Not Fitting The Mold

So, TINS. I decided after several years as a nursing assistant, that I wanted to be an RN when I grew up. By the time that things lined up, I had already started working for EMS in Da City. So, I set to knocking off the pre-requisite classes I had not already collected, and waited for my Nursing school application to be processed.

Now, at this time, there were very, very, very few men in Nursing. The school I applied to, a community college, had a decidedly  problematic academic tendency among the population from which they drew their students.  So, since I had attended Tremendous State University for a couple of years, it seemed that I was a good candidate to handle collegiate level studies. For these reasons, it developed that I was accepted to this school.

In the course of the intake, I had to interview with an admissions officer. We talked about coursework, and finances. She asked me about what financial aid I had lined up. I admitted that I had none, and planned to pay for school through Da City’s tuition reimbursement program, as well as my earnings.

She did not think much of that idea, for some reason. “Mr. McFee, we do not allow our students to work.”

I was surprised. This was, after all, nearly 1980, and I had thought that liberated women, and various movements to remove barriers had changed things. Simply to be certain that I had heard her correctly, I asked her, “Er, ma’am? you do not ‘allow’ your students to work?”

“That’s right, Mr McFee. We do not allow our students to work.”

“Uh, ma’am, you do realize that I am working full time, have a house, and am my own only source of support, right?”

“Mr. McFee, you need to plan for that. We do not allow our students to work while they are in school.”

“Uh, OK. Uh, ma’am, so, where do you live?”

“Why do you ask me that?”

“Well, I support myself and you are telling me that I cannot work. I suppose that means that I’m moving in with you.”

THAT got her attention! “Mr. McFee! You are NOT moving in with me!”

“Hmm. So, how about you document that you have told me that your experience is that students who work while in school do not perform as well as those who do not. You could note that I have acknowledged that warning, and the school’s extensive experience behind that warning. You could write down that I will elect to work while in school, and therefore, any failure on my part will be in spite of your vehement admonitions. Do you think that will work for you? It is a chance that I am willing to take.”

“Uh, Mr. McFee, please sign here, next to my notes to that effect. Thank you. Welcome to Un-Named Community College School of Nursing. You have selected a challenging course of action, both academically as well as because you have chosen to work. Good luck!”

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“But, what do I do?”

So, TINS, TIWFDASL as a nursing supervisor at The Little Un-Named Hospital In Da City (TLUNHIDC). One night, I received a call from our ICU. The nurse on the other endtold me that she had an order to transfer a patient, from our hospital to The House Of God. She asked me what I wanted her to do.

(Again), I thought, “This! This is why I get the Big Bucks!”. I told her, “In that case, I think you ought to transfer your patient to The House Of God!”

She responded, “But, I don’t know if they have a receiving physician at The House Of God.”

My rejoinder, “Well, then, call the House Of God, talk to the nurse in their ICU, and verify that there is a receiving physician.”

(Henceforth, I’ll dispense with the “He said, She said” business. From now on, any dialog beginning with “But…”, is her. Any other dialog, is me.)

“But, what if their physician hasn’t received report from our physician?”

“Note that fact in your nursing notes of that conversation, call our doctor, and invite him/her to call House Of God’s receiving physician, and remedy that oversight.”

“But, I don’t know if report has been called!”

“You might elect to look in the chart, for a note documenting that report has been called. Or, when you talk to their ICU, ASK!”

“But, what if report has not been called?”

“Well, while you have them on the phone, give them report. And chart that fact.”

“But, I don’t know what ambulance service to call, to transport that patient!”

“Ask the switchboard who is next on the rotation, and call that service.”

“But, I don’t know if the family has been notified.”

“So, the required phone number is in the chart, correct? Once all the other pieces are in place, phone the contact person, bring them up to speed, and document same in your notes.”

“But, what do I do about his property?”

“I suppose that bagging it up, and sending it with him, might be reasonable.”

“But, what about the chart? How am I going to send the chart with him?”

“Most nurses photocopy it, and send the photocopy with the patient. I recommend you do likewise.”

“But, how am I going to get it photocopied?”

“Most charge nurses, have the ward clerk servicing their floor do the photocopying.”

“But, we cannot spare her for that long!”

“You have an eight bed unit, have three vacant beds, haven’t had an admission in 6 hours. If you cannot spare her, right now would be a good time to fill your supervisor in on what catastrophe is unfolding in your unit!”

(her: “stutter…stutter…er…um…uh…”)

(Me) “I’m waiting?”

(Her) “But…But…What do you want me to do?”

“Get a pen and paper.”

(her) “What?”

“Get a pen and paper.”

(her) “Why do you want me to get a pen and paper?”

“Simply do it. Now.”

(her) “I have a pen and paper.”

“Good. Write this down. Call The House Of God, verify that our doctor has reported to their doctor.

If not, call our doctor, and invite him to do so. You give report, and chart same. Call the ambulance service that the switchboard tells you is next up on the call list. Call his family, bag his property. Have your clerk copy the chart, and send that copy with him. Have you written all that down?”

(Her) “Uh, yeah.”

“Do you understand all that?”

(Her) “Uh, yeah.”

“Ok, now Do IT!”

End of call.

Oh, Tempores! Oh, mores!

When I walked into the exam room, the olfactory evidence of marijuana hit me as if I had walked into a wall. If the lights had been flashing, and there had been earsplittingly loud rock music, I would have thought I had been transported back in time to the Grande Ballroom.

It’s often entertaining to interview stoners. Typically they have difficulty maintaining a linear train of thought. I encounter associations that I, sober, have difficulty following. So, I asked this soul how I could help them.

They told me that they used eyedrops (No, they did not know what eyedrops. Nor did they have said drops at hand. Of course not. Why would I care what medications they took?) They told me that they had a bacterial infection, due to these eyedrops. How, might you wonder, could they have a bacterial infection due to their eyedrops? Congratulations, you, too, can have a career in clinical medicine.

Now, for the loose associations. My new friend related that they had several transplants, of a sort that they could not identify. (Most of us might think that knowing WHAT SORT OF FREAKING TRANSPLANT we had received, might be nice to know. Just in case, ya know, we had to see some sort of clinical professional. Ever. ) Their exact words? “You know, a transplant of that stuff!”

Kinda unhelpful. Plan “B”: elicit indications of said “bacterial infection”. I expected something along the lines of discharge, or fever, or productive cough. Again, with the loose associations.

“I just know I’m sick!”

And, my friend, what sort of experiences led you to conclude that you are sick?

“I’m just sick!”

They told me in PA school, that, if you listen to the patient, their story will tell you what is wrong. I suppose that my instructors had never met my stoned new friend.

So, I examined ears, looked in this soul’s throat, felt for swollen glands, listened to lungs and heart, palpated abdomen, and found a completely normal exam, if you discount the marijuana fumes emanating from their every pore, and bloodshot eyes. Oh,yes: and, if you exchanged not a word with them.

So, trusting that the med list my MA had elicited from my mentally wandering friend was accurate (if you ignored the absence of any mention of, uh, EYE DROPS thereon….), I described my stock spiel of symptomatic relief medications available over the counter, and handed them a typed list thereof.

They nodded, agreeably, and shuffled to the door, off to wander the local environs.

Yep, I am DEE-LIGHTED! that marijuana legalization passed in our last election! How can that go other than well?

On the up side, it will provide a blatant and olfactory Jackwagon Flag. Once you encounter some happy-go-lucky soul out in public, wafting reefer fumes hither and yon, well, you may avoid wondering if they are a fool or not. Just sniff.

Career Goals

So, once I graduated from PA school, we moved to Rural Ville. I had a job in the ER 
of the local hospital, so the kids went to the local school. Surprising, no?

My kids were in 8th grade and 9th grade. There were the usual transition rough 
spots, but they adapted soon enough. 

One day the school had a career day, and everyone got to describe their career 
plans. There were the the nurse wannabe-s, and future farmers, and prospective 
engineers. 

My one son had physics research in his sights. The other was less particular: 
"Not nursing!". 

My youngest came home after the career day, indignation oozing from every pore.
He couldn't contain himself. 

"So, we all have our little spiels. This one wants to be a baker, that one wants to be 
a nurse. Another wants to be a farmer. One kid said only this: 'Ahmgondrahvtruck!", 
and sat down. 

"Not 'I'm going to drive a milk truck", or 'a grain truck', or 'an over-the-road truck'. 
Nope! Just 'truck.' 'Ahmgondrahvtruck'. Where do they find these people?"

I had no answer. 

Yet ANOTHER Tale of Public School Wonderfulness!

When She Who Must Be Obeyed, and I, and our family had moved to another school district, we, surprisingly enough, registered our children in that new school district. We were provided a sheaf of paperwork to be completed, and, in leafing through my homework assignment, noticed a physical form for each child.

I examined it, and noted that, at the bottom, it required the signature of a “Licensed Health Professional”.

I pointed this out to SWMBO, and she asked me what I intended to do with this insight.

“Well, I’ll perform physicals on our children, document them, and sign the forms. Save us the hassle of a doctor office visit!”

She protested that I was an RN, and that they meant for a doctor to sign the form. I invited her to point out where, on the form, it so stated.

She turned it this way and that, and, finally, was compelled to admit that it did not so state explicitly, “but that is what they meant!”

“Perhaps, that is what they should have said!”, and I went off to retrieve my stethoscope and children.

I performed all the diagnostic maneuvers required, documented my findings, and, at the bottom, where it called for the “signature of a healthcare professional”, I signed it Reltney McFee RN, BSN.

Several days later I took the kids to school for registration and walked into the office. The woman there told me she needed some documentation of address so I gave her a utility bill. She needed some ID for me, and I provided my driver’s license. She needed a phone number, and I provided it. Next she asked for the School physical forms. She examined them, and asked, “Who is this?”, indicating the signature.

“That’s me!” I said. She asked me if I was a physician, and I replied, “No I’m not. I’m an RN.”

“You cannot sign this form!”, she informed me. I leaned over the counter, pointed at my signature, and observed, “Yet, it certainly appears that I have signed it!”

“But, you have to be a doctor to sign this form!”

“No”, I corrected her, “it requires the signature of a licensed health professional. I am a registered Nurse, and am therefore a licensed health professional. Hell, I’m even licensed by the Bureau of Health Professions!”

Unswayed by my logic, she informed me, “Nurses aren’t health professionals!”

I picked up a phone book. “Oddly enough, the Board of Nursing seems to think that nurses are health professionals. It’s a local call: why don’t you call the Board of Nursing in the state capitol, and straighten them out? I’m sure they’d enjoy having you correct their little misunderstanding!”

And then I smiled.

She stuttered a little bit, looked flustered for a little bit, went into the back office and then came back out and said “We’ll take it this time.”

I smiled and said thank you and went on my merry way. Next year the kids came home from school and had these physical forms that need to be filled out. I looked at them: there at the bottom of them it said “signature of Nurse Practitioner, MD, DO, or Physician Assistant”, none of which I was.

My nursing school instructors would have been so proud of me! I was an agent for change, and the school system had changed their forms at my instigation!