HIV Transfer

So,TINS©, TIWFDASL©….well, OK. I was a nursing supervisor, and therefore, in the view of my peeps, I was, at best, not an impediment to their doing their jobs.

So, in any event, this was way, way back in The Dark Ages, Before Cell Phones (Gasp! No! There were PEOPLE, way back then?!?). This was around the time that some bright clinician noticed that there was a peculiar form of impairment of the immune system, that seemed particularly prevalent among homosexuals (currently described as MSM, for “men who have sex with men” in the clinical literature), and IVDAs (“Intra Venous Drug Abusers”). Nobody was really clear on how this was transmitted, although some sort of exposure to bodily fluids originating in one of the sufferers of this malady seemed a common feature of acquiring it.

My little hospital had a drug rehab unit, the purpose of which was to smooth the discomfort of discontinuing narcotics use, so as to help the recovering addict start to re arrange the other pieces of his/her life, into a non drug dependent direction.

So, it developed that our medical director of this unit had determined that one of his patients on the rehab unit did, indeed, have this acquired immune deficiency syndrome. (You may have already recognized the acronym “AIDS”). In these dark days, the capability of treating this disease was limited to specialty units in tertiary referral centers, and therefore we made arrangements to transfer our patient to The House of God, Local Edition.

I called the contract transfer ambulance service, and provided the needful information. All was set, I turned to my next problem. Or so I thought.

On the order of an hour later, I received a page from the drug unit. They desired my presence, pronto. I trotted on up.

Once buzzed into the unit, I beheld a pair of basic EMTs, one irritated patient, and one pissed off charge nurse. I drew the charge nurse aside, and asked WTF was happening.

“These idiots are acting like extras from “The Andromeda Strain”, and refusing to take our patient unless they and he are in full isolation garb, and they didn’t bring anything. They are insisting that we outfit them with masks, gowns, gloves, masks, and surgical hats. You’ve been to the same in-services as I have. That’s bullshit. Unless they are going to share needles in the back of the ambulance, there is nearly no risk whatsoever. Could you please talk some sense into these guys?”

I invited the ambulance crew to join me in the nurse’s lounge, and asked them what the issue was. One spoke up. “That guy has AIDS. I don’t wanna catch no AIDS. That’s why we need all that protection!”

Now, remember. This was a BASIC transfer. This guy was alert, lucid, cooperative, not bleeding not coughing up amphibious life forms, continent. All in all, not spreading any bodily fluids anywhere at all. It had, I’ll admit, been several years since I had been on the road, but my paramedic license was still current, and I was unaware of any evolutions in pre hospital care on a basic inter hospital transfer that might place these guys at any measurable risk. I told them as much.

“Yeah, well, I dunno how it was way back in your day, but nowadays, well, we gotta protect ourselves!”

Uh, yeah. “Back in my day”. So, my response was measured, and professional. “Gentlemen, please get comfortable. I’m going to chat with your supervisor, and we’ll get this all squared away, pronto!”

I lied. I talked to MY supervisor, the director of nursing, and told her my little tale. She was, to be charitable, irritated, and mused aloud about her to-do list for the morrow. Prominently featuring contracting with the Non Imbecile Ambulance Service, which, so it appeared, would NOT be the employer of the happy go lucky souls with whom I had shared our nice little chat. She suggested that I share that project with the on duty supervisor of the Incumbent Ambulance Service, with the suggestion that they may want to reflect upon how far into this project they really wanted her to get. “Yes, Ma’am!”

I called their dispatch, invited them to have their on duty supervisor call me, right stat like, and awaited the return call.

This worthy was not any sort of improvement over the dolts that he had caused to be sent to us. I smiled, reminded him that we’d be in touch, and went back to the unit.

By this time, both EMTs were garbed as if for joint replacement surgery, absent only the PAPR respirators. They had wrapped the cot with plastic, and then, standing several feet from the cot, invited my patient to “Sit!”.

Nice.

I apologized to the patient, and wished him the best of luck at the House of God, Local Edition. He shrugged, thanked me for my efforts, and gracefully in demeanor, settled in for his ride.

A couple of days later, one of the medics from A Competing Service stopped me in the hallway. “I heard you put a good word in for us, and we now have your transfer contract. Thanks!”

I corrected him. “I didn’t say one thing about you guys. Likely, my boss remembered your stellar performance with our out-of-state transfer a couple of months ago, and when the need for a new contract came up, remembered you and how smoothly you guys ran that.”

I didn’t tell him to thank The Incumbent Ambulance Service, and their crew of Laurel and Hardy.

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“Little Mary Sunshine is NOT a Force Multiplier!”

Once upon a time, long ago and far away, I was nursing in an ER in a medium sized city. For some reason, I was unable to evade being placed in charge.

Lord Knows that I tried! While I have established that I can be reasonably effective in a supervisory role, I really do not like it. For one thing, it places me in overly close proximity to Suits. I do not enjoy proximity to suits. Hell, my Suit Aversion Disorder led me to work midnights, in the first place! (well, that and shift differential, as well as seven-on-and-seven-off scheduling, to be honest.)

For another, I get subjected to all the bullshit from other departments, which, invariably, appears to consist of interacting with slothlike souls who manifest only one burning desire: skate through their shifts, while expending as little effort as is needed to maintain their receipt of a paycheck. Notice, I did not attribute to these chuckleheads the desire to actually do something resembling their jobs. That would be different.

Finally, when in charge, I get to cope with all the malignant and ill considered decisions regarding staffing the aforementioned cursed suits have enacted.

So at this point I was working in a relatively urbanized area, with a sixteen bed ED, in a town with three total Eds of various sizes. We had been short staffed for an extended time. This, of course, made me oh, so very happy. Or, not. I had been bitching, complaining, protesting and generally making known that not only was this sort of staffing insufficient, but, into the bargain, was considerably short of their own goddamned published staffing parameters, written by the goddamned suits themselves, and for which I would be written up should I let someone go home leading to staffing short of these parameters.

Well, as it developed, one of the Junior Suits (our assistant director) was compelled to show her smiling face up to work some of the short midnight shifts. She was, let us say, “entertaining”, to work with. She would “help out” by triaging. Well, when you triage someone, it is helpful if you (1) obtain and record vitals, (2) ascertain, and document allergies, medications, medical history, as well as (3) history of present illness, typically elicited by asking something along the lines of, “So, Mr./Ms/Xr X, what motivated you to come out in the dark of night to join our happy little party?”. You did notice how much fun I seemed to think it was, to, ya know, DOCUMENT, the aforementioned items, right? Sort of like that was, oh, I dunno, a GOOD THING, or something?

So, it develops that Little Mary Sunshine did not document (or even obtain; it was difficult to sort that one out) vitals, allergy/med/history, or present complaint information, at least, not consistently. In addition, it seems that an ED physician with, say, a dozen patients, really, really gets petulant if these items are not there in the chart to be found. Slows him/her down, considerably.

Then, there is the part about both bedding the patient, as well as noting such fact on the greaseboard, as well as reporting off to the the nurse who would, oh, I don’t know, maybe BE CARING FOR THAT PATIENT.

Finally, it was established practice to start the needful IVs, collect the blood, and send it to the lab, along with a requisition for the bloodwork the physician was going to be desiring to see. None of which had penetrated Little Mary Sunshine’s cranial vault.

She was no more helpful as a “floor” nurse, Which is to say, she would half ass do things, not tell anybody at what point she had grown disinterested and wandered of Ghawd alone knew where, let alone document anything that she, by some miracle of random happenstance, completed.

As my partner, Andy, opined, “Ya know, she is not really a very effective force multiplier!”

Much more nicely phrased than the tsunami of profanity that was boiling away, waiting for me to spew forth as my OWN opinion of her “efforts”!

So, visiting as she was from the warm climate of Daytime “Suitworld”, Little Mary Sunshine was chilly most of the time. (she might have been warmer, had she been moving about as briskly as the rest of us, but, then….) Andy, once again demonstrating the situational awareness that made him a fine nurse and great partner, noted this fact, and brought it to my attention one long, long night during a missing Mary moment.

He implemented a plan based upon this observation, and turned the department thermostat down to around 60, from the typically balmy 70 where it normally rested.

Well, time passed, Mary Sunshine wandered around, fucking things up, and soon the HVAC system equibrillated at the new set point. Mary zipped up her sweatshirt, and began to complain that it was cold.

Nice of her to notice.

Shortly thereafter, she loudly opined that “You guys seem to have things under control. I’m gonna go back into my office and do some paperwork. Call me if you need me!”

Once she was safely away down the hall towards her (independently heated) office, we returned the thermostat to the baseline setting.

The rest of the night passed as the typical clusterfuck of shortstaffed jackassery, fortunately not exacerbated by halfwit half assed managerial fumble fingering.

Child Rearing Tales

So, TINS, TIWFDASL….well, OK, really, this is another child rearing tale. Our oldest son, Adam, was approaching middle teen years, and, in The Unnamed Flyover State (TUFS), that meant anticipating driver’s education, preparatory to acquiring a driver’s license. At that time, the child in question had to be around 15 years of age, so, shortly after Adam’s fourteenth birthday, I sat him down for a little chat.

“So, Adam, you starting to get excited about taking driver’s ed?”

“Yep! I really can hardly wait!”

“Outstanding! Now, you do realize that, here in TUFS, you aren’t required to get my signature in order to take driver’s ed, or to get your license, right?”

He responded with a blank look. “Huh? All the kids in my class say that your parents have to sign for you to take driver’s ed, or to drive!”

“Well, they are mistaken. You do not require my signature in order to drive, or in order to take driver’s ed!”

He reflected upon this for a moment, and his face brightened. “Oh, yeah, right! I’ll just get Mom to sign!”

I sat back. “Say, I have an idea! How about you go talk to your mother, and ask her about that idea! Let’s say, for some reason, that I refuse to sign for driver’s ed, or for you to drive, ask her what her next move might be! Come on right back, and let me know what she says, OK?”

He scampered off. From another part of th house, I overheard low pitched murmurs, as of distant conversation. The murmurs ceased, and Adam made his reappearance.

“So, tell me about that ‘no signature’ thing, please, Dad.”

That told me how his conversation with his mother had gone. He had said something along the lines of “Mom, if Dad won’t sign for me to take driver’s ed or to drive, will you?” Her response had likely gone along the lines of “Have you lost your fucking mind? What makes you think your dad and I would not be on the same page regarding something like that?”

So, I answered him. “Well, Adam, in the Great and Sovereign State of TUFS, you do not require a parent’s signature in order to take driver’s ed, nor in order to drive!”

“Dad, that can’t be right! All the kids in my grade tell me that you need a signature!”

“Well, they are all wrong. Indeed, here in TUFS, you can get your driver’s license, you can take driver’s ed, without my signature, or you mother’s. Why, once you are eighteen, it is all very simple! You simply sign for yourself!”

He looked thoughtful for a moment. “But, Dad, why would I want to wait until I was eighteen to drive?”

Now, I looked thoughtful, for a second. “Adam, that is an excellent question! I am confident that your behavior between now and then will demonstrate the answer you came up with!”

So, fast forward several years. I had had this same conversation with Betty, Number Two child. She had taken, and passed driver’s ed, and acquired her license. She was driving whenever she could wheedle the loan of a car from her mother or me. She was also, as an adolescent girl, not entirely meeting behavioral standards.

Her mother TDW-Mark 1, and I, considered her transgressions, and intervened when needful. When behavior did not improve, we physically took her license, and secured it. After the “license grounding” had elapsed, she, again, could drive. More misbehavior, more license grounding.

Finally, she had demonstrated sufficient lack of grasp of acceptable behavioral standards, that we were done grounding her from driving. TDW-Mark 1 and I held a conference, featuring Betty. I reviewed past interventions.

“Betty, you did (whatever), and had been told not to. We took your license for a week, and told you that another violation would result in us taking your license for two weeks. You violated (whatever the rule in question was), again, and so we took your license for two weeks, and told you that the next time would be a month. Again, you violated (rule), and we took your license, and told you that the next time, we would simply yank your license and stop screwing around with this stuff. Well, last night you did, again, violate (rule), and so, now, your mother, and I, and you, are going to the motor vehicle office, and you are going to lose your license.”

She responded, “Well, I will just go there tomorrow, and get it back!”

I smiled at the sixteen year old. “I do not think that it works that way, Honey!”

She looked at me, and brought me up to speed (or, so she thought). “All the kids at school tell me that I can, and I just will!”

I produced her license from my pocket. “See this name here, at the bottom? Where it says Director of Department of Motor Vehicles? Read that name, please, Honey. The print is a little small for my old eyes!”

She read, “’Alyssa, M. Snodgrass’ Why do I care about that?”

“So, sweetie, which one of your classes is she in with you?”

“Huh? Nobody in any of my classes has a name like that!”

I looked at TDW Mark 1, and she looked at me. We then turned our gaze to our darling daughter. The TDW Mark 1 carried the ball. “Well, Betty, that is indeed a surprise! Since Ms. Snodgrass is the director of the department of motor vehicles, and is charged with writing, and enforcing, the rules for who gets, and who loses, a license to drive, perhaps she knows just a teensy, weensy, little bit more about how all that stuff works, than your illiterate, self absorbed, ignorant, prideful, and arrogant classmates. Doncha think?”

Betty gaped at her. Her mother smiled, serenely. “So, honey? Get your shoes, and let’s go. Now, Honey, now!”

With that, our little gaggle promenaded into the DMV office. Once our number had been called, we strolled up to the desk, and the civil servant asked, “What can I do for you?”

I smiled, my best won the jackpot smile, and proclaimed, “We are here to have this child,” and my sweeping wave indicated the glowering Betty beside me, “officially credentialed by the Great and Sovereign State of TUFS, as a pedestrian!”

The poor woman, only trying to get through her workday, looked at me blankly. After a second, she asked, “What?”

TDW Mark 1 clarified it for her. “We are here to yank this child’s license.”

“Oh, right. Please may I have the child’s license?”

I produce it. “And, your ID, please?”

We produced it.

Tap, tap, tap went the keyboard. Our new friend, the DMV Lady, then snipped off one of the corners of Betty’s license, and, looking up, asked, “Do you want this back?”

I looked at TDW Mark 1, and Betty. TDW Mark 1 looked back at me, and smiled at the DMV Lady. “Oh, yes, indeed, we want it back!” she exclaimed. “We’re gonna frame that bad boy, and hang it in the hallway, where all of us can admire it every day!”

Random Thoughts

Random Thoughts, Accumulated over a couple of weeks

(1) I know I have led a bad life (Ask The Plaintiff!). Therefore, I know that I’m going to Hell. If Dante Alighieri was correct, those of us going to Hell will experience our own personal, customized Hell.

Several times, it has occurred to me that, in my own personal Hell, I will be the clinician in Hell’s urgent care. There, I will spend endless shifts packed with trivially ill souls, who will take protractd periods of time to NOT answer my questions.

(2) I used to carry a can of CS teargas in my hip pocket, Back In The Day. Department regulations prohibited carriage of a firearm, so, what the heck, tear gas was First Runner Up in the self defense sweepstakes. So, one day I was in class, pursuing paramedic certification, and the top of the can, “safely” packed in my hip pocket, broke off. That left a puddle of corrosive tear gas in my seat. Curiously, there were no tears, which had, let us say, interesting implications for it’s efficacy as a self defense tool.

What there WERE, were sizable second degree burns on my asscheeks. That made for entertaining runs, as my ass slid to and fro while my partner drove our ambulance to emergency responses.

(3) This one time, I was working this one place (Hey! How about that RIVETING! Intro? Huh?) and they staffed the two provider clinic with two folks to work the floor, meaning they had to room patients, make appointments for followup, register and discharge patients, make referrals, answer the (incessantly ringing) phone, do procedures (breathing treatments, perform EKGs, take x rays, perform in house tests), and answer questions from random folks who walked in to ask questions about their bills or try to get their blood drawn (which happened at the lab, two doors down).

Kind of demanding, right? Well, somebody took a minute to call the office manager, suggesting that stuff either wouldn’t get done, or would get done incorrectly due to the pressure of multiple competing demands upon staff.

Her reply, as reported, was priceless. “Clinical medicine is like Zumba! You just have to keep up!”