WuFlu, Kung Flu, Chinese Flu, or Coronavirus: It IS a big deal, but not for the reasons you likely have been told!

The number of projected deaths, when all is done, is not THE PROBLEM. At north of a million people (that’s one million, or more fathers, mothers, brothers, sisters, sons, daughters, grandfathers and grandmothers. And aunts, uncles and husbands and wives.), that is certainly bad enough. Particularly if someone you love is enumerated in that group. Life changing. Reality altering. Leaves a hole in your heart, your life, that you cannot imagine, unless you have lived through it.

BUT! THAT is not THE PROBLEM. THE PROBLEM, is the follow on effects, as a tsunami of ill inundates our already (on a good day) marginal health “system”, that it is in no way prepared for.

“Just in time” inventory systems will not bite us in the ass. Nope, not at all. Rather, the shortfalls and absent supplies will make us yearn for simply being bitten in the ass. Indeed, the “bite us in the ass” problem will more closely resemble the “bite in the ass” one might receive from a hungry great white shark, or, maybe, a ravenous tiger.

Ragarding the magnitude of THE PROBLEM, you need honest numbers, and then you NEED TO UNDERSTAND THOSE NUMBERS! See Lawdog’s blog, here , for an explanation of testing error (false positives/negatives, and the implications thereof).

See Aesop’s articles, here, for his description of the second order effects, and how it will make a clusterf…er, HUG! look like a picnic with your Bible study group. I do not know about timing, but, based on 30 + years as an ER nurse, and a dozen as a PA, and several as a medic, well, his assessment of effects is certainly defensible. I pray he is wrong, but I do NOT believe that he is wrong. (While you are there, read his other posts, about the follow on effects, about how this has been mishandled since, oh, 20 or more years ago, and about missed opportunities).

(and, READ HIS COUNSEL [in other posts] ABOUT PREPAREDNESS, BOTH LOGISTIC AND TRAINING! AND TAKE IT TO HEART!)

Good fortune to you all, and WASH YOUR DAMNED HANDS! NOW, DO IT AGAIN! AND AGAIN!

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Back From Vacation. I Have Stories!

I just got back from vacation (well, by the time you folk(s) see this, I will have been back for a couple of weeks, but, anyhow…) So, here are two anecdotes, serving as a sort of “Cruise: after action report”

The elevator counseled “Patience!”

TDW-Mark II and I were on a cruise, earlier this year. I had worked considerable extra shifts, in order to avoid financing this adventure. So, TINS©, there we were, soaking up sunshine and living the life, and we were attempting to take the elevator from whatever deck that we were on (say, deck 3) to Deck 14 (which would be “The Serenity Deck”, relatively quiet as well as sunny).

There were numerous other people who had a similar idea (which, on a cruise ship with something like 2,000 + passengers, is likely to be unsurprising). So, when I pressed the button to summon the elevator, there appeared, after some time, to be no response. I again depressed the elevator call button, and was surprised to hear a typical robot like female voice emanating from the elevator, counseling “Patience!”

TDW was very, very amused.

Departure elevator lobby Hide and Seek

TDW-Mark II is, well, petite. At the end of the cruise previously mentioned, we arose early, got out crap together, and joined the lowing herd stampeding towards the gangway. As we were on a middle sort of deck, well, all the folks who had arisen around the same time as we had, and were on upper decks, well, the elevators were full up by the time that they arrived at our floors. (I, of course, lacked the insight that, should we enter the elevator ON THE WAY UP, well, we would ALREADY be on that elevator, once the upper floor folks tried to join us. Alas, THAT insight, however useful it might have been at the time of departure, did not occur to me until, well, just now. Good timing.)

In any event, soon there would arrive an elevator with space for one of us, but not both. After several such events, I directed TDW-Mark II to enter the next elevator, and I would join her downstairs once I myself became the room-for-one-more elevator passenger.

Great plan. Well, except for one issue. Recall that my wife is petite. Consider one readily foreseeable result of lots of people deciding that RIGHT NOW would be a good time to depart, luggage in tow. Yep, I arrived on the departure deck, waited for the crowd to move so far as to allow me to exit, and did not see my wife. She called to me, and I heard her, but could not place her in the lowing crowd.

I decided that this problem resembled the childhood swimming pool game of “Marco Polo”, wherein contestants were forbidden the use of their eyes, and had to find, and tag, other players. “It” would elicit calls from the other players, by calling out “Marco!”, requiring the others to respond “Polo!”.

I implemented my solution. “Marco!”, I called out.

“Polo!” responded TDW-Mark II. I placed her across the lobby, but still could not see her.

“Marco!”

“Polo!”. Ah, there she was, hand a-waving. We “swam” through the crowd, meeting just a little ways “downstream”, and therefrom making our way past checkout, and on to Customs. The rest of our trip home was uneventful, except for the guy who, in the left hand lane of the expressway, decided that he had to exit RIGHT FUCKING NOW!, and swerved, abruptly, across three lanes of traffic and onto the off ramp. Fortunately, it appeared that the other drivers had experienced this sort of shenanigans before, as they braked, and nearly seamlessly allowed Mr. Late Decider off the expressway, and out of our lives.

But, except for that, it was all good.

Paramedic School Stories, Part Two:

Which brings us to STORY NUMBER TWO: (remember the grading scheme outlined last week) In the fullness of time, the second semester ended. I calculated the point total for each student, compared said total to the pre established thresholds for each grade, and, based upon this calculation, assigned grades.

I posted these grades, after turning them in to the program director, who was my immediate superior.

Shortly thereafter, I received a phone call from one student, let us call her Little Mary Sunshine. She was upset at her grade.

“Mr. McFee, you gave me an A minus, and I think that I deserved an A”

“Oh?”

“Yes. I think that you should have given me an A.”

“I agree with you.”

“Oh? You are going to give me an A?”

“Nope. I agree that you think that you should be given an A. On the other hand, you earned an A minus.”

“But, I checked my scores! I only missed an A by a single point!”

I checked my grade book. Yep, needed 920 points, earned 919 points.

“I agree with your calculations. You missed it by a single point.”

“I think that you should simply give me that point!”

“How interesting. I however, do not.”

“But…but…it’s not FAIR!”

“In what way?”

“I think you should just give me that point, and then I’d have an A!”

“If I were to give you that point, you would, indeed have an A. On the other hand, you, indeed, EARNED an A minus.”

“But..but..It’s Not Fair!”

“May I ask you a few questions?”

“Uh, OK.”

“You were present in class the first day of class, correct?

“Uh-huh.”

“As well, for the midterm, and the final that first semester, correct?”

“Uh-huh.”

“Likewise, the first class of the second semester, and the mid term of that second semester, correct?”

“Uh, yeah.”

“Did you hear me talk about extra credit, on each of those 5 occasions?”

“I suppose so.”

“And, did you speak to me one solitary time about any sort of extra credit of any sort?”

“But…but…I never imagined that I’d need any extra credit!”

“Yet, here we are. Had you turned one solitary extra drug card, and the only things on that drug card that were correct were your name, the brand name of the drug, and the generic name, you would have earned that extra point. You did not do so. If you do not care about your grade that much, why should I care any more than you demonstrably do?”

Sometime later I received a call from the director of the program, who asked me about Little Mary Sunshine’s concern. I related the conversation, as related above, and summed up: “Bob, it’s your program. You run it, you are responsible for it. If YOU want to give her that A, go ahead. Simply understand that I will not be signing any other grade form for her. You want to do it, be my guest.”

I heard nothing further on that topic.

More Paramedic School Stories: The First:

Years and years ago, before I left Da City’s employ as a medic, I had completed nursing school, written my boards, received my license and was living large. For certain values of “large”, that is.

I had been offered, and accepted , a position teaching pharmacology, part time, for the program that I had graduated from. The textbook we used (Nancy Caroline MD: “Emergency Care In The Streets”) was outstanding, and provided a clear template around which to build my lesson plans.

One of the innovations that I introduced, from my own nursing school days, was a particular format for drug cards. The point thereof was to have, on a 3 x 5 or 4 x 6 card, the names of the drug in question (trade and generic), the common dosing and route of administration of the subject drug, indications for using the drug, contra indications for using the drug, the mechanism of action of the drug, and the class (often, these last two overlap: a drug classified as a “Beta Blocker” worked by blocking beta agonism on the sympathetic nervous system. If you had mastered that point, you knew that the drug would serve to slow heart rate, mildly constrict arterial muscles (net effect of lowering blood pressure due to slower heart rate and decreased strength of contraction leading to diminished cardiac output), CONSTRICT bronchial muscles, and reduce intra ocular pressure. Or, you could write all that stuff out. For every beta blocker you encountered. Fun times. I simply earned what beta agonism tickled, and knew that blockade thereof reversed those effects.)

In addition, the cards noted nursing considerations (things the nurse, or paramedic, ought to have in his/her mind when employing this medication. Like, Beta blockers: check and recheck heart rate, blood pressure, and monitor the EKG, looking for slowing conduction of the electricity that controlled things).

Now, some of my students were first timers. They were folks who, as you might imagine, were taking paramedic classes for the first time.

In The Un-Named Flyover State, the licensing drill went something like this. You successfully completed the course, and took the exam. Pass it in one, bingo, license in hand, go out and fight disease and save lives.

If you failed the exam, then you got one chance to re take the test portion that you had failed.

If you failed the retest, you had to successfully complete a refresher course, whereupon you could re-test, again.

If you failed THIS test, you had to take the entire generic paramedic program, from step one, all over again.

As it happened, a couple of students had, indeed, found themselves taking the paramedic class, in order to qualify for a FOURTH retest.

So, TINS©, I laid out my expectations, had conjured up a 1,000 point, two semester grading scheme, wherein around ½ of the grade (250 points each semester) would come from the midterm and final, combined. Another 25 points came from each quiz, administered each week in class. 16 weeks in a semester, no quiz on mid term or final weeks, and two other weeks off for review for the mid term and finals, 20 quizzes.

I announced at the beginning of each semester that I would consider extra credit in the event that any student came to me in advance, suggested something that would reflect additional pharmacologic study, and be pertinent to paramedic practice.

So, STORY NUMBER ONE: Somewhere around mid terms, one of the students rose in class, and delivered a pronouncement: “Reltney, paramedics don’t need to know all this stuff. Nurses, yeah, I get that nurses need to know this stuff, but paramedics don’t!”

I invited him to hold that thought, and we could speak, in detail, after class. After the end of class, this fellow, along with a couple of his work mates, all met with me, eager to set me straight.

As it happened, all of these folks were of the looking-at-a-fourth-retest group.

I invited my correspondent to state his case. He did so, as outlined above, with no new explicative material, no new rationale for his position.

I deliberated a moment, and fact checked myself. “So, you have taken the paramedic exam, correct?”

“Yep!”

“And, you failed it, is that correct?”

“Uh, yeah…”

“Then, you took it again, did you not? And, failed it, again, am I correct?”

“yeah…”

“And, again, after a refresher course, you took the paramedic exam, and, again, you failed it, is that also correct?”

(much more quietly) “yes…”

“So, I’m confused: you are not an RN, are you?”

“Uh, no…”

“So, let me see if I am understanding you: you are telling me, who has taken, and passed, the paramedic exam, and who is, also, an RN, that you are in a position to have an opinion that I ought to find persuasive, regarding what it takes to successfully take and pass the paramedic exam, based upon your experience in taking the exam, and failing it, what, three separate times?, did I hear you correctly?”

He mumbled something indistinct, and found somewhere else that he felt the need to be.

And, I did not hear THAT particular argument again.