Tangents.

A long, long time ago, in a Blue Hive not so very far from here, I was Fighting Disease, and Saving Lives. In addition, I was pursuing my BSN, as in my imaginings, that which I desired to do required a graduate degree, and THAT required that I earn a baccalaureate degree.

As it developed, this week’s version of BSN program entry prerequisites included physics, and so I registered for, and took, a physics class. Of course, I worked 1900 to 0700, and, equally of course, class was from 1900 to 2000. So, I played “Let’s Make A Deal!” with one of the guys from day shift. In exchange for Day Dude staying over to 2030 hours, I would stick around until 0830 the following morning, allowing Day Dude to sleep in a bit. Sleeping was an activity generally highly thought of in my circles.

I am a bit of a science dilettante, and enjoyed the academic aspects of the course. This one time, I had a question regarding the material. Once class had taken a break, I approached the instructor. Since I had to immediately scurry off to the firehouse post class (see above), I was in uniform. In those days, EMS uniform was tan shirts (think sheriff office), and forest green pants. On each shoulder was a large (think, Seventh Cavalry sized) patch proclaiming the bearer to be a part of “Da City Fire Department, EMS Division”, rockered around a large, forest green, “Star of Life” which occupied the very center of the patch. Not particularly subtle, amirite?

So, I approached the instructor. As my turn to have his attention arrived, I started to speak my question, only to be interrupted by him. “Are you some sort of forest ranger? “

Wow, talk about flight of ideas! I ignored him, and asked my question. He asked his, again. I answered him. “Nope, I’m EMS, See?”, and turned so the large patch was almost in his face. “Now, about the class….”

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Life Happens

So, for the past year or so, my internal goal was to post a new tale roughly every week. Last week, Friday, 27 August, I did not. And, paying attention as I do (for am I not a steely eyed, all knowing, situationally aware gem of readiness?) (or, not so much. Go with that one!), I noted this fact yesterday.

First, the bad news. My mother is elderly. Indeed, she is yet stretching the “elderly curve”. Therefore, she is medically fragile, although you wouldn’t know it from a perusal of her medicine cabinet. Hell, by that metric, she’s healthier than I am!

So, early last week, let us say, she had “a medical issue”. With Brother A being an accountant, and Brother B being a factory worker, well, that leaves Brother C (that would be me!) to be the medical intermediary. Most of us might find that to be, well, distracting. Indeed, I did find myself distracted. So, while we await biopsy results, doctor office visits, in this The Age Of WuFlu, and related malarky, I work, do my household chores, and sleep, when not voyaging to Da City to visit The Maternal Unit.

All of this to say to the hundred or so guests who visit this site every week, thank you for your patronage, sorry about the skipped week thing, and I ought to have more “Sea Stories” coming up in a week or so.

Random Thoughts, Part IV

You may have heard of the ChicomFlu. It has been all over the news, and, evidently it is all Mr. Trump’s fault. Interestingly, the same folks voicing concerns about Mr. Trump being a fascist dictator, who is planning on a putsch in order to become President For Life, also are criticizing him for failing to seize control of the economy, and not dictating the minutiae of our lives in order to Halt! This! Scourge!. Apparently, that entire Federalism thing, and Tenth Amendment thing, bypassed these commentators in Government class.

Or else, our government schools failed them. Again.

So, in clinical medicine, in 2020, we now have drive in care. Care, that is, of a sort. So, folks drive up (remember that point), announce themselves (no clown’s mouth, thankfully!), and our registrar trots out and registers them. Our MA does preliminary interview, and obtains most of the vital signs (except BP). I then suit up in an impermeable gown, goggles, N-95 mask, with another lesser mask over top of it to prolong it’s service life, and gloves, and stroll out. I interview them through the vehicle window, examine ears, throat, auscultate heart sounds and breath sounds (and, by the way, I can tell you things about your engine and transmission). With this information, I form a diagnosis, formulate a plan of care, and instruct the patient in that plan.

I nearly always ask if my patient smokes. If the answer is affirmative, my response if “Stop doing that!” Occasionally, when the answer is “No”, I have indisputable olfactory evidence that this is an untruth. If I can smell your marijuana fumes through two masks, you are doing it wrong.

*History Lessons*

If you live in Bagwanistan, or Cuomo Valley
 New York, or, really anywhere, KNOW 
YOUR DAMNED MEDS!

It's commonly considered to be A GOOD
 THING if I avoid prescribing a medication
 that, in concert with whatever crap you
 take daily, will turn you into a flaming 
zombie, or cause your ears to drop off. So
 write that shit down someplace where 
you can find it. This appears to be a novel 
insight to a significant fraction of the
 population.
 

And, while you're at it, ask your pharmacist 
what you're allergic to, and WRITE THAT 
DOWN, as well. 

And, for those of you who are thinking
 that “All that is in my record!”, uh, well,
 if your records are in, say FREAKING
 FLORIDA, it might be a bit difficult for
 me to access. Particularly on 
weekends, or after 1800 hours their time.
 By the way, this also applies to folks
 whose records are in Milwaukee, and are
 visiting Flambeau Hospital, since that is
 the nearest healthcare to Copper State
 Park in BFE, Wisconsin.  Big City Hospital
 in Milwaukee may not see us as an 
entertainment subsidiary of their 
megalithic hospital system, and your info
may well be securely hidden away, 
from us. 

Jes' sayin. 

The Fellow Who Would Not Go

A long, long time ago, in a Blue Hive not so very far from here (In truth, not nearly distant enough!), I was a nursing supervisor. This one time, TINS©, TIWFDASL©, and I received a phone call from one of my nursing floor charge nurses.

It developed that one of our physicians had written discharge orders for this one gentleman, let us refer to him as “Mr. Man”. Mr. Man was apparently of the opinion that our physician was mistaken, and that he, Mr. Man, was not sufficiently recovered to return to his home. I responded, spoke to the nurse, and then spoke to Mr. Man. He pretty much recreated the report that I had heard from the nurse, culminating in his ultimatum: “I’m not going anywhere, and you cannot make me!”

I phoned the physician and relayed my conversation. This doctor asked me a few questions, corroborating his assessment of the patient’s clinical circumstance. Having done so, he reiterated his plan of care: “Mr. Man does not meet the criteria from the insurance company, who is paying for his hospital stay, and they are not going to continue paying for his stay. He is discharged, I have written prescriptions, and arranged a post discharge office visit. If he has issues, we can discuss them at that visit.”

I relayed this to Mr. Man, and he again indicated his determination to remain. I returned to the nursing station, and invited my friend the security supervisor to show his smiling face, so that we could confer. My friend the security supervisor had no new input, although he sent a couple of officers to stand by the floor, in case Mr. Man decided that some interpretative dance, so to speak, would make his case more effectively.

Shortly, the med nurse was passing by, surprisingly enough, passing her afternoon meds. I stopped her. “Do you have any meds for Mr. Man?” She consulted he med book. “Yep, he has (whatever) due at 2 o’clock!”

“Hand it to me. I’ll take this one over from you.” I placed the meds securely in the med room, and returned to my chat with security. Sure enough, as I had expected, Mr. Man put on his call light, shortly after he noticed the med nurse pass by without stopping. I answered his light (security dawdled just down the hallway).

“Yes, Mr. Man, what can I do for you?”

“I am supposed to get (whatever) around this time. I just saw the nurse pass me by.”

“Why, yes you did, sir. You see, since the doctor has discharged you, you are no longer a patient here, you are now a visitor. It is not our practice to administer medications to visitors, and so the med nurse did not have any medications for you.”

“How am I supposed to get my meds?”

“Discharged patients usually obtain their medications from a pharmacy.”

“I bet you think you’re smart! You cannot make me leave! I’m staying right here!”

“Yes, sir, I understand what you are saying. Is there anything else?”

“No. Go away!”

With a smile, I departed. A couple of hours later, supper time arrived. I removed Mr. Man’s tray, and sent it back to dietary, with the admonition that he had received orders for discharge, a therefore would not require meal service. Indeed, shortly he noticed the aides passing supper trays, and, again, he engaged the call light. Again, I responded.

“Mr. Man, what can I do for you?”

“You could serve me my supper tray!”

“Oh, sir, I’m sorry! We do not feed visitors. You have been discharged, and therefore are present here as a visitor.”

“How am I supposed to get something to eat?”

“A lot of people find that a grocery store is helpful in this regard. Other folks find restaurants to be more to their liking.”

Again, I was dismissed.

In our facility at that time, visiting ended at 2000 hours. Our switchboard operator announced this fact, and bade all visitors a good evening. I popped my head into Mr. Man’s room, and reinforced this message. Security, this time in the person of the security supervisor, accompanied me.

“Sir, you will have to leave soon.”

“I dare you to throw me out!”

Security responded. “Sir, our usual practice is to ask folks to leave. Those who do not depart, are trespassing, and we ask Da City Police Department to handle that. I imagine the responding officers will ID such a person, run a LEIN check, and either walk that person out, or, if somebody were to have outstanding warrants, arrest that person, and lodge them in jail”

Mr. Man again indicated that our audience with him had come to a conclusion.

Outside the room, we heard one sided conversations as of telephone calls, and, from what we could discern, seeking transportation. Again, shortly, we were summoned by the call light. Mr. Security and I responded, and I (again) asked, “Mr. Man, what can I do for you?”

“I don’t have my prescriptions, and my ride will be here in a couple of minutes.”

“Yes, sir, I’ll get right on that!”

I secured his prescriptions and discharge instructions, and Mr. Security and I returned to the room, where I delivered the instructions and prescription, and then the security supervisor and I wheeled Mr. Man to the door, where he sprang from the wheelchair, entered a vehicle, and exited our lives. Whew!