Whenever I Start to Think That I am The Smartest Guy in The Room, I am in the Wrong Room!

Another time, I was fighting disease and saving lives as the afternoon nursing house supervisor. Start of shift stuff had been done, I had made some rounds, and arranged for staff to get off the unit to eat. I was piddling around with some paperwork of some sort, and heard an overhead page of “Code Red: 1 East!”

At that time, in this facility, 1 East was our psych unit. I phoned the switchboard, and she told me that there had been a pull station activated on the unit, and I needed to go verify it before she could call the fire department.

Uh, excuse me? WTAF??!! I directed her to call 911 right freaking now, and communicate the alarm at once. “But, our policy is to wait until the supervisor verifies the fire!”

I told her that, employing the telepathy that had stood me in such good stead in years on the Fire Department’s EMS division, I had just this second confirmed the alarm, and she needed to stop dicking around, and call the fucking firefighters.

I hung up, and took off at a trot for the nursing unit, and unlocked the door.

Immediately, I was happy that the alarm had NOT been delayed. The unit was quite smoky, and the smoke was starting to bank down to about shoulder height. I found the charge nurse, and asked her for report. She reported that every patient had been accounted for, and every one was presently in the day room, with two sets of smoke doors between them and the fire room. One of the patients had, somehow, ignited his mattress, and then things got exciting.

The security supervisor and I did another sweep of each room, double checking that nobody was on a floor, or draped over some furniture. Happily, nobody but the two of us was there. Oh, yes: the two of us and the first due engine company.

The firefighters trundled the smoking mattress out of the unit and into our alley, whereupon they performed a sort of urban baptism ceremony, pouring The Healing Waters Of Engine 56 upon the Sinning Mattress.

The next morning I had a stern chat with my boss, and the phrases “NFPA standards” and “fire code for health care facilities” were flung about. Along with the observation that the reported SOP was ABSOLUTELY inconsistent with the prevailing standard of care.

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Phone calls that make you go”WTAF??!!”

So, TINS, TIWFDASL as a nursing supervisor in a small hospital in Da City. I had checked our afternoon staffing, and accounted for all the staff. I had wandered around, meeting and greeting my staff, and made arrangements such that everybody could eat. I checked in with security, and, as usual, there was nothing happening.

I was back in the nursing office, completing some paperwork or other, and received a call from the switchboard. The operator informed me that Channel 69 news was calling, asking about some patient who had fallen out of a window at our facility. I told the operator to send the call to me, and stat call the security supervisor to meet me in my office, RFN.

The call was odd. (Now THAT is a surprise, idn’t it?) The caller identified herself as a reporter for one of the local stations, and that they had received a report that a patient had fallen from a window, and landed on a roof of part of our building. I responded that this was inaccurate. I knew this to be inaccurate because, in the event that such a thing had occurred, the staff would call me immediately, no such call had been placed, therefore no such thing had happened.

We concluded our conversation, and I turned to my friend the security supervisor. I asked him to immediately inspect our roofs, either in person or with one of his officers doing so in person, and ascertain the absence of anybody (or, any body) on any of our roofs. He hopped right to it.

Next I called each of my charge nurses, and ordered them to immediately, with no delay, personally lay their eyes on each and every one of their patients. They were ordered to immediately call the switchboard to report that they had indeed personally laid eyes on every one of their patients, or stat page me overhead in the event that any patient was not physically on their unit.

One charge nurse protested that she was too busy to perform this task. I noted that this was what we termed “a work order” in our employee handbook, and her options were to get to it, right now, or prepare their soliloquy for 0900 the following morning, wherein they would have the opportunity to convince the director of nursing that they should, indeed, continue their employment at our hospital. Because ANY other response other than “Let me go, so I can get to this”, would result in their being clocked out and escorted from the building, right about now.

Surprisingly, that elicited compliance.

The security supervisor paged me, requesting that I meet him in the cafeteria, that being about the center of the hospital. I arrived and he briefed me: his officers had inspected the roofs, and noticed nothing awry. A couple of his officers had shanghaied the maintenance man, and secured a ladder. They were going to climb up and re-inspect the accessible roofs, to verify what their preliminary survey had suggested. And, nobody/no body had been found.

I physically went to each nursing unit, spoke with each charge nurse, and had them show me their census, along with a report of their actions to inspect each patient. No missing persons. Hallelujah!

I phoned my immediate supervisor, and gave her the short form report. Of course, the long report, in five part harmony, with full orchestration, with circles and arrows and illustrations to fully communicate the entirety of the affair, was waiting on her desk for the morning.

Health Care Stagecraft

So, I see children from time to time. Commonly, they are dubious about the entire “Going to the doctor” thing (yeah, I DO realize that I am not a physician, I am a midlevel. May I observe you explain that distinction, to an anxious child?) With that as a starting point, you can imagine that my approaching said anxious child with a stethoscope, and then with an otoscope (“the ear looking thingy”) might not end well. Yeah, me too.

One of the lessons I learned on Da Street (besides knock from the side of the door, and always have a second way out of any room I enter, and always have a knife, and…well, the important lesson is…..) is misdirection. On the street this manifested itself as changing the topic of conversation, as, on a hostile scene, announcing, “WE have to go and get the stretcher!”, and then both of us doing so, and motoring merrily away from the threatened free fire zone. Returning, if at all, with police.

In a more sedate clinical setting, this manifests itself with my (now) stock spiel for kids.

“This here (hold stethoscope up) is my body tickling thingy. Now, this is really, really tickley, but I only have one, right? That’s not enough to share. So, if you laugh, everybody will know how much fun it is, and they will be sad. ‘Boo-Hoo! (insert child’s name here) got tickled, and I didn’t! That is so unfair! I am so sad!’ Now, we don’t want them to be sad, do we?” (generally, toddler-sober negative head wag) “So, try very hard not to laugh, so that they are not sad! Okay?”

(generally, “ok”)

Once heart and lungs are auscultated, I continue with my misdirection. “You did so very, very well in not laughing, now we move up to the ear tickley thingey! Same rules, try not to laugh so that they do not know how much fun it is, and they are not sad that I cannot share, okay?”

Generally, again, “Okay.” While the child is trying to identify what the heck is so darned tickley about otoscopy, I finish.

One bonus point, is, even if the child screams and kicks and writhes, I can congratulate them. “Wow! You did so very well! I don’t think that they even suspect how much fun that was! You can stop pretending, now! You have successfully finished! Well done!”

Sometimes it is healthcare stagecraft, that lets you complete your job.

Duty.

Occasionally, I am humbled. Sometimes, I am moved to tears.

So, TINS©, I was lolling around the house on Christmas Day. TDW-Mark II and I were casually surfing the web. I had my handheld amateur radio on, monitoring our county’s fire dispatch. Because, well, I can.

In our county, emergency personnel are generally volunteers. The EMS is paid/full time, Sheriff and local PD are paid/full time, but the firefighters and rescue are volunteers, dispatched by pager. The tones dropped for a cardiac arrest, CPR in progress, in the outskirts of the county. Now my county is rural, primarily (by surface area) farmland. The ambulance was called out, as well as the County Seat Fire Department (Hereinafter, CSFD).

I heard EMS acknowledge, and the duty fire chief as well. He (the chief) directed that the firefighters respond without him, as he was a couple of miles from the scene and would respond directly.

Dispatch then filled in the dispatch information, beyond the address. A 70-something male had collapsed. CPR was in progress. He was vomiting, and the family was clearing his mouth as best they could. A couple of minutes later (likely that seemed like days, to the folks on the scene, performing CPR on one of their family!), the fire chief called out on the scene “Chief on scene with one firefighter. Sheriff on scene. Dispatch, roll one engine for manpower.”

So, let’s “dolly back”, and consider this. With the possible exception of the deputy (who might have responded, off duty, from home in his patrol car), all these folks were snug in their own homes, fat, dumb and happy, savoring the anniversary of The Birth of Our Saviour, as well as immersing themselves in the excitement of the children at All! The! Presents! they had received.

They carry pagers because, well, that’s what they do. More likely than not, they do not see themselves as heroic, or making sacrifices, because, after all, in most of America (hell, I suspect in most of the world), the men and women performing these jobs simply see themselves as doing what needs to be done, because they are able to do so.

And therefore, when the pager alerted them, they grabbed their coats, put on their boots, and left their warm and happy homes, heading to somebody else’s home, someplace where, as Chief Dennis Compton of Mesa, AZ Fire once described it, “We are responding to somebody’s worst day of their life”.

So, as I imagine it, the duty chief was enjoying a Christmas with his family, the tones dropped, and off he went. Before he could get out of the door, one of his sons, or maybe a son in law, (or daughter or daughter in law, here in the 21^st century) said something like, “Hey, Dad! Hold up a second! I’m taking that call with you!”

These folks voluntarily immersed themselves in another family’s tragedy. Strove to hold the line, to reverse the evident course. Went to work on Christmas.

When the firefighter came on the radio requesting the sheriff department’s (volunteer!) Victim Support Team, I could call that play. I do not know if I teared up at the family’s terror, at their loss, at the fact that forever more Christmas would not hold happy childhood memories, but, rather, would be “the day grandpa died”, or if I teared up thinking of the folks who, simply “doing their jobs”, had left their warm homes in response to some stranger’s plea for help.

But, I wept.

Please, give a thought to those who respond to those calls, today and every day of the year, all over the world.

And offer a prayer on behalf of those they go to rescue.

Comments

I enjoy comments. Comments mean both that somebody read my post, and, also, considered it and having considered it, was moved to respond. Good Times!

Some of my comments appear to be written by individuals who do not speak engrish particularly well, or, and more likely in my opinion, are authored by software.

Which is one reason I am not worried about “AI” taking over health care.

For your entertainment, here is one example.

“Hi there, simply changed into alert to your weblog through Google, and found that it’s really informative. I am going to be careful for brussels. I抣l appreciate if you happen to continue this in future. Lots of other people will be benefited from your writing. Cheers!”

For Ghawd’s Sake, Please, please, please, be careful for Brussels!

The Reveal!

You may not be surprised to learn that I spend considerable time meeting folks, and some of those folks do not bowl me over with the force of their intellect.

Occasionally, somebody who does not otherwise impress me as being particularly dull witted, appears to decide that The Reveal is needful, NOW!, and therefore proceeds to impress me that they are, in fact, an idiot.

So, TINS, TIWFDASL, and I was interviewing some soul about his particular malady. As is my usual practice, I inquired about what symptoms had precipitated today’s office visit, duration of symptoms, what had been done prior to visiting me to address the symptoms, simply as a beginning.

So, this soul related that his symptoms had been treated on a couple of previous occasions, in the past month, and had transiently improved, and then returned. He had, so he told me, been treated with “an antibiotic”.

“What antibiotic?”

He did not know. “The antibiotic that they prescribed for me.” (as helpful as THAT is….)

“How long did the doctor have you taking that antibiotic?”

“Until it ran out.” (Certainly. Of course.)

I attempted to discern how long it had taken before the antibiotic had run out, since treating Malady “A” might call for a 5 day run of The Z Pak (boo! Hiss!), whereas Malady “B” might be addressed by 28 days of Doxycycline, for example. Ya know, just as if I cared what had elicited this gentleman’s symptoms, with an eye toward, oh, gosh, I don’t know, maybe TREATING HIM EFFECTIVELY, or something.

At this point, he felt it relevant to review some of the high points of his resume. For some reason.

“I’m college educated! I’m not an idiot!” (uh, sir? First, college educated maps poorly onto “not an idiot”. Not a very high correlation. Secondly, in circumstances where you wonder if it might be appropriate to reassure somebody that you are NOT an idiot, it is very likely that you are about to reinforce the impression, that you ARE an idiot. That certainly has been my experience in my own life, you may want to consider if there might be some parallels in your own.)

I somehow got back on track, and began my review of systems. At this point, he revealed that, in his estimation, “You are being dismissive of my concerns!”

HUH? Inquiries about your allergies, medications, and medical history are not “my attitude”. That’s how I attempt to avoid prescribing something to you that you either are allergic to (and you did not mention to my nurse….), or that might interact malignantly with your regular medications. For example, I dislike eliciting a GI bleed (stomach bleed: think bleeding ulcer) simply because you did not think that it was relevant that you take coumadin (a blood thinner), now that you are here for your orthopedic injury. Should I prescribe ibuprofen (popularly known as Motrin), that in combination with your coumadin might lead to a life threatening GI bleed, and I feel that to be a bad thing. Occasionally, that review of systems elicits something kind of important, like chest pain or difficulty breathing, that you forgot to mention, because your ankle pain is the only thing that (for some reason) you are concerned about.

But you are paying me to be concerned about that other, life threatening, stuff, and have the wit to not miss it.