Life in Da City! · Pains in my Fifth Point of Contact

SURPRISE!

So, there I was, fighting disease and saving lives, and my MA came to me, regarding somebody who had arrived for a subsequent Covid inoculation. This soul had informed my MA, AFTER THE INJECTION HAD BEEN ADMINISTERED, that she, the patient, had had a reaction to her first inoculation. She described this reaction as swelling, itching, and feeling ill. This had developed in a couple of hours after the injection.

It turned out that, today, this patient had, indeed, developed swelling, runny nose, cough, and whole body itching within FREAKING MINUTES after her injection. (those of my studio audience who have some sick people experience might recognize these indications as harbingers of anaphylaxis)

Weellll, we administered some IM Benadryl, some IM steroids, a breathing treatment, and close attention from my MA. Several repetitions of vital signs and reassessments later, this lady had seen her breathing improve, her itching subside, her swelling tapered, and the cough and runny nose reduced.

So, pro tip: If you swell up after the first dose of whatever the frack you are being injected with, tell a motherfucker, ya know, like, BEFORE you get the next injection. Personally, my geezerly ass will very, very much appreciate it.

Life in Da City! · Pains in my Fifth Point of Contact

Your View, Is *NOT* The Entirety of The World

So, TINS©, TIWFDASL©, alone as my midlevel walk in clinic shift started. We were supposed to have two of us from opening, but, well, some of us are renowned for strolling in something on the order of 30 minutes late. In addition, there was a third provider slated to come in around 2 hours after opening, and work til close.

To start off with, I had a 5 pack of kids. Well behaved kids (Thanks be to Crom!), but, five at a time nonetheless. All in one room, so, of course, it appeared to whoever else had decided to start their day with a visit to the walk in clinic that I was taking something over an hour with one patient.

One such soul opened her exam room door, around 40 minutes after we had opened our doors for the day, and while I was on Number 3 of 5 in the 5 pack, and asked “how much longer?”

I was charting, and replied, “20-30 minutes”.

She asked, “How come?”, and the MA explained “there are 5 in front of you.”

The questioning patient was surprised. “How can that be? There was nobody here when I arrived!”

The MA answered “I had already roomed them when you had arrived”.

“That’s crazy!” observed the impatient patient.

I was kind of busy. My response was “Yep.”

Duty · Having A Good Partner Is Very Important! · Protect and Serve

HALLOWEEN

A long, long time ago, in a county very far away, I was an ER nurse working nights. Indeed, this was so very long ago, that The Plaintiff had not, yet, become The Plaintiff.

It so happened that one Halloween I found myself working. At that time, in that county, we had a dispatch radio in the nurses’ station. After all, in a small hospital, in a very rural county, if you have advance notice of ill tidings, well, sometimes you can gather your selves, and more effectively address the particular ill tidings that are brought to your door.

My shift started at 1900 hours, and day shift had hardly departed when the tones went off dispatching the firefighters, rescue, and sheriff’s department from a couple of townships over. The nature of the call chilled my blood: child pedestrian, pedestrian vs auto on one of the local two lane state highways.

In rural The Un Named Flyover State, traffic on our state highways commonly travels at around 60 mph. Now, KE=1/2 MV2. That means that a, oh, say, 3000 pound vehicle at 60 mph runs around 361,040 foot pounds of energy. (By comparison, a 30-06 bullet runs around 3,133 foot pounds, and will kill any large game animal on the North American continent). When this strikes a, say, 80 pound child who abruptly darts out from between parked cars, well, it is catastrophic.

And, it was, indeed, catastrophic. Responding to the call, mothers, fathers, uncles, aunts, sons, daughters: the entirety of the emergency response apparatus in that corner of our county: hell, from couple of surrounding counties, as well: responded, praying, hoping, that somehow they could mitigate this disaster.

It seemed as though the medics spent seconds on the scene. It likely seemed like hours to the horrified family. One second, this child was running along, gleeful and excited at Halloween, eagerly anticipating All! The Candy! that would soon be spread out on the living room floor, and a second later, he was unconscious, broken, in the road.

The county and State Police ran interference, shutting down the expressway to speed the ambulance along it’s way. Our local city cops closed the cross streets, and the medics screamed into our parking lot, where we waited, alerted by the phone call from dispatch.

There were an amazing number of personnel in and about our ER that night. Every floor in the hospital detailed someone to either help, or stand by to see how they could help. The lab was there, cardiopulmonary, and that is not to mention the firefighters from our town, and our cops, in the parking lot, waiting to see if they, too, could help.

The ER doc was not about to half step, and employed every tool at his disposal. But, sometimes Death wins, and we can do nothing to forestall His victory.

We nurses cleaned the child up as best we could, tucking him in with clean linens, and a clean fresh gown. We tried our best to make him appear simply asleep.

The family came into the resuscitation room, and wailed their grief. In that setting, there is really nothing that you can do, nothing of any substance. We stood by, silent witnesses to their heartbreak.

Eventually, they had wept themselves dry. Neighbors assisted the parents from the room, to drive them back home. Later, they would have to plan his funeral, put away his toys, clothing, and things, and come to terms with the forever loss of their little boy.

Halloween would never ever be the same for that family.

A couple of hours later, TDW-Mark I (subsequently The Plaintiff) stopped by. She had taken our two kids then aged 6 and 3, Trick-or-Treating, and they were so darned cute, it finished me. I swept them up into a hug, and likely puzzled them by weeping. Truth be told, I suspect that TDW was surprised, herself. Until one of my partners told her the story of earlier in the night.

Fun And Games · Life in Da City! · Pains in my Fifth Point of Contact

My FAVORITE! Things

My FAVORITE! Things

@ When, as part of my assay of History of Present Illness, I ask you how long you have had your (cough, or whatever other symptom motivated you to march you happy butt into my clinic), please, Please, PLEASE do NOT!!! say “a good little while”, or something similarly non responsive to my question. I will simply repeat my question, using the same words, and the same pleasant, inquiring tone, over and over, until you do, indeed, tell me “2 hours” or “2 days’ or “2 weeks” or “2 months” or “2 years”. Simply so you know, IDGAF how long you have had this symptom, on the other hand, it does have some implications for what plan of care I ought to consider in order to, ya know, actually benefit you.

@ Similarly, for the love of Crom, do NOT tell me, in response to my question, “What have you done for (your symptom)?”, that you have “taken over the counter”. Should any of you in “the studio audience” desire to understand just how unhelpful this is, please spend a few minutes on only one freaking aisle of any drug store you wish, and attempt to catalog the dozens of freaking allergy meds therein. By way of illustration, if you have used a nasal steroid, that would be helpful for me to know, since, should that have been unhelpful, I will be required to up my game.

If OTOH, you simply took The Multi Symptom Dreck You Saw Advertised On The TeeWee Last Night, well, I can then recommend some, oh, gee, I dunno…EFFECTIVE OTC medications, instead.

@ I love it when Joe-Bob goes to (St. Elsewhere) yesterday, does NOT pick up his prescribed medications, and swings by my clinic. Because “I’m not any better”.

@ When I direct you to call your family doctor and arrange followup, and you reply, “They always tell me to go to walk in!”

So, you’re telling me that WALK IN prescribes your blood pressure meds, your psych meds, as well as your diabetic meds?

All this is news to me.

@ When I ask, as my review of symptoms, “Have you felt as if you had a fever?”, and you reply, “I don’t have a thermometer”. (how did folks FEEL feverish, before the invention of the precise thermometer by Farenheit in 1714?) Or, alternately, “your nurse just took my temperature, and said I do not have a fever.” (which, of course [a] I already freaking knew, having reviewed the vitals and nursing notes before I walked in the door, as well as [b] NOT answering my freaking question!)