio, while beginning resuscitation of my youngest son there on my truck’s front seat. Second Edition, I would snatch David from Adam’s hands, begin resuscitation right there on the beach, call EMS from my handheld radio (“Where are the goddam first responders?”), while directing Adam to collect the other children, and send eight year old Beverly to retrieve my medic bag from my truck LIKE RIGHT FREAKING NOW!

That day, Adam excelled in Listening To and Following Directions (Thank you, Adam!). The “light bulb” went on over his head: he picked his little brother out of the water, and handed him to me after a few steps. The “videos” went on playing in my head, as I weighed the efficiency of each action alternative, and quickly evaluated improvements to each generation of The Plan. I sat Dave down next to me, back on the beach, and began to ask him “Dave, are you alright? Dave? Dave?…”

Once Adam had picked him up, Dave began to look around with this sort of “Whoa! Way Cool!” look on his face. After I had asked him if he was alright for the hundredth (well, okay: maybe only the seventh) time, he looked at me as if I had lost my mind, and said those magic words: “Yeah, Dad. I okay.”

Tapes stop. Breathe again. Tremble. Call in other children. Closer look at Dave. Realize that I will, never in life, require therapy for constipation. Acknowledge the Attentions of a Merciful God. Request no lapses, again, in His attention like unto that just completed.

The Disturbed and Unruly Pedestrian

Nearly fifteen years ago, we lived four miles outside of a small town in the northern reaches of Michigan’s Lower Peninsula. It got really dark at night, and there were only 3 or 4 neighbors in the mile on either side of us along our curving country road. It is there one night that my family and I met a strange soul.

It was middling late at night, after the children had gone to bed, and my wife and I were watching television and talking quietly. The home we had at that time was a raised ranch, with the living room approximately 6 feet higher than the entry hallway. We heard a knocking at our door, and, being the reasonable and prudent ex Da City street medic that I am (read: untrusting), I dressed appropriately prior to answering the middle-of-the-night knock. I placed my Browning High Power into my belt holster on my strong side, and secured a .357 revolver in a crossdraw holster on my weak side. Both were hidden beneath the sweater I was wearing that chilly autumn evening. I placed a 12 ga pump shotgun at the top of the stairs, and handed my wife the AR 15, and my second revolver, with the direction to wait by the telephone, also at the top of the stairs. Then, I went to greet our guest.

Through the closed (and still locked) door, I asked what I could do to help him.  In the course of my greeting, it struck me as peculiar that, chilly as it was outside, he was barefooted and shirtless.  He asked to come in to use my telephone, which I was not about to allow him to do.  I offered to call somebody for him. That was not, it seemed, satisfactory. He repeated his (now) demand that I let him inside, and I again declined. He began to catalog my character flaws and personality shortcomings, and at about that point my wife determined that the time had come for a Law Enforcement Consult. She called 911, and began to explain to the nice dispatcher how much we would enjoy the presence of a deputy.

Our visitor was escalating, and growing more creative with his appraisal of my social skills deficits, and at last announced that he would simply kick in my door, lay hands on me, and then use my phone. I noted that that was a strategy not calculated to enhance his long term, high level wellness (that’s just the nurse in me, coming out…). He looked at me, surprised, for a moment, and repeated his threat to violently enter and assault me. Changing tack, I told him that I would kill him, if he should act on this plan.

Perhaps I ought to note that I am not any sort of physically imposing specimen of burly manhood. In fact, I’m more of the Walter Mitty with bad eyesight type. Ok, heavily armed Walter Mitty with bad eyesight. Our guest seemed to doubt that I could indeed stop him, and asked me how, possibly, I thought I could do so.

Sensing a Teaching Moment, I told him “I kind of think that this Browning here on my belt will stop you”, to which he replied, “You don’t think a puny 9 mm will hurt me, do you?”

Reasonable thought. I responded reasonably: “I don’t know about that, but I’m pretty sure that it will distract you, while my wife empties the 30 round magazine from that AR into your soon to be dead ass. It seems to me that if you play your cards wrong, the nice deputy will never hear your side of things. You probably ought to simply wait on the porch, and tell him all about what an asshole I am, once he arrives”.

It seems that our new friend not only knew my mother, but the deputy’s mother as well. (at least to hear him talk, he seemed to think so). Fortunately, he seemed so focused upon reviewing my mother’s poor life choices, that he failed to implement one of his own, remaining on my porch for this little lecture series. After several chapters of this analysis, he finally felt the time had come to move along, and so he wandered off into the night.

Maintaining a vigilant posture, we waited for the officer to arrive. Mr Congeniality did not make another appearance, and, as I saw the patrol car enter our driveway, we secured the firearms, and greeted the officer. The officer asked, reasonably enough, where we thought our guest had gone. I pointed out the edge of the pool of illumination our yard light provided, and stated “Right about there”. The officer said he’d look around the area for our late, unlamented guest, and see if anything was up. We never heard anything more, but I was glad I had something more compelling than my boyish good looks and sunny personality to greet Mr. Happy when he demanded to be let in our door.