Above and Beyond

So, TINS©, TIWFDASL©…. Well, OK: REALLLLYYYYY!, I was holding up the counter, and awaiting my next patient, when one of the registrars came up and informed me, “Reltney, I’ve got this sick lady out in the drive up, and I really think you need to see her! Like, right now!”

To set the stage, my urgent care has (surprisingly!) urgent care patients, as well as folks who arrange to be tested for Da Rona. This latter group makes their appointment, drives up, telephones in to announce their arrival, and my registrar gowns up, registers them (now, THAT is a surprise, amirite?), and one of the MAs gowns up, strolls out, tests them, and hands a sheet of instructions (prominently featuring the admonition to quarantine for ten days, or until negative results are forthcoming) to the patient.

This particular soul had not made it past the whole “registrar registers them…” part. This particular registrar, let us call her Eloise, has been doing this for several months. She is one of those quiet, efficient, takes-care-of-business folks that make things in general, and our agency in particular, run. She is not a nurse, not an MA, may not have any “medical training” whatsoever.

Nonetheless, Eloise had appropriately identified that this patient, nominally here for coronavirus testing, was way, way, way sicker than (a) coronavirus testing was gonna help in a clinically relevant timeframe, as well as (b) way, way, way, way! too sick to be driving around. So, she came and got me.

I went to the patient, shortly afterwards followed by an MA who had overheard Eloise’s pronouncement. I was impressed by the fact that this woman reported chest pain, nausea. left sided neck pain, left sided jaw pain, as well as being unable to tell me her allergies, or medications, or medical history, and could not state the name of her boyfriend (whom she wanted called to retrieve her vehicle) as I shortly had determined that this nice lady was going to shortly be the recipient of over 50 years of pre hospital emergency care wisdom and experience, as well as diesel therapy. (ambulances nowadays generally run on diesel).

I told Eloise to get an ambulance, and the MA hopped in, to clear a room for this patient. Eloise evidently had delegated that task, as she returned promptly with a wheelchair, and I noted another MA on the phone to dispatch, as Mrs. Chestpain was wheeled in.

As I assessed this soul, engaging in conversation all the while, it struck me that her ability to track the conversation was deteriorating before my eyes. Not a good thing.

Soon EMS arrived, packed her up, and set about their own part of her care.

I called report to the local ED, explaining the above.

I then went in search of Eloise’s supervisor. I informed this worthy that, in my opinion, Eloise had saved this woman’s life. Had she not had her head in the encounter, had she not noted “chick don’t look right” (the fundamental item of nursing assessment), had she not sought me out and had she not compellingly made her case that this was a SICK person, well, Mrs. Chestpain might have driven off, to die from (her heart attack)(her stroke)(a collision from her impaired ability to navigate), or (all three).

For some reason, I had occasion to speak to my physician supervisor around that time. I repeated the foregoing story, as well as the foregoing analysis, to her.

“Well, you know, Reltney, you also saved her life!”

“Ma’am,” I responded, “I have dozens of years of schooling, decades of emergency and clinical experience to enable me to do that sort of thing: it’s kind of what you are paying me for! Eloise, on the other hand, has none of those things. You are congratulating me for doing my job. I’m applauding Eloise for thinking outside of the box, outside of her job description, and acting effectively to get this woman the help she desperately required. Thank you, but Eloise went above and beyond her job. She is what made everything else happen.”

As a side note, here’s what the preceding paragraph looks like, when your cat helps you:

“Ma’am,” I responded, “I have dozens of years of schooling, decades of emergency and clinical experience to enable me to do that sort of thing: it’s kind of what you are paying me for! Eloise, on the other hand, has none of those things. You are congratulating me for doing my job. I’m applauding Eloise for thinking outside of the box, outside of her job description, and acting effectively to get this woman the help she desperately required. Thank you, but Eloise went above and beyond her job. She is what made everything else happen.”pppppppppppppppppppppppppppppppppppppppppppppppp

Thanks, Kitty. i do believe that I have this under control.

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