A long, long time ago, in a county very far away, I was a nursing supervisor. I had migrated into supervision after several years as an ER nurse.
One afternoon I arrived at work, and the offgoing supervisor reported that a gentleman had been brought in and admitted for his heart attack. Now, in these far away days, there were no angioplasties, no stents. There was no TPA, no other thrombolytics (“clot busters”). Indeed, the state of the art, outside of referral hospitals, was oxygen, hydration, rest, aspirin, and pain control. We had THAT, in abundance!
So, a couple of days later, one of the CCU nurses took me aside, and informed me that this guy was, to employ her own professional and finely tuned appraisal, “acting kinda squirrely”.
It developed that the attending physician determined that this soul was both having/recovering from a MI (heart attack), but, in addition, was a florid alcoholic, and was entering into DTs. Like, classic, textbook, tachycardic, hallucinating, writhing, pre-seizure tremulous, DTs.
Simply to make everything just nice, the internal med doc that the cardiologist consulted did not believe in using benzodiazepines for alcohol withdrawal. (that would be medications like Valium or Librium, useful both for the sedating effects, as well as their efficacy in protecting the patient from convulsions that might be lethal.) No, he insisted in using antipsychotics, which weren’t altogether effective in addressing his twitching nor his restlessness. Shit.
Well, he survived all this excitement, and, eventually (like, 4-6 weeks worth of eventually) was ready to go home.
Our discharge planner discovered that our new friend was a resident of Florida which we, in The Unamed Flyover State, were not anywhere near. He had wrecked his vehicle in the initial confusion, and therefore had no vehicle to get him home. In any event, what with his MI, and his lengthy stay in Thorazine Land, was in no sort of shape to (a) drive home to Florida, nor (b) master the intellectual challenges inherent in navigating the interstate home, even if he was strong enough to physically do so, Which he was not.
Her investigations revealed that none of his family was in any sort of position to happily drive up here and retrieve him (which of course begs the question of what was he doing here, with his pleasantly confused self, something like 1200 miles from home? And alone?)
So, once the dust settled, he was still our problem, and The Suits determined that springing for a flight home would end the financial drain that he represented, since no insurance company in the Western World would pay for him to reside at the Grand Hotel De Our Little Hospital, once his medical need had resolved. I did mention that he was squirrely, right? Well, our discharge planner hypothesized that his heart attack, and DTs, had trampled his previously marginally sufficient coping mechanisms, and he was, now, fully senile. Therefore, putting him up, unsupervised, in a hotel, would not work out at all well.
So the plan was laid. Our discharge planner purchased a plane ticket. He had specifically purchased a ticket on a nonstop flight, determining that there would be fewer opportunities for him to wander off, and get lost Ghawd Alone knew where. Then, she dumped it in my lap. I called A Competing Ambulance Service, and spoke to a supervisor.
“I have this guy, and we are going to fly him home. He is not altogether there, and so he needs both supervision, and a chain of custody. The flight is at 5 pm, so I want him at the gate at 4 pm sharp. I want your crew to physically deliver him to the boarding gate, physically observe him belted into his seat, and obtain a signature as a receipt from the flight attendant who seats him. Can you do all that?”
“Sure. You just have to set it up with the airline. OK?”
“Outstanding! I’ll set it up, and call you back.”
So, I called the airline. I spoke with a supervisor, and laid out my problem, and my view of the solution. “Sure, no problem. We can do that. Anything else?”
“Yep. Can you get a receipt for my guy, from the folks who pick him up, and then call me with the fact of safe arrival, please? Then, mailing us the receipt would be wonderful!”
“Sure, can do. Gimme your name and mailing address!”
I called the Competing Ambulance Service back, and brought the supervisor up to speed. “Oh”, I added, “One more thing. We’ll hand the plane ticket to your medic, and also hand him or her the chart. That HAS to go with him, and is part of the chain of custody business. OK?”
“OK!”, was the response.
So, on the appointed day, I was at the nurses station awaiting The Competing Ambulance Service crew. Once they arrived, I reviewed all the foregoing. Both medics nodded, and one opined, “Yeah, that’s all according the the briefing we got from the supervisor. Where’s the chart, and the ticket?”
The charge nurse handed both items over. The medic made a show of placing the ticked into the inside pocket of his jacket, turning so both his partner as well as the nurse and I could see it settled deeply into it. His partner tucked the chart beneath the pillow, and they were off!
Around 1630, I got paged to pick up a phone call. “Mcfee!” was my greeting.
“Mr. Mcfee, this is Bob from The Competing Ambulance Service. My crew just radioed me to let me know that your patient is on the flight, seatbelt secured, and they have a signature form one of the flight attendants. So far, so good. That attendant has you phone number, and will phone you once he has been handed over to family at the other end.”
And, as promised, around 1930, the crew from The Competing Ambulance Service arrived, hunted me down, and handed me a copy of their trip sheet, prominently featuring the name, signature, and employee ID number of the flight attendant accepting Mr. Man for his flight.
To frost my cake of WIN!, the next day the night shift supervisor relayed via days, that our patient had successfully, and uneventfully, been handed off to his family at his destination.