“This is no shit….”

Occasionally, I receive a comment to the effect that my acronyms are confusing, and my correspondent has been unable to divine their meaning. (which would be why I have a tab captioned “Abbreviations, Acronyms, Jargon and Terms of Art”). Perhaps it might be entertaining (well, I might be entertained!) should I review how that particular preamble arose.

Something on the order of 40 years ago, the magazine Soldier of Fortune had an article about “War Stories”. Near as I can recall, from the mists of time, there were three essential elements of any good war story.

First, the Obligatory Disclaimer: “This is no shit!”

Second Required Element, The Required Preamble: “There I was, fighting disease and saving lives….” (In the SOF formulation, it was more along the lines of “fighting communists and defending Freedom…”)

Third Required Element, The Compulsory Thematic Element, wherein The Narrator is a HERO, of Olympian proportions, overcoming impossible adversity.

So, there I was, seated on the bench (yes, reminiscent of “The Group ‘W’ Bench” of Arlo Guthrie/Alice’s Restaurant fame) outside the Department Doctor’s office. The preceding evening, while carrying some soul out of their house on West Boulevard, the gusts had lofted some speck of debris into my eye, and I had reported same to my supervisor, who had sent me to ED and those worthies had sent me home for the evening. In order to return to duty, I had to be cleared by the Department Doctor.

I was seated among a batch of firefighters, and we all were swapping stories of how we had come to receive orders to report here. This fellow slipped on wet pavement and had wrenched his back, another had injured his knee, and was only awaiting clearance from the department to return to duty, since his orthopedic surgeon had released him post operatively.

The next guy to tell his tale clearly had been schooled in The Grand Tradition of Firehouse Stories, and rolled right into his story. “Yeah, we caught an alarm, and the first floor was pretty well involved. We knocked it down with the deck gun, and started an interior attack. So, there I was, fighting fires and saving lives, and the floor fell in! Dumped my ass into the basement! Everybody was pretty excited, until they dragged me out, and found I was only banged and bruised up. The chief sent me to the hospital, they sent me home, and now, here I am!”

My turn. “I was on a run on The Boulevard, and some dust got blown into my eye…” (“….and they all moved away from me on The Group ‘W’ bench…”) “…and the lieutenant ordered me to go to ER, and they put me off for the night. I thought that it was overkill, but, what are you gonna do?”

They all moved back, and one offered, helpfully, “Kill a morning outside the department doctor?”

Yep, pretty much.

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Self Defense Cost Benefit Analysis

TINS, TIWFDASL, I had caught the detail, and the happy go lucky soul with whom I was working that particular night on Da City’s EMS, decided it was time to ask me about my ballistic vest. Now, it was not any sort of secret among members of the department that I wore a kevlar vest. After all, in Those Days, Da City was known as “The Murder City”, and not without some justification. We chatted about the threat profile we confronted (although, the chat went along the lines of “What? Do you expect to be shot?” My response was “Nope. I wear this for those scenes on which I do NOT anticipate being shot. On those on which I anticipate being shot, I will simply refuse the run until the police have secured the scene!”)

This guy, no doubt thinking himself clever, pronounced, “Well, if the scene goes to shit, I’ll run out, and you follow me! That way, your vest will protect both of us!”

My rejoinder was, “In that case, you had best be certain that you do not slow down, lest you have my bootprints all up your back, as I run you over!”

Later, my partner and I discussed the vest and EMS. He asked, non-snarkily, how I had come to the conclusion that the vest was the way to go.

I noted that the vest cost me about as much as a Colt Government Model in .45 acp.

It was not a felony to wear the vest concealed, in contrast to the Colt.

It was not a black letter violation of department regulations, in contrast to the Colt (or any other firearm).

The vest would not inadvertently discharge, in contrast to the Colt, where that was a potential problem.

The vest was not going to drop out of my pocket, on the floor of the ED, in front of Ghawd and Everybody, in contrast to a handgun which another of our peers had won the opportunity to explain.

I would not in any circumstance hesitate to use the vest, in contrast to the Colt.

Finally, I was interested in meeting the soul who could relieve me of the vest, and hurt me with it, again, in contrast to the Colt.

So, I wore a vest. Others, or so I was told, elected to wear a firearm.

Parenting Skills

I was interviewing a soul, who had brought their spawn along with them (because, why WOULDN’T you bring your 5 year old to your urgent care visit?). Said spawn (of course) had no self entertainment skills, likely due to the screen the named patient/parent placed into his hands immediately upon his whining that he wanted the phone, right now! While I was endeavoring to elicit nature of present illness (eg: what are your symptoms, and why did you determine that coming to urgent care was the thing to do?), duration of present illness (and, please Ghawd, please, say something more specific than “a good little while!” Pleasepleaseplease!), and provocative or palliative factors affecting this illness, said sprat was entertaining himself with the phone, and, it developed, felt the burning need to experience the sound track in his very marrow. In order to accomplish this task, he set the volume at eleven. Of course, in the confined space of the examination room, it was deafening.

I stifled my initial impulse to wrest the device from his hands, dash it to the floor, and grind it beneath my heel, all the while shrieking “Kill! Kill! Kill! Kill!…”, and then, settle upon my seat, and, calmly, ask, “Now, where were we?”

Instead, I continued to ply my patient with the appropriate questions, in a normal, soft, tone of voice. Of course, the named patient could not hear a damned thing I was saying. I smiled, and repeated my queries in the same, soft, calm tone of voice.

Still, the cacophony drowned out my every word. I smiled, and paused. The light began to dawn in my patient’s eyes. She turned to Little Jimmy (or whatever this child’s given name was), and directed him to silence the device.

He whined that he could not hear, should that happen. She repeated herself, and he again whined.

Then, in a feat of effective parenting nearly unsurpassed in my clinical experience, she retrieved the phone, silenced it, and pocketed it. Little Jimmy whined and groused, but his mother turned to him, directed him to quiet down, lest they “have a chat” in the vehicle, and turned her gaze, again, in my direction.

Miraculously, Little Jimmy settled down. I completed my examination and interview, and everybody went their separate ways.

Dr. Google. Again.

Shocking as it may seem, when I interview a patient (and examine same), I actually have a plan in mind. In the course of that interview, and that exam, I have both findings that I anticipate finding, as well as findings that, should they be present, redirect me from my initial assumptions.

That might be considered “testing my hypothesis”. Sort of like, oh, I dunno, as if it were derived from the scientific method, or something.

So, therefore, when my next patient’s opening conversational gambit, in response to my introduction and query, “what can I do for you?”, is something like, “Give me something for my bronchitis”, well, it is sort of at a tangent to the information that I am seeking.

For some reason, I assumed (yeah, I know….) that the diagnosis part of the interaction was, also, **MY JOB**, along with the plan of care part.

I tried again, in a different manner. “So, what sort of thing led you do conclude that you have bronchitis?”

“I googled it.”

Not helping. For some reason (perhaps I am a glutton for punishment), I tried again. “What sort of thing did you google, in order to establish that you had bronchitis?”

“My symptoms!”

I had a couple of competing thoughts right about then. One was, ONE MORE STUPID ANSWER! JUST ONE! would lead me to remedy their zithropenia and depart. Another was, I was soon going to have problems buying hats, due to the hornlike callus that I was certain was growing from my forehead, secondary to beating my head against just this sort of wall, repeatedly. The third thought, and the one upon which I acted, was that I both had a professional obligation, as well as a morbid fascination, to pursue this conversation, and determine if I was, ever, going to elicit a recitation of symptoms, history of those symptoms, efforts already undertaken to mitigate those symptoms, and how those symptoms have progressed, if indeed they have progressed at all. Oh, yes: and if there were any illness among this soul’s acquaintances.

The conversation continued, with, painfully extracted, the retinue of symptoms seeing light. I conducted my exam, and, unsurprisingly, found this individual had mucoid post nasal drip (just like every other soul in The Un-Named Flyover State!).

Mr. Google asked about an antibiotic. I reviewed my examination findings: breath sounds did not indicate any pneumonia or bronchitis, and therefore, an antibiotic directed at same would be targeting problems that he did not have. Eardrums were not red or bulging, indicating the absence of a bacterial middle ear infection, and therefore an antibiotic for a bacterial middle ear infection would be treating a problem that he did not have. The back of his throat was not red, nor swollen, and did not have the patchy exudate universally described as “white spots”, and therefore strep pharyngitis was not among his maladies, and treating a strep infection that he did not have, would provide him no advantage.

I concluded with the observation that he **DID** have post nasal drip, one’s throat was, apparently, not well engineered for post nasal drip, and commonly became irritated, with this irritation manifesting itself as pain and a sore throat, or a “tickle” and a cough, or both. I continued to note that reduction or resolution of his post nasal drip, accomplished by my stated plan of care, would remove the stimulus for his cough and therefore, address his symptoms as well as his problem.

I refrained from asking if Google had explained THAT shit to him? Hmmmm?