Uncategorized

“These are a few of my favorite things!”

Exhibit 1: Cleti seeking work noted excusing them for their call off yesterday. When I did NOT see them, And there is no record of any visit anywhere. And, of course, no symptoms today. (Hangover, anybody?)

Exhibit 2: Jane Doe arrives, reports (complaint). My MA elicits a chief complaint, obtains vital signs, verifies medications, allergies, medical history. Generally, as the MAs with whom I work are smart and on the game, they try to identify what, if anything, Jane Doe has attempted to manage her symptoms with, as well as how long this has afflicted Jane.

Since not uncommonly the interrogatory the MA initiates will get those ol’ neurons a’firing, and other, potentially relevant, information will bubble to the forefront of Jane’s consciousness, I will myself reiterate the allergy-medication-history-symptoms-duration-efforts to remedy these symptoms line of inquiry.

So, when you have twice assured health care professionals that you have NOT employed anything to address your sniffles, for the love of Crom, do NOT interject into my instructions, right after I instruct you to employ any of a dozen over-the-counter nasal steroid sprays, that “I have already tried Flonase!” (or whatever).

It wastes my (indeed, as well as your) time, provides you with the appearance of stupidity, and raises my blood pressure.

Item 3: (Heads Up! This is NOT a ‘sick person’ story!) If any of you have shopped for a vehicle recently, you may have noticed that nearly every vehicle in America that has four wheels and an engine, has a back up camera. My new truck, indeed, does have one.

So, TINS©, there I was at the gas station, looking for a vacant pump. This one fellow pulled away, and I noticed, as I approached the spot that he had vacated, that the woman parked at the next pump behind him had, well, let us say that she had decided to determine how far she could stretch the dispensing hose forward, and still reach her gas inlet.

I pulled in, and backed my full sized truck up, attempting to avoid replicating her hose stretching experiment. Of course, that required that I approach her front bumper closely, a fact that I observed in my (Surprise!) back up camera display. I halted, something like 6-12 inches from her bumper. I exited, and approached the pump to begin my transaction, and she looked me over, and observed, “You got kind of close to my bumper, ya know!”

I smiled, indeed, with a smile that likely even reached my eyes. “Yep. That’s why I have a back up camera, to make sure that I did not get too, too close!”

She looked surprised at that. “You have a back up camera?”

Again, as I started to pump my own gas, “Yep, sure do!”

Uneventfully, she drove away.

(TDW-Mark II observed two things: First, “When she spoke up, I pulled down my visor mirror, so I could keep an armed eye on things”. Secondly, as she and I discussed it later, she observed, “You were nicer than I would have been. I might have observed, ‘Ya know, sweetie, it’s kind of sad that the Rover brought you back here!'”)

Item 4: I have whimsical voices in my head. In this, The Age Of Da Rona, folks seeking entry to our clinic are interviewed. Those who answer affirmatively to any of several inquiries get “drive through” health care. The registrar noted the vehicle, as well as the complaint.

That leads to several whimsical moments. For instance, there is the “GMC sinus” entry. That would be an altogether new variety of sinus affliction.

Then there is the notation of the “Tan Dodge Congestion”. (Hmm. THAT’S a new model name for me!)

Or the “Silver Ram”, leading to the chorus in my head serenading me with

“City sidewalks,

Busy sidewalks,

Dressed in Holiday style,

In the air there’s a feeling of Christmas.

Children laughing, people passing
Meeting smile after smile
And on every street corner you’ll hear
Silver RAM
Silver RAM, It’s Christmas time in the city….”

Finally, Item 5: a comment in response to post at Gun Free Zone blog (https://gunfreezone.net/journalists-are-dumbasses-who-think-that-tv-shows-are-reality/)

Christopher Schwehr

APRIL 23, 2021 AT 2:04 PM

It’s known as FOCUS: Fuck Off ‘Cuz U Stupid.

Fun And Games Off Duty · Gratitude

Dad’s Blood Infusion

So, TINS©, TIWFDASL©…well, while This Is (indeed) No Shit, I was NOT, in this tale, Fighting Disease And Saving Lives. Rather, years ago, I was in The Un-Named Eastern State, visiting the Momette and my father. Dad had had a cardiac arrest something on the order of a year and a half prior, and had, miraculously, recovered entirely intact. Subsequent to that, he was found to have cancer, and THAT had NOT had a miraculous outcome. He had undergone several surgeries, and finally had been referred to hospice.

Let me say this about hospice. These folks, in this corner of that state, were a Gift From Heaven. No shit, honest-to-God, straight up. If I were to be found to have a heart, they certainly warmed it.

Today’s lesson concerns one of Dad’s surgeries. I had taken some time off, and was in The Un-Named Eastern State. Dad had come out of surgery, and we were there to visit him: Mom, My Brother The Accountant, and myself, who, at this point (yeah, my stories sort of jump from one point in time to another, don’t they?) was an actively licensed paramedic, as well as an RN, and nursing supervisor. I had been an ED RN for something on the order of 5 years at the time of this story. In anticipation of there developing a need for me to make a longer term presence in my parents’ home, I had obtained a Nursing license in the Un-Named Eastern State.

So, we were standing at Dad’s bedside, and I noted that he had blood running. As a nurse, we all learn, early on, that from the time that the blood departs the blood bank, until the last drop of hemoglobin rich goodness leaves the bag for your patient’s veins, no more than four hours must elapse. Anything not infused at the four hour mark, will still be in the bag as it is returned to the blood bank.

Idly, I observed that the bag appeared to be half full, and dropping sluggishly. I looked at the blood bank tag, which documented, among other things, the time the infusion had started: approaching three hours previous to my inspection thereof. I inspected the tubing, looking for closed clamps, kinked tubing, or other impediment to flow. On Dad’s hand, just upstream from the IV catheter, I observed a tight bend, something resembling a slight kink in the tubing.

I released the tape, opened the loop a bit, and re taped it, and gave things another looking over.

My mother reproached me. “Reltney, I don’t think you should mess with that. You should call the nurse.”

I was surprised. “Mom, I *AM* a nurse! In fact, I’m even a nurse, in *THIS* state!”

She replied, “Oh, you know what I mean!”

Uncategorized

Memorial Day

May you all have a contemplative Memorial Day, full of gratitude for those who gave their last breath, to protect, preserve, and defend this experiment in self government.

Please consider this, a story of one such sacrifice.

https://www.google.com/url?sa=t&source=web&rct=j&url=https://tulsaworld.com/archive/mission-saving-mariam/article_caeece59-65cc-56a2-8558-867ee99161ce.amp.html&ved=2ahUKEwiVwujTz-3wAhVAKVkFHReVDngQFjAFegQICBAC&usg=AOvVaw1wJBISE5G8uolzvme0pfGP&ampcf=1&cshid=1622247821492

“Saving Miriam”, regarding Corpsman Chris Walsh.

I read it, and my damned allergies overcame me.

Duty · Sometimes You Get to Think That You Have Accomplished Something!

Parenting Win

This gentleman gets it, and kudos to him for Being The Dad.

https://ogdaa.blogspot.com/2021/04/sunday-video-2_01180543565.html#comment-form

As may prove to be no surprise, it reminds me of one parenting encounter of my own, years and years ago. One day, TDW-Mark I, our children and I were out someplace having dinner. It had occurred to me that TDW-Mark I might enjoy an evening NOT in the kitchen, and so we bundled up our brood, and went out to dinner. So, there we were, conversating and dining and generally having a nice time, when Number Two Son, whom we will call Charlie, apparently decided that he was not receiving enough attention. Now, Charlie was, at this point, something like 3 years old. I expected that he would know better, but, well, I was mistaken.

So, he was yelling, and standing up in his chair, and generally making a scene. I attempted to verbally redirect him, but, no-go.

My wife was not enjoying the shenanigans, and therefore I decided to remedy her dilemma. I stood, scooped Charlie up, placed him over my shoulder, “fireman’s carry” style, and walked out of the restaurant.

I could feel the eyes on me, as we departed, with a Bill Engvall-esque vibe of “somebody’s gonna get a whooping!” But, I had a slightly different plan. (don’t imagine that I was not tempted…)

Outside of the restaurant was a low stone wall. I sat Charlie thereon, and assumed my R. Lee Ermy persona. I placed myself nearly nose-to-nose with my son, and barked, “You are not a baby! You know how you are supposed to act! This acting up is NOT acceptable! You will sit there, quietly, until you are able to behave correctly! Do you understand me?”

His eyes teared up, and he replied, a quaver in his voice, “Yes, daddy.”

I snarled, “Very good! Now, you tell me when you are able to behave like you know you are supposed to!”

I stood, wrapped one hand in the other, behind my back, and paced back and forth before him, a scowl written large across my face.

After several minutes of this pacing, I turned to my son, and addressed him. “Have you had enough? Are you ready to act right?”

He sniveled, “No, daddy. Not yet.”

I had to abruptly turn, to hide the smile that burst across my face, and to hide my struggle to not laugh out loud.

Another couple of minutes later, he volunteered, “Daddy? I’m ready to behave, now!”

We re entered the restaurant and Charlie was subsequently the very model of proper toddler behavior.

Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

The Apple Does Not Fall Far From The Tree

Long ago and far away, I married The Woman Who Would Become The Plaintiff. She brought two children with her, a son, hereinafter referred to as Adam, and a daughter, who we will refer to as Brenda. These children had two different fathers, Brenda’s being Of The African Persuasion, as an old medic partner of mine had termed it. TWWWBTP (“the plaintiff”) was, herself (as am I) of the white-bread heritage group.

This led, of course, to her mother referring to her brood as “My own little league of nations”.

Well, time passed, love bloomed (and, subsequently, withered), and my children (all four of them, notwithstanding that fact that two of them had my chromosomes, and two did not) all grew up, became adults, and set off to establish their own families.

Brenda had her own adventures, eventually settling down with a good man, who accepted her oldest daughter, treating her as his own. Brenda wound up having four children in total, ranging from melanin enhanced, to melanin deprived. (genetics can work out in surprising ways).

So, Brenda tells the story of having photographs of her mother (anglo), dad (anglo), oldest child (genes from 1/4 Africa, 1/2 Central America, and 1/4 Europe), and three youngest children (all of whom were paler, having no Central American genetics). You might imagine a picture gallery of “shades of gray”, if you wished.

Co-workers would wander past, and notice the chromatic array featured in her pictures, prominently displayed on my daughter’s (biracial her own self) desk.

“Who’s that?”, they would ask, gesturing at the children’s photos.

“My kids.”

“Who’s that?” they would ask, pointing at my photo.

“My dad.”

Who’s that?”, pointing at The Plaintiff’s photo.

“My mom.”

In Brenda’s telling, there would follow a metaphorical “tennis match”, and her interlocutor’s eyes would go from photo “A”, to her own visage, to photo “B”, and back to her face, and back and forth, for a couple of iterations.

“Were you adopted?”

“Nope.” (I never started adoption proceedings for my two oldest children, a failure on my part.)

More gaze-tennis, as they attempted to process this. And failed.

Brenda finished her tale, grinning. “I really enjoy spinning up folks’ minds! Most never seem to make sense of it!”

Which tale reminds me of another yarn, circling around my story of Carmen’s (the oldest child) surgery. I accompanied my daughter to Carmen’s pre op visits, both because she (Brenda) kind of wanted to focus on her child (imagine that!), as well as, I surmise, Brenda thought that having nurse-and-midlevel-Dad at hand, might be comforting.

So, TINS©, There I Was, sitting in the interview room as the intake nurse was interviewing Brenda, regarding Carmen’s medical history. The nurse asked Brenda, “Is there any diabetes, heart disease, lung disease in your family?”

Brenda responded, “Uh, no, no there isn’t”.

I chimed in (pay attention to this: Brenda is my STEP-DAUGHTER, recall!), “Honey, don’t you want to mention my cardiac stents?”

So, my daughter turned her gaze my way, and, gently, admonished me. “Uh, Dad? I really do not think that *your* genetics are going to affect Carmen. Do you?”

Brenda then turned to the nurse, and clarified. “He’s my step dad, you know.”

Fun And Games Off Duty

Mocking Spammers

Now, I am by no means any sort of authority in such matters, but, I cannot help wondering if, oh, I dunno, READING ONE ENTRY OF THE FREAKING BLOG might help you avoid appearing to be a (poorly programmed) machine?

Because, those of you who have read a single one of my posts likely know that they do not have word one (at least, not salutary word one) about “computer systems”.

Following is a “comment”:


Freebies
7 hours ago·www.cravefreebies.com/freebiesUser InfoSpamTai Chi: You’re Doing It Wrong!

I have seen loads of useful things on your site about computer systems. However, I’ve the judgment that notebooks are still not quite powerful enough to be a wise decision if you often do projects that require a great deal of power, including video enhancing. But for net surfing, statement processing, and the majority of other prevalent computer functions they are just fine, provided you may not mind the small screen size. Many thanks for sharing your opinions.

Reading and comprehending. It is A Thing!

Duty · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

You Call Me “Packrat”, I Call Me “Well Prepared”

So, TINS©, TIWFDASL© in the little, rural ER at Erewhon Memorial Hospital (slogan: “Both Nowhere, and Backwards!”). Remember (because, after all, y’all have read, studied, and committed to memory Every Single One of my blog posts, of course!) that long ago, and far away, I had been an orderly on the gen med floor of TBTCIDC. In that capacity, I had been presented with two keys, one of which would unlock a Posey brand locking vest restraint, the other of which would unlock a Posey brand limb restraint. The key to this latter resembled a handcuff key, only on a considerably larger scale.

One evening, in Erewhon’s ER, a local State Police trooper entered, seeking some assistance. It seemed that out towards the periphery of our county, some child had found Grandpa’s antique handcuffs, and has secured himself to a radiator or some such immovable object. This child had done so, PRIOR to identifying the key required to unlock the handcuffs, and, of course, said key was nowhere to be found. The officer was on the verge of inviting the local fire department to demonstrate their extrication skills, featuring property damage, destruction, and loud noises, but wondered if we might have something less dramatic, to release the child. The officer noted that the key required resembled a handcuff key such as the key he, himself had, only considerably larger in size.

Fancy that.

I observed that I was in possession of something resembling that which he sought, and he could give it a try. I rummaged around in my Bag Of Tricks, retrieved my Posey key, and presented it to the officer. His eyes lit up, as he noted that this appeared to be just what he was looking for.

He returned, a couple of hours later, reporting that indeed, my key had unlocked the offending handcuffs, the child had been released, no property damage had occurred, and everything ended happily.

Contributing to my legend, of “If McFee doesn’t have it, You do not need it!”

Pains in my Fifth Point of Contact

Cletus and the sick note

Perhaps you have heard of The Cornosvirus, aka The Wuhan novel Coronavirus, aka the WuFlu, aka The CCP Pox, aka The Shanghai Sniffles. Now known, PC-ly, as C.O.V.I.D. (sounds like a Bond villain, don’t it?). So, TINS©, TIWFDASL©, and Cletus, trivially ill, wandered in, requesting a test for the Coronavirus as well as a return to work note (he related that he had called off sick for a couple of days, and, and needed a doctor note in order to return to work). He related that he had run out of paid time off, and needed to return to work.

The next day, my registrar hunted me down, and presented me with the dilemma: his employer had called, asking what to do about Cletus. Cletus had evidently informed his employer that he, Cletus, had been tested for the WuFlu, and they (the employer) were asking what to do about Cletus returning to work?

“My note stated that he was medically released to return to work, once he had a negative coronavirus test result in hand.”

My registrar returned, “But his result won’t be reported for another 4-5 days.”

“Yep. And, once he has that negative result in hand, he can return to work.”

“I told them that. They are on hold, still asking me what to do about Cletus.”

“Lemme talk to them!”

I picked up, announced myself, and asked what I could do for them?

“We don’t know what to do about Cletus, since he does not have his test result, but your note says that he can return to work.”

“Ma’am, my recommendation is that you follow your organization policy regarding employees who have been tested for coronavirus, and pending results.”

“But, he doesn’t look sick, and we don’t know of any exposure to C.O.V.I.D.!”

“Uh-huh. So, what do you folks do about any other employee who has been tested for coronavirus, and does not have results yet?”

“They have to quarantine at home, until ten days or a negative test report.”

“Perhaps it would be a good idea to follow your organization’s policy in this regard.”

Fun And Games · Gratitude · Life in Da City! · Pains in my Fifth Point of Contact

Random Thoughts Part VI

Assessment of the elderly, sounding confused.

When I am assessing a patient, and ask, in my interview, ref location/day of month/day of week/name/etcetera, when you are not the patient, and YOU answer, talking over the patient, please realize that IDGAF about YOUR mentation, and when you coach the patient, it really, really interferes with my assessment. Plus, it is entirely likely that I myself KNOW the place/day/date/season/etcetera, because, you can bet your ass that if it were NOT Tuesday March the 41st, I would certainly be somewhere else, doing something else, other than attempting to struggle my way through your interruptions of my evaluation of your parent.

In a similar vein, when I ask Jim-Bob where he hurts, probably, when you coach Jim-Bob, admonishing him to “Tell the doctor where you hurt”, you are not really contributing any value whatsoever to the interview. If Jim-Bob indeed comprehends my question, you are only adding noise and distraction and likely, that is NOT helpful. If, on the other hand, Jim-Bob does not understand my query, your repeating it IN THE VERY SAME FREAKING WORDS, neither adds to the information that I require, so that I may care for Jim-Bob properly, nor facilitates timely implementation of that care. So, unless Jim-Bob does NOT speak Engrish, himself, please STFU, and allow me to interview the patient. Or, perhaps, go boil some water, gather a fresh newspaper and some clean shoelaces, right now, please.

Which will, of course, require you depart the exam room and allow me to complete my interview and examination.

Thank you.

Thoughts about Cost vs Price:

Lowe’s “bargain bin” AA battery powered cell phone charger: $10

Having several in your Bag-O’-Tricks at work, so you can hand one to a patient you’re sending to ED via ambulance, whose phone is dead: Kharma.

Having that guy get my cheap-o, bought-on-a-whim charger back to me, with a thank you: PRICELESS!

EMS LAW OF ALTITUDE: Patient’s weight divided by number of floors above street level equals a constant, “K”. Therefore, a 300 pound inert patient on the first floor is roughly equivalent to a 1200 pound patient on the 4th floor. With no functional elevator. And the first due engine company out on a working fire.

(redacted)’s Law: (I don’t have permission to use his name, but it’s not *MY* formulation) When responding to an EMS call, and you are pretty sure that you are on the correct block, but, for some reason, folks in this neighborhood do NOT have any house numbers, seek out the most tumbledown anonymous house on that block, and knock, Your patient awaits inside.

(redacted’s partner)’s Corollary Number One: The one house on the block with ghetto gates (bars on the doors and windows), is your call.

Corollary Number Two: Occupants of the house with the gates KNOW who is performing all the neighborhood B & Es.

Corollary Number Three: There is nothing inside the grilled house worth stealing. The decor is milk crates, cast offs, soiled mattresses on the floor. Even odds that the smell makes the place a haz mat scene.

Final Thought”

Please, please, please! If your physician has ALREADY prescribed a medication for your affliction, take the freaking med, BEFORE your come to my clinic stating that you require treatment for that selfsame affliction! Because, it could happen that my self control may lapse, and I may, indeed, ask you just how exactly I may help you, when you not only were prescribed, but physically picked up, the very medication that I would have prescribed (and, indeed, wound up prescribing) for your problem.

But, OF COURSE, you weren’t here to get a work note! Totally!