Guardian Angel, Working Overtime

So, TINS©, TIWFDASL©, working a weekend gig in a very, very rural corner of The Un-Named Flyover State. I was a mid-level in, completely out of character for me, a very, very rural hospital’s (VVRH) walk in clinic. I was working with an LPN, a woman of sense, alertness, and industry. Sometimes, Blessings are not obvious.

So, mid morning, she gave me report on Our Next Contestant. Late 20’s fellow, had complained of back pain for a week or two, and he attributed this pain to “I pulled my back, working out doors”. So, this was long about February, and in VVRH’s catchment area, it was mighty freaking cold. Snow, long about hip deep, lined the roadways, and the roads, themselves, had been plowed, and, in keeping with Flyover State Rural Road Commission Operating Procedures, had *NOT* been salted. Since everybody got their water from wells, and most of us thought that salting our water was ill advised, the roads had some sand applied, “upstream” of intersections.

I listened to the vitals, and noted her assessment that “this guy doesn’t look right”. I entered the exam room, introducing myself. He told me that he had started to hurt a couple of weeks prior, the pain in his back, described as “Like something tearing”, had increased with time, despite his employing the ever popular intervention of “ignoring it, hoping it would go away”.

Having concluded on this beautiful sunny 8º F day, that is was *NOT* going to get better, he had WALKED three miles into town, by his estimate, seeking help.

He had muscle spasm in his back, true enough, but something about his story sounded several degrees out plumb. I palpated his belly, and felt something therein pulsing away. He also reported that my pushing on his belly, made his back pain worse. I was not certain what it was, but I was pretty sure that this was way, sway above my pay grade.

I phoned the ED physician, spun my tale of oddness, and he accepted my patient. My nurse wheeled him down the hall to Emergency, and we plodded through the rest of our day.

Nearing the end thereof, the ED physician walked in my door, and told me a story, featuring my long walking friend. He, the physician, had also thought that the examination, along with the back pain, was odd, and so he, the physician, had CT’d my patient. That study revealed a honking big, seriously dilated abdominal aortic aneurysm (a dilation of some part of the aorta, in this case in my patient’s abdomen).

For those in the studio audience who are not medically inclined, the aorta is the single largest, highest pressure, artery in your entire body, running about 2 cm in the area just below your diaphragm, about at the level of your renal (kidney) arteries. Those of us who have studied the US Military’s tactical trauma care course, or have had some sort of “care under fire” training”, will have learned that, should the aorta be penetrated, either by projectile or through a rending of it’s wall, the entire blood volume of an adult male (running around 5 quarts) can empty out in something approaching a minute, plus or minus. One thing that places you at risk of experiencing that, besides the projectile-through-your-aorta thing, is having a large aortic aneurysm abruptly rupture.

Of course, in VVRH, there was no abdomino-thoracic surgery service. My friend the ED doc attempted to arrange a transfer for this fellow, only to be SOL (Surenuff Outa Luck). The roads in our corner of the state were being snowed in, and therefore ground transport to pretty nearly anywhere was not going to happen.

Doc cast his net more widely, and more widely. Adjacent State Big Time Medical Center would accept him, but, alas, we would have to figure out how to beam him up transport him there. Middling Outstate Medical Center could not accept him, since they had no vacant ICU beds, which our new friend would certainly require, assuming he survived (a) the trip, (b) the surgery, and (c) the post op period. Any one of which could end him.

Next Up Upstate Medical Center, alas, similarly had no ICU vacancies, and so, finally the physician negotiated a transfer to Downstate Academic Medical Center, who, miraculously, sent a fixed wing aircraft and critical care transport team to our little single runway county airstrip.

A couple of weeks later, I was working a weekend as was the physician in question. He made a point of strolling over , and relating the above to me, both because it was remarkable that the patient had not only survived the trip, as well as the surgery, and the recovery, into the bargain, but was home, and evidently neurologically intact. The doc knew this, because this fellow had come into ED seeking care for a sprain or some such thing, that he had newly acquired, working outdoors!

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The “Wrecks” Story (or) How I Met My Vet

A long, long time ago, TDW-Mark I, our children, our dog and I lived basically right down the block from where I type this today. This particular tale is about the dog. The children had been allowed to name him, thinking that we would spell the name the way that they would, as “R-E-X”. However, TDW-Mark I was possessed of a considerable sense of humor (at one time…) (after all, had she not been married to me for nigh onto 20 years?). SHE determined the spelling, “W-R-E-C-K-S”. This was due to the fact that he resided in a household with adolescent males, who were, themselves, high spirited. Therefore the dog was, himself, well, energetic is a kind way of phrasing it.

So, TINS, one morning we awakened, let the dog out on his chain, and settled in for breakfast. After several hours, we noticed that the dog had not barked to be let back in, his usual practice once he had had enough of The Great Outdoors. We looked to see what was up, discovering that the chain had broken, and the dog was not in evidence.

We searched the neighborhood, finding no trace of the dog. We produced “lost dog” flyers, and mounted them at intervals about our corner of our small town. That produced no results.

After a day or two, TDW-Mark I sent me to the local police department, The County Seat Police Department, and I learned that one of their officers had encountered a dog resembling our missing Wrecks, who had been struck by an automobile, and had been transported to a local vet.

I traveled to the vet’s office, and asked after our dog.

This vet confirmed that he did, indeed, have my dog, and that the dog was surprisingly uninjured after his encounter with the car the previous evening. This was determined after x-rays and examination. I asked him how much I owed him for his care. “Nothing. You don’t owe me anything.”

I persisted. “You spent no small amount of your time, and your expertise, on a dog that you had no idea if he would ever be claimed. I get that you do so out of the goodness of your heart, and as a service to the community. On the other hand, I can pay for the care you lavished on my dog. Indeed, if you insist on thinking of it this way, you can imagine that I am paying for the other critter, that goes unclaimed, such that you are not required to pay out of your pocket, for performing a public service, simply because you can do so, and it needs doing.”

I took a deep breath. “It offends me to think that you are going to be leeched off of by some schlub. I am not going to be that schlub. If for no other reason, please take my money because you ought no be penalized simply because you are a nice guy.”

He told me, “Thank you, but, really, you do not owe me anything. Thanks for the thought, but, we are good!”

I smiled and replied, “So, in that case, here is a check for $150. The next time somebody’s dog gets injured, and they cannot pay you for their care, let me help defray the expense you incur.”

And, he has been my family’s vet ever since, going onto 25 years.

GRATITUDE

My mother died last month. She had passed her 100th birthday, and was living in the house she had occupied for something like 40 years. The immediate trigger to her death was liver failure, occasioned, most likely, by an adverse interaction between anesthetics and a century old liver. She had fallen, a couple of days prior, and fractured her hip. The surgery, fortunately, was for this sort of thing, uncomplicated, and she evidently tolerated the surgery side of the affair pretty well.

That is to set up the following deliberation. Gratitude. My mother was able to spend her last months in her house, because my youngest brother pretty much dropped everything, and moved in with her. The woman who has been his family’s housekeeper for something like a generation (from well before The Plaintiff became The Plaintiff, in fact!), also dropped her comfortable daily routine, and became my mother’s de facto practical nurse. Wordy as I am, I am unable to adequately describe my gratitude to my brother, and (let us call er…) Angelica. I thanked them both, even though my brother sloughed it off, “You would have done the same, if you had been able. Hell, you *did* do the same, for Dad.” Angelica simply smiled, sniffled a bit, and turned away.

Mom was able to live pretty independently in the two years prior to that, due to my middle brother, and his wife, let us call her “Donna”. Due to Donna’s efforts, in particular, Mom was able to live in her own apartment, have her dog with her, and, generally, run her own life. Donna made certain Mom got to her doctor appointments, got and took her medications, had her clothing laundered, had food in her frig, and that the dog got walked. All this on top of running her, Donna’s, own household, and helping her husband, my brother, run his business. Thank you.

Prior to that, well, there are, and were, neighbors who looked in on Mom. Then, there is The Car Service Guy. https://wordpress.com/post/musingsofastretcherape.wordpress.com/431 During one power failure (different from The Car Service Guy story), her neighbors physically took her in, where she stayed at their house, warm due to their generator, eating their hot food, and remained until the power was restored. Without these folks, not a one of whom was any sort of kin to my mother, she could not have lived in the house that she loved, for as long as she did, as nearly independently as she did. Thank you. God Bless you.

Police officers in her town, on a couple of occasions, looked in on her at my, and my brother’s request, and reported back that she had been fine. Thank you.

Several of my youngest brother’s friends, living “only” one state over, would drop in on her a couple of times a year, helping make sure that she was getting on alright, and providing an “eyes on” report to my brother. Thank you, as well.

I have to say, the shriveled vestigial organ where my heart may have once resided, is warmed by the good example of these folks. Not for them the bullshit “You voted for Trump! Demon!, or “You voted for Biden! Traitor!”, pejoratives that seem to pass for political discourse. Simply, good people, watching for their neighbors, and living the admonition, “Whatever you did for one of the least of these brothers and sisters of mine, you did for me.”

Good people, good examples. Thank you.

Phone Company Follies

I had moved from Da City, to a more rural corner of the state. I accepted a job there, as a nursing supervisor. Since my medic license was active, I planned to volunteer with the local rescue.

In the course of securing housing, I arranged for utilities: electricity, propane delivery, and phone. Given the very rural nature of this county, and the presence, here and there throughout the state, of party lines, I inquired about same. Indeed, my question to the person taking my phone order was, “Since I am going to be a nurse for the local hospital, as well as a volunteer with the local rescue, having a private line will be very important. Will I have a private line?”

Her reply, verbatim, was “Private line? No problem!”

I subsequently learned that in Bugtussle, or wherever this particular numbnut was, the meaning of the phrase, “no problem!” was altogether different from the meaning I had become accustomed to.

I learned this when my phone rang (and, differential ringing was whole ‘nother mystery, that I did not understand at that point in time!), I picked up the handset, and found somebody-indeed, two different, and stranger to me somebodies, at that!- greeting each other.

I inquired of my colleagues at work, they being wise in the ways of rural living inasmuch as they were, well, already doing it. I learned that there was such a thing as differential ringing, that in my corner of the county there were, indeed, party lines and that it certainly appeared to be the case that I was the proud subscriber to one!

Against my will.

With this insight in mind, I telephoned the local office of the telephone company, and asked about my “private line”. I learned that the plans called for me to get a private line sometime after the year 2000. This, in a conversation taking place in 1989.

I was not (favorably) impressed.

I next called the regional office, and spoke to the Schmoe In Charge Of Taking Calls From Disgruntled Customers. This schmoe informed me that the new millennium could be celebrated, likely, by me placing calls on my new, and private, telephone line.

I reviewed the “Private line? No problem!” statement of the employee, the fact that I did not, in fact, have a private line, and that due to work and volunteer considerations, this was, and would remain, unsatisfactory.

While it was not phrased that way, the resulting communication could be summarized as “Tough luck!”.

I next uncovered, and called, the number for the Midwest Schmoe In Charge Of Taking Calls From Disgruntled Customers. I learned that the the construction plans for this telephone company did NOT include building out private lines in my corner of the state until after 1999, ten years hence. I reviewed my previous conversation with the order taker, and suggested this was inconsistent with what that worthy had stated would be fact.

Again, while it was not phrased in these words, I was told that that would be my tough luck.

So, I called my Un-Named Midwestern Fly Over State Public Utilities Commission, and was connected with the gentleman charged with fielding complaints regarding, among other things, the telephone companies.

He introduced himself. “Nikolai Tesla. What can I do for you?”

I suggested the position was ironic, given his name, and he agreed. I began my plaint. I reviewed the “Private line, no problem!” misdirection, and my unsatisfactory climb up the chain of command, seeking redress from the phone company. I interjected, “You know, it is ironic that I am calling you in the first place. I tend to be small government, minimal regulation, best government is least government sort of guy.”

He paused, then asked, “Do you mind if I savor that irony, for just a minute?”

“By all means, savor away!”

We resumed our conversation, and Mr. Tesla took my contact information, and promised that he would keep me posted on new developments.

I next called my representative in The Un-Named Flyover State, State Legislature. I spoke with a legislative assistant, and reviewed the material, presented above. I told this soul that my desired outcome was that my representative’s office would hound the PSC over my complaint about the phone company, and that I would be invited to any hearing, the next time the shitweasal telephone company wanted any sort of rate increase. The aid promised me that they would make a few calls, and look into things.

I spent the next couple of weeks fighting disease, and saving lives. (Bet you wondered if I was gonna work that in, somehow! Well, wonder no more!) Since I was working 3-11, I tended to rattle around my residence for several hours after work, before going to bed, awakening generally at the crack of noon. So, I was surprised one morning around 0800 to be awakened by the noise of a barely muffled engine, seeming to arise from the end of my driveway.

I dressed, and walked to the street, asking the workmen there what it was that they were doing?

“We’re putting in a private line. You did want a private line, didn’t you?”

“Sure did! Thank you, gentlemen! Carry on!”

I was tempted to ask him if I had overslept, and it was 1999 already?

“Show Me Some Teeth!”

One afternoon, I came in to my shift as a nursing supervisor, and the director of nursing had, it appears, JUST finished receiving a phone call asserting that somehow, the hospital staff had lost some patient’s dentures. Of course, I was the High Value Target in that particular free fire zone, and I caught the assignment. “McFee! You find out what happened to this patient’s dentures! Do not rest until you find them!”

I promised my best efforts, and was reprimanded. “I do not want your best efforts! I want you to show me some teeth!”

Uh, Ok. Yes ma’am!

I inspected the patient room, freshly cleaned by housekeeping. No dentures. I went to billing, the keeper of the valuables, and searched for property that had remained unclaimed. No dentures.

I interviewed our laundry folks, and inquired regarding foreign objects in the washer or drier. No dentures.

I inspected the patient intake form, cataloging the patient’s property at arrival. Of course, there was indeed a notation that the patient had brought her dentures with her to the hospital.

I took a break, and visited the security supervisor. We chatted for a bit, until he asked why I had not been wandering around, and had not been in evidence that shift.

I told him the Story Of The Missing Teeth, and my efforts to transition that tale into a dental retelling of The Prodigal Dentures: “Rejoice! My teeth, that have been lost, have been found! Kill the fatted calf, prepare the feast!”

Along with my, thus far, horrible fail in accomplishing it.

He sat back, and a thoughtful look crossed his face. “So, Reltney, do you need to find THE teeth, or just any teeth?”

I observed that the patient in question might feel a little, well, odd, wearing somebody else’s teeth.

My friend the security supervisor opened his safe, and extracted some ancient dentures. He then clarified things for me. “See these green teeth, here? Now suppose they were inadvertently dropped outside the door here, in the driveway, and some inattentive security officer, like, say, me, were to accidentally run them over, like, six or eight times? I doubt that anybody would put the shards into their mouth, you could show your boss teeth, albeit broken teeth, and so she would be happy, the complaining patient would get new dentures, so they would be happy, and your boss would stop breathing down your neck, and so you would be happy. How many opportunities do you think you will get to make that many people happy, all at once?”