Tai Chi: You’re Doing It Wrong!

I recently purchased a new pickup truck. I had been pining for this truck for several years. It took me several years to drop the hammer, because I wanted to thin the herd of my indebtedness, as well as build up my “rainy day” fund again.

Having finally made my purchase, I had several accessories that I desired, and was not about to finance over 6 years. I wanted a “headache rack”, planning to mount antennae for my amateur radio (“HAM radio”), a CB, and other radios that TDW-Mark II and I employ when traveling, or weather spotting, and thereby avoid drilling holes in my shiny, new, truck. (I DID mention, I have a new truck, right?)

So, TINS, there we were, turning off Main Drag in Nearby Bigger City, preparatory to pulling into the lot of The Truck Accessory Place, when we (TDW and I) noticed a disheveled looking adult male approx age of mid twenties, standing in the second driveway of The Truck Accessory Place (hereinafter referred to as TTAP), swinging his arms, and having an animated conversation with person or persons unseen by us.

Nice.

We pulled up to TTAP, entered same (locking my truck in the process), and hailed the counterman. “So, has homeboy here been boxing with dragons very long?”

I received a puzzled look in response. “Huh?”

“See the guy out there, boxing with person or persons unseen by you and me? How long have the dragons in his mind been attacking him?”

He walked around the counter, gazed out of the window, and opined, “He doesn’t look like his mind is quite right.”

I concurred. TDW-Mark II stood nearby, hand concealed in her purse. Her purse wherein she had her sidearm. She stood so as to not obstruct my strong side draw, should that become A Thing.

Mr. Counter returned to his side of the counter, and dialed police dispatch. He described his observations, and asked for an officer to respond. I watched as the boxer bobbed, weaved, punched at unseen adversaries, moving himself toward the neighboring business.

Soon, he crossed the street (startling several drivers on that street, in the process!), and wandered off into the thicket there, not to be seen again.

It has been told that Colonel Jeff Cooper, of Gunsite and Modern Technique of The Pistol fame, was once asked, “Colonel Cooper, if you knew that you were going to a gunfight, what gun would you prefer?”

He is quoted as saying, “If I knew that I was going to a gunfight, I’d stay home!”

I like avoidance. I’m tickled that Mr Dragon Boxing, did not present a lethal force threat.

Doctor Google.

Those of you who have read more than a couple of my musings, might not be surprised to hear that I genuinely attempt to do the best for my patients that I can. It seems to me that I ought to allow you, the patient, to benefit from my two years of ADN RN school (community college), another two years of RN-to-BSN school (Bachelor in Nursing), 30 + years of experience as an RN, layered upon 1 year of Basic EMT school, another year of Advanced EMT school (ie, “Paramedic” school). All this leavened by 3 years of Physician Assistant schooling, culminating in 15 + years of clinical experience since obtaining my PA license.

Not to mention something on the order of 2,000 hours of continuing medical education, over those 15 years of clinical midlevel practice.

So, therefore, please contemplate the possibility that, when I appear reluctant to prescribe The! Z! Pak! for your stuffy nose, postnasal drip, and cough, it may not be solely motivated by the fact that I am an asshole. Indeed, it just might be because, after all the aforementioned clinical experience and schooling, I might doubt that antibiotics will successfully address your discomfort, and the alternative, over the counter course of medications that I try to suggest (in between your interrupting me every several words) will, in my judgment, actually make you feel less ill.

Jess’ sayin.

Self Own (or) EMR follies

It occurred to me that I have been venting, recently, on a tear about my encounters with third parties that, well, are not dazzling me with their brilliance. Perhaps, in the spirit of full disclosure and honesty, I ought to own up to a couple of episodes that tell one and all why my pencils no longer have erasers. Here’s one recent experience.

When I first encountered electronic medical records (EMR), many, many years ago, one of my precepting physicians walked me through his office’s EMR. In the course of his narrative, he observed that, “One of the follies of the EMR is that it will allow you to thoughtlessly chart very stupid stuff, easily and repeatedly. You have to be careful of that, or you will look like an idiot.”

I was reminded of that physician’s wisdom the other day. I had a gentleman in my clinic, seeking care for a sexually transmitted disease (STD). He reported that he had been notified by his paramour that she, the paramour, had been diagnosed with some STD or another, and therefore he would require treatment before another round of Happy Fun Times could be arranged.

Cool. I performed my exam, obtained the specimens required to verify the particular sort of affliction that had been visited upon him, and ordered the appropriate medications. Then I sat down to chart.

In order to save charting time, I have a pre populated template, citing various common or normal findings. I reviewed my template, preparatory to signing off on this chart and moving along to the next patient, and noted my common finding of “post nasal drip”, “runny nose’, and “sore throat”.

I corrected these entries, thinking at the time, “If you have a runny nose, sore throat, and post nasal drip because of your venereal disease, you are likely way, way too sick to be seen by my midlevel self!”

SURPRISE!

One day, not so very long ago, I arrived at work, and went to log into the electronic medical record (EMR). Generally, there is no drama. I power up the computer, click through the labyrinth of password prompts, web pages, and suchlike preparatory to actually accessing the charts of the patients that I would see that day.

On this day, I could not access the EMR. Since I am somewhat geezerly, computers are NOT in my wheelhouse. I assumed that I had mis keyed my password, and checked it, and re entered it. No joy. I re checked it, and re-re entered it. Again no joy. The computer steadfastly ignored me.

I finally determined that I was not going to be able to cajole the computer into opening up and allowing me entry into the charts. Therefore, I called tech support. Of course, I was electronically placed into the queue, and serenaded by somebody’s version of soothing music.

Since I try to arrive early, so as to allow me to still be on time should traffic be screwed up in my commute, I placed my call around 10 minutes prior to my start time.

Something like 40 minutes later, I spoke to a human being, who took my information, placed me on hold (again!), and soon returned. She informed me, “Oh! You cannot log in, because we changed your login name!”

Now, let us consider this. If you or I were to, oh, let’s say, figure that for some reason we needed to change somebody’s log in name, you, or I, for that matter, might wonder if it would be a good idea to, oh, gosh, lemme see….. TELL A SUMBITCH WE HAD CHANGED HIS FREAKING LOG IN!

Maybe, even, before his next duty shift, perhaps?

I shared this with the young lady. “Wouldn’t that have been useful information to share with me?”

She had no reply.

I thanked her for her time. I turned to the floor staff, and announced that I was, at last, logged in. I observed to my colleagues, “If only, if only, I had provided my personal e-mail, so somebody could change my log in, and, gosh, let me know!”

Reading Recommendation

https://eatonrapidsjoe.blogspot.com/2020/10/home-field-advantage-egress.html?showComment=1602787988156#c8439774302017330220

I don’t think that this guy needs *my* paltry recommendation, but, he has successfully drawn me in, and engaged me. His series-s are very, very thought provoking, in a Aesop’s “Tomorrow” sort of way. Lots of food for thought both at a “micro-economics” as well as at a “macro-economics” level.

Is your larder prepared for the presentation of spice? Metaphorically speaking, of course.

Improvise, Adapt, and Overcome!

TINS, TIWFDASL at Medic 13, and we caught a run. Initial dispatch information suggested that this was a heart attack.

We arrived on the East Side of Da City, at the stated address, and discovered out patient was awaiting us, upstairs. The folks who were encouraging us to step right up and set to business, were pretty excited. As we arrived and entered the bedroom wherein our patient awaited us, well, we could see why.

Our initial patient survey was, to be charitable, not encouraging. The bedroom was nearly entirely filled by a double bed, and that bed was nearly entirely filled by an unbreathing human being. Unable to detect a carotid (big ass neck artery) pulse, we concluded that this soul was in cardiac arrest. Doug and I knew that there was NO WAY we were going to move this person, let alone move them down the stairs, into our ambulance, continue a resuscitation en route, and offload same at DBTCIDC.

While I started CPR, as best as I could on the bed, Doug called dispatch on the handi talkie, and brought them up to speed. “Dispatch, we need an engine company, or two, for manpower. We have a active cardiac arrest, on a patient estimated weight of 800-1000 pounds. That is a stat call.”

Dispatch acknowledged our call, and responded, “We will send you help”.

Doug and I both set to resuscitating this soul, until our help, a second MEDIC UNIT, arrived. This crew, Mariel and Don, while welcome, came nowhere near the lifting power we anticipated in ten firefighters. Doug relieved me, and I shared this insight with dispatch. “Dispatch, we need at least one full engine company, perhaps two, and we need them several minutes ago! This is a working cardiac arrest, and there is no way we can move, let alone lift, this 800-1000 pound patient!”

Dispatch informed us that that would be a chief level decision, and I was happy to buy into their decision making process. “Very good dispatch. We need our superintendent on this scene, stat. This is a patient safety issue, and our patient is in full cardiac arrest.”

The field supervisor, a captain in our division, jumped in. “Dispatch, this is shift captain (insert name here). I am on the way to Medic 13’s scene code one. They need an engine company. Please dispatch one immediately.”

Soon, a DCPD scout car arrived, disgorging two of the single tiniest female officers I had ever seen.

Right behind them came our captain. He (the captain) edged his way through the crowd of civilians (who were, helpfully enough, insisting that we simply “snatch him on up, and carry him on down to the hospital!” (while NOT climbing the stairs to lend a hand!)

Our captain surveyed the four rescuer CPR taking place, and retired to his vehicle to have a chat with dispatch.

Mariel had removed our cot from our ambulance, securing it in their rig, wisely determining that our patient, upon the floor, would fill the entire module. As she returned up the stairs, bringing every backboard strap that she could find, the first engine company arrived.

The officer of that company trotted up the stairs, took one look, and about-faced, running down the stairs. Shortly, he returned with 5 firefighters, and a salvage cover. Everybody heaved, and the cover was stuffed ½ way beneath our patient. Everybody “Ho!’-d, and it was pulled out from beneath him. Now we had a carrying apparatus, and the firefighters set themselves at each corner, Doug in one middle, me in another, Don at the head, and Mariel at the feet, and we slowly maneuvered our patient down the stairs, and into our ambulance. Mariel and I climbed in the back, Don took off to meet us at the ER, and Doug set out.

I had the walkie talkie in my pocket, and I could hear his conversation with dispatch while Mariel and I CPR’d our little hearts out. Doug suggested that another engine company ought to meet us there, and that the ER ought to be notified of our patient’s girth. Initially, they seemed unenthusiastic, until our captain suggested that either they dispatch an engine company to the ER, or the Chief of the Firefighting Division, since he, the fire chief, would be the one explaining everything to the news media.

Engine 5 met us at the ER. TBTCIDC had lashed two cots together outrigger style, and everybody moved our patient onto the cot. Once he was in the ER, our part of the show was over.

We effusively thanked our captain, as well as the fire crew.

Random Thoughts, Part IV.

Another day, fighting disease, and saving lives. Another opportunity to consider the fact that everybody brings sunshine into my life. Sometimes, that is when an individual enters my life…….

A long, long time ago, not so very far away, Doug and I had a run on a soul very much like our “O’BEAST!” friend. That reminded me that some folks have so much misery and unhappiness in their lives, that they have enough to share with everyone around them. Or, so they appear to think!

Regarding that: any particular miserable soul provides me the opportunity to be unhappy for a half hour, maybe an hour. On the other hand, they are wallowing in their sourness, unpleasantness, hour after hour, day and night, 24/7/365. Who is worse off?

Among THAT population, are folks who appear to lack an education in The Classics. This is manifested by their diction, their articulation, as well as their vocabulary. From time to time, “Back In The Day”, we in the ED would have one (or more) of these souls gracing us for an extended time, while their livers metabolized them towards freedom. (It takes a while to detox from a high level drunk!) Such a philosopher would feel compelled to share with us all his ruminations about Maternal-child relationships, and conjecture about our particular manifestation of those relationships. (generally running along Oedipal sorts of speculations) Along with thoughts about hygiene and the value to be found in regularity, and legitimacy of parentage (or something like that).

One physician characterized one individual’s declamations as reflecting a certain “Poverty of conversational themes”.

Maternal Update

Several folks commented, asking how my mother was doing, or wishing her, and my family, well.

Thank you, all. TDW-Mark II and I were both touched by your kindness.

Presently, she is chirpily ensconced in The Maternal State, with my brother, The Accountant. We have chatted, several times (Mom and I), and she is happier where she considers herself to be “home”, than back here in The Un-Named Fly-over State.

She has had her first radiation therapy treatment, and I await an update from my brother/mother.

And, once The Brother Who Is An Accountant has had His Way with several of God’s Children, who are NOT exemplars of “The Healing Arts”, well, THAT will be the topic of a blog post of it’s own.

A very DARK post.

In the meantime, I will attempt to figure out how to give major props to physicians, in the no shit highest traditions of Medicine, who have genuinely Taken Care of Business, to my mother’s benefit, and see if I can do so without blowing op sec.

I will simply say, they are cut from the same bolt of cloth, as the car service guy, who with no drama, no fanfare, simply do their christian best to do the right thing. (see my post of 6-28-19)

“Engendering Collectivity In Nursing”

So, TINS, TIWFDASL, and I had been admitted into the BHSU College of Nursing. I had moved on from Da City’s EMF (“The ‘Mergency Muthafuggers!”, as we had been so colorfully denominated on so many occasions), and was nursing in the ED of one of the nearly dozen small (at that time, around 300 beds) hospitals dotting Da City. I went from being chief steward of the union representing the medics, to a staff peon working nights.

Another of the nurses working with me was also pursuing her BSN, and so we study buddied up. We both had been old schooled in The Wisdom Of The Student, as so found ourselves in the rear 1/3 of this cavernous several hundred seat lecture hall, where the Blue Hive State University held it’s class on “Transitions in Nursing”. This was aimed at those of us entering the BSN program. The instructor of this particular class appeared enamored of Florence Nightingale, the Victorian English woman whose work caring for wounded and ill British soldiers in The Crimean War laid the foundation of contemporary Nursing.

This infatuation was reflected as this instructor read to us all from a book of Nightingale’s life. Amusingly, from time to time, she (the instructor) would hold the book above her head, turned towards us so that we could “see” some illustration or another, and detail the citation accompanying the illustration. (“Did you bring your binoculars?”)

From our seats, some 50 or more meters away, this was not as informative as our instructor appeared to consider it.

Once she had exhausted her store of Florence Nightingale trivia, she (the instructor, not Ms. Nightingale) moved on to instruct us in the advantages to be found in group efforts to improve the workplace. She described these efforts as “engendering collectivity” (and, do we not all wonder if, forty years later, in The Enlightened Twenty First Century, if the Thought Police would allow any of us to speak in those terms?), and appeared to believe that this was an unmitigated Good! Thing!.

Let me follow a tangent, if you please, for a brief intermission. I had mentioned that I had been a steward for the union representing Da City’s EMS. Interestingly, my father in his own youthful years, had had a hand in the formation of the American Newspaper Guild, which was a union for (surprisingly) newspaper folks.

So, I kinda grew up steeped in old school, Democrat political world view (think Scoop Jackson and Jack Kennedy, Not Occasio Cortez or Gavin Newsome), including the value to be found in an organized workplace. In that world view was the “real politik” perspective of the cost paid by the organizers initially struggling to create that organization. Examples such as The Fight Of The Overpass as the UAW attempted to unionize the Ford Motor Rouge Plant, or the Homestead Steel Strike, and other struggles as folks attempted to start, and foster, unions, including organizers being blackballed, being intimidated or outright assaulted.

So, as the instructor droned about “engendering collectivity in the workplace”, I eventually let my boyish enthusiasm overcome my naturally shy nature.

I raised my hand, was called upon, and stood. “Ma’am, I was a steward for the union representing EMS in Da City. My father helped organize the American Newspaper Guild. In the professional labor circles with which I am acquainted, we have a technical term for those who seek to engender collectivity in a previously unorganized workplace. That term, is ‘unemployed’.”

I sat down. Oddly enough, I was never again called upon, for the balance of that semester!

O’BEAST

A long, long time ago, in a galaxy not so very far away…Ok, it was something like 40 years ago, and Doug and I were working Medic 19 on nights. We caught a run on a sick person of some sort, and arrived to find a not-so-very-sick person, in an ill humor.

For some reason, this soul appeared to believe that employing us as a lightning rod of sorts for every missed opportunity, failed hope, crushed dream, and malign bit of luck that had befallen them, would in some manner alleviate their misery. I was not seeing it, but, whatever.

Since Doug was of The African Persuasion, whereas I, myself, was very much of the White Bread Persuasion, well, Ms. Misery, herself melanin enhanced, took him under her metaphorical wing, and expected him to commiserate with her in her plight.

Horrible fail.

I was driving, and so stood off to the side whilst Doug negotiated with Ms. Misery. He had worked pretty damned hard to get to where he stood, and was, let us say, unsympathetic to those who did not appear to exert themselves even minimally to better their lot. While he attempted to conceal his views from the folks on the street, we had detailed conversations in the firehouse on this, and other, topics.

Eventually, Ms. Misery concluded that the only succor we were about to offer her involved a trip to the ER, where she anticipated spending her evening, with no benefit to her pity party prospects. Therefore she directed us to depart, bidding us (and our mothers) farewell.

Once back in our truck, as Doug completed the run sheet (and I moved us to a neutral corner, several blocks away), I noted our friend’s considerable girth. “Glad she SNR’d herself. Obese as she is, I’d hate to attempt to carry her large self anywhere.”

Doug chuckled. “Obese? Were you there, as she yelled at us? With that attitude, she was Oh-Beast!”