PROFESSIONALISM

While my divorce was unwinding, I was working midnights in the ED of Mid Sized Hospital in the Adjacent Relatively Big City. I had a seven on/seven off schedule, which worked out pretty well for the week on/week off custody schedule for the youngest two kids.

So, TINS©, TIWFDASL© (well, to be precise, I was standing in my kitchen, looking around to see what I had forgotten to pack for the night to come), when my phone rang. My darling daughter was on the line. “Hey, Dad! How would you like to come over and take a look at your grand daughter?”

“I’m always up to visit my grand daughter, as well as her mother! What’s the occasion?”

“Well, Carmen is having some difficulty breathing, and I’d like you to look at her and tell me what to do.”

“Be right over. Unlock your door!”

A couple of minutes later, I was knocking on her door, stethoscope around my neck. Brenda opened the door, and I heard Carmen wheezing from across the room. “Call the ambulance, right now!”

Brenda was unconvinced. “Dad, if we call the ambulance, they will simply take her to Local Small Town Hospital. They will simply wind up transferring her to Next Town Big Hospital. Why don’t we just drive her to Big Hospital, ourselves?”

Good time for me to collect data. “Honey, do either you or baby daddy know CPR?”

“Um, no.”

“Y’all have oxygen in your car?”

“No!”

“You guys have any way to alert Big Hospital ED that you are coming in hot with a critically ill child?”

“You know we don’t!”

“So, let’s call EMS, who do indeed know all those things, and have all those things, so that they can treat Carmen properly, hmm?”

“We’ll just drive her over to Small Town Hospital, ourselves.”

“NOW, sweetheart. Right now!”

“I just have to…”

“No, you don’t. Get your ass on the way, right freaking now, and no more delay. Now!”

As they cleared the door, I phoned Local Hospital ED, where I had been an ED nurse, and provided a heads up. “Hey, my daughter is on the way with my grand daughter, who is in respiratory distress. Under a year of age.”

“When will they be here?”

“Open your door, now!”

I locked up, and made my way to Local ED. Once there, I saw the staff meeting that was a pediatric critical child. The ED physician was in the room, my daughter and baby daddy, two ED nurses, a respiratory therapist, the lab, and a couple of other folks that I could not make out in the crowd. I spoke to my daughter, and told her that I was off to work, and I’d stop by in the morning to see how things were going.

I called my daughter the next morning, on my way out of work, and met her at the Big Hospital Peds ICU. She told me that, unsurprisingly (to me), Local Hospital had tested, x rayed, oxygen-ed, and IV-d Carmen, and then transferred her to Big Hospital, via Peds Mobile ICU ambulance. Carmen was considerably improved over last night. I could not hear any wheezing, and she appeared to breathing easily within her oxygen tent. I said my hello to Carmen, ascertained if my daughter needed anything from me, and said my goodbyes to return home, and to bed.

Carmen was discharged the following day, and Brenda had a ream of instructions, as well as the opportunity to administer breathing treatments, as well as oral medications, to an infant several times daily. As a civilian, not a nurse.

A couple of weeks later, I was again preparing for work, and, again, received a phone call from my daughter, again inviting me to visit Carmen. “Always delighted to visit. What’s the occasion, this time?”

“She’s struggling to breathe, and the breathing treatment did not seem to help today.”

I instructed Brenda to immediately go directly to Local Hospital ED. “But, they will simply send her to Big Hospital again!”

“Yep, that is entirely likely. As is the fact that they will send her in a peds MICU, with a physician, respiratory therapist, and a couple of paramedics. All of which I highly approve of. Now, get going, right now!”

I, again, met Brenda at our local ED, again Carmen was the center of a veritable staff roll call in the treatment room, and, again, that evening she was whisked as described, approvingly, above, back to peds ICU at Big Hospital.

I stopped by the next morning. Brenda greeted me. “Dad, just like you said, they transferred her by ambulance back here. When we arrived, all the ICU nurses remembered Carmen, and were crying as they brought in the vent, the crash cart, and the intubation cart. Mom was here, and, gotta tell you, I was trying as hard as I could to keep it together for Carmen. The nurses’ crying was *NOT* helping! If mom had not been here, I would have lost my mind!”

I replied, “Honey, your mom is a pretty good nurse, and she keeps her head really well in a crisis. I’m really glad that she was here for you!”

And, at that point, I did the smartest thing I had done in a while. Right then, I shut up!

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“He Didn’t Have To Be”

Well, campers, the sun is shining, it is 40-something outside, and that means that, in The Un-Named Flyover State, it is time to start sunbathing!

Well, almost, but not quite. In any event, it is time to reflect, gratefully, on the looming advent of spring. And, that turns me back to my recent theme, gratitude and thankfulness.

In 2006-2007, The Plaintiff divorced me. It was a dark time. I had taken-for-granted (perhaps, one of our problems, right there?) that she would always be there, and that we would always work through our rough spots. I was, of course, mistaken, and the divorce provided irrefutable evidence of same.

I was immersed in depression, and found myself weeping at traffic lights, for example. (Has anybody else experienced the angst, the melancholy, pouring out of a RED LIGHT?) (uh, no? oh, ok. Maybe it was simply me…..)

It was in the midst of this self pity party, that my step daughter (who I have everywhere else referred to as my daughter, as that is how I view her, notwithstanding the fact that she has none of my chromosomes) made for me, and gave me, a Christmas gift, that I treasure to this very day.

Brad Paisley has a song, on his Who Needs Pictures album, entitled “He Didn’t Have to Be”. The narrative is a step child (in Paisley’s, and his co writer’s case, a son), who gets included early on in his single mother and (to be) step dad’s activities, and how that forms a family. My daughter copied that song, and created a slideshow, set to that song, of photographs of my children, their mother and I, as our own family formed, and grew.

I wept. At the time my daughter created that slideshow, she was, herself, a single mother, working full time, as well as going to school full time. Her child, my oldest grand daughter, had spent more than a little time in pediatric ICU. My daughter had spent who knows how many hours collecting those photos, organizing them, arranging them, including that song, knowing that it would touch my heart, perhaps knowing, even, that I *needed* that memoir.

That was the single nicest, most apt, most engaging Christmas present, that I have ever received. She gave it to me for Christmas 2007, and I played it, again, today.

Over 13 years later, I wept, again. Thank you, honey. You have touched me, again. Still.

For so many reasons, I am grateful for my children.

Kharma

This looks like it’s going to be a lengthy spiel. Hope y’all are ready!

Perhaps, in previous ramblings, I have touched on the assertion, I credit it to Ragnar Benson, relating that, if one were to consider the deaths and illnesses attributable to contaminated water supplies, it is not unrealistic to consider that it is entirely likely that plumbers, and assurance of safe water that is their stock-in-trade, have preserved more lives, and done more to alleviate human illness and suffering, than all the physicians ever born.

I remember this thought every time that I am credited with saving lives, or some such stuff. I am as good as I am, in large part due to the folks with whom I work.

And, then there is the lay-of-the-land aspects that can accompany cordial relations with your co-workers.

So, TINS©, TIWFDASL© in a walk in clinic in Da Nawth Country. It had been somewhat tumultuous , negotiating with my locums company, as they had contracted that I start on “Date A”, yet, 4 or 5 days prior to “Date A”, had informed me that things were not organized as needed, and some aspect of my credentialing was awry, and therefore I was not going to start on “Date A”. Therefore, I was not going to be getting paid, starting on “Date A”.

I acknowledged this tidbit. I asked when they anticipated my starting work, and starting receiving pay.

My recruiter could not tell me.

I noted that I had a contract stating that I would be working for The Locums Company, starting on “Date A”, and I anticipated starting to receive pay from The Locums Company, beginning on “Date A”.

The recruiter protested that, since I was not fully credentialed, I could not work, and therefore I would not be getting paid until all these wonderful things came together, and I was, indeed, working.

I set a limit. A hard limit. “Well, simply so that you understand how things will work, *SOMEBODY* is going to be paying me, starting on “Date A”. Your input into this conversation, is will it be The Locums Company, or will it be somebody else. And, just to make everything even plainer, whoever is paying me on “Date A”, will have my loyalty. That means that, if you folks are *NOT* the ones paying me, and you abruptly get your shit together, and invite me to start working at your client’s clinic, well, I am not about to pimp the folks who are providing me with a paycheck, simply because your organization is so grabasstic that you cannot get your credentialing in a group, by the date that *YOU* specified.”

He sputtered, “We have a contract! You have committed to work for us!”

I had read that contract. “Yep. You committed to pay me for my clinical services starting, oh, next Monday. Now come you, to inform me that you are not planning to pay me, starting next Monday. Now, I am not a lawyer, I do not play a lawyer on TV, and I did not stay in a Holiday Inn last night, but it certainly appears that you are proposing to breach one of the foundational elements of your contract, and thereby nullify the entire thing. If you are paying me, then my time is yours. If you have breached that contract by not paying me, then you can go piss up a rope.”

He continued to sputter. “I cannot simply approve paying you for not working.”

“Cool story. Howzabout you speak to somebody who can, indeed, authorize you to abide by the terms of your contract, and let me know how that turns out? As for me, I’m looking for work. If you get your shit together before I find other work, perhaps we can move forward in a mutually profitable way. If not, well, toodle-oo!”

The call terminated. I placed a call to Another Locums Company, with whom I had worked, and who had demonstrated that their stool was, indeed, in a pool. That recruiter and I had a cheery chat, and she promised to see what they had available, and call me back as soon as possible.

The next day, The Locums Company recruiter, who triggered this rant, called me back, breathlessly informing me that they *WOULD* pay me, as if I was working 40 hours, 9-5. In return, I would be on a 24 hour alert to report to the client clinic, upon The Locums Company’s notification that all had been ironed out. His tone was consistent with “…and don’t you try to weasel your way out of it!”

My response was, “Well, if you are paying me, then my time is yours, and I will be available to report for work as soon as is reasonable. 24 hours sounds reasonable.”

So, I hung around, puttering around, and after a couple of days, received The Call, shortly followed by a call from The Client Clinic. These worthies articulated concern. “Uh, you know we are up north, right?”

“Yep. I kind of had figured that out, in the course of the interactions with The Northern State Licensing Authorities. Those conversations led me to assume that this placement would be in The Northern State.”

“So”, they continued, “It’s January, and, well, we get snow here.”

“I had assumed that snow had something to do with your state’s reputation as a skiing destination.”

“So, have you ever driven in snow?”

This was surprising. If somebody had read, oh, the FIRST 6 INCHES of my FREAKING RESUME, it is exceedingly likely that this reader could figure out that I had spent considerable time in A Northern Fly Over State, wherein, every year, there was an abundance of snow on the ground for, oh, heck, 5 or 6 months of the year. My response did not, however, convey this surprise. “Uh, yeah, some.”

“Are you comfortable driving in snow?”

Another aside: it occurred to me that this particular line of inquiry might have been useful, say, during the freaking phone interview. Not the goddamned day before I was to drive my clinical ass up to start work. Again, my response was milder than my thoughts. “Yeah, I’m Ok with driving in snow.”

But, they were not going to let this go. “Are you sure? We really get a lot of snow, you know!”

I was over this line of conversation. “Look, I grew up in A Northern Fly Over State, we get assloads of snow every winter. If you have seen my resume, you will realize that, not only did I learn to drive in that state, I worked my way through Nursing school working for EMS in Da City in that very state. My children were born there, and every one of *them* learned to drive in the winter, in the snow. Since this is not Fairbanks Regional Medical Center, I am pretty sure that I have seen me some snow, and that I can handle it.”

I packed up my stuff, and set out for The Client Clinic.

I got oriented, and was introduced to the EMR. On my first day in clinic, I introduced myself to the registration staff, and the floor staff. Between patients, we swapped stories. This MA was prepping for Nursing school, that one was in undergrad for business. This other one was a survivalist, and prepping for The Zombie Apocalypse. (Kindred spirit, right there!)

A couple of weeks into the contract, things were tranquil. My MA asked me if I knew why my predecessor had quit, abruptly.

I allowed that I did not know all that much about it, simply that this soul had departed with inadequate notice.

Her eyes lit up. “Ahh! You need ‘The Rest Of The Story’!” She informed me that my predecessor had discovered that he, the clinician, had not been accredited with two of the most common third party payors in that area, and, since they were something like 70-80% of the payor mix, not receiving payment for care of those patients would present a cash flow problem of significant proportions.

It seemed that the clinic had elected to have this clinician’s visits billed as if another, credentialed, provider had in fact seen, interviewed, evaluated, diagnosed, and treated those patients. Since this was not exactly accurate, it potentially could get ugly. Very, very ugly.

When it appeared that this clinician would not see that situation remedied, right stat like, that clinician elected to remove himself from that particular pot of stew, immediately. Hence, the opportunity which featured me fighting disease and saving lives.

I spoke with my recruiter at once, and observed that, he either would provide satisfactory evidence that I was, in fact, credentialed with these payors, or I would unass that scene so fast that The Flash would ask, “What the fuck was that, that streaked right past me?” And, he did not have a lot of time to convince me that this was actually so.

An hour later, he not only effusively professed my actual credential-hood, he e mailed me copies of supporting documents, such that my black heart was grudgingly convinced that it was truff! (pronounced “True-ff”)

And that, boys and girls, is one reason that I treat my floor staff, and other co workers, nicely. That, and it is simply good manners.

More Mangled Machine-glish

Occasionally, a post will write itself. I recently received the following “comment”.

“vui cung dafabet20 hours ago

Pretty section of content. I simply stumbled upon your weblog and in accession capital
to claim that I acquire in fact loved account your blog posts.
Anyway I will be subscribing to your feeds and even I
success you get entry to constantly quickly.”

Now, I am by no means the smartest guy on the block, nor am I the most literate. I do, generally, do OK for myself in those regards. I have to admit that I cannot tease any meaning out of the word salad that this “comment” is made of. I have, in fact, had more useful conversations with actively psychotic individuals, mid hallucination, than this series of words portends.

Thought experiment: what would the vocabulary equivalent of a random number generator look like? I suspect very much like this.

And, we continually get told that machines will take our jobs.

I doubt it, unless they teach AI to snark, and drink.