KITTEN TAILS, PART THREE

Our Cat Farm grew, as Momma Kitty joined us. One autumn day, TDW-Mark II observed Momma Kitty come onto our porch, and eat the dry cat food we had been placing out for her. TDW opened the kitchen door, on this pleasant autumn day, and verbally invited Momma Kitty to enter, and get acquainted.

Much to our surprise, she promenaded into the kitchen. She next sat herself in one of the windows, and we could not convince her to move. TDW then retrieved our travel crate for the one dog, opened it, and Momma Kitty simply walked in, settled down on the dog bed, and looked at us as if to say, “Well? Do you think you are done?”

We secured the door of the crate, and realized that we now needed to find, and retrieve, her latest batch of kittens.

TDW (perhaps, by now, y’all have realized who is the brains of this operation. And, it’s not me, apparently.) had observed the dogs lingering over a particular potion of the porch, as surmised tha the kittens would likely be located underneath.

So, we accessed the underside of the porch, TDW entered, and passed out the two kittens she found therein. The first kitten, now know as Oliver, was a wee bit, and appeared to have a lesion of some sort on the back of his neck. (this later was identified by our vet as an abscess) The second kitten, now know as Trixie (due to the black and white, “cow camo” pattern of her fur, reminiscent of TDW’s pet cow from her childhood), appeared to have some sort of mucoid material from her one eye. We wondered if the litter had been larger initially, and suspected that the stimulus to bring Momma Kitty in might have been some predator (we have raccoons about) might have attempted to clean out the litter, and these two, and Momma, survived.

We cleaned them up, as a start, and arranged for vet assessment. Oliver got an antibiotic, and his abscess resolved. Trixie was another story.

The vet could not visualize her one eye, and voiced concern that this might be a viral conjunctivitis, and have a corneal ulcer associated with it. She wondered if this would, in fact, heal, or if, once healed, she would have no vision in that eye.

So, we became cat nurses. Trixie got her eye ointment twice a day. After several weeks, she improved. And, since curveballs seem to be my lot in life, one of the other cats appeared to develop pink eye as well.

Since conjunctivitis is wildly contagious, unsurprisingly the other cats developed it. To my surpirse, only 7 of our ten cat herd did so: the three oldest appeared to miss that fun. So, we drew a kitty MAR (medication administration record), and began twice a day sick call.

The bad news was that the biggest of the kittens Was Not Having the medication administration. That led to Sumo Cat “Parenting”, which is every bit as much fun as it sounds. Particularly for those of us who bleed freely. And do not have hind claws. Fortunately, TDW, wise in the ways of Catdom, determined that should we profit from the old aphorism “letting the cat out of the bag”, and place Reluctant Cat into a sack made of two retired pillowcases, his paws and claws would be neutralized, I could immobilize his head, and she could administer the eye medicine.

To Reluctant Cat’s credit, he either did not realize that he could readily gnaw the shit out of us, or else elected to let this insight pass by, unacted upon. In either event, he improved.

The good news is that, soon, we would corral Reluctant Cat, and his escape artist sister (previously referred to as the superball, or the furry bottle rocket), and medicate them.

That task accomplished, we would administer treats, in the form of canned cat food, which they seemed to very much enjoy. Then, we would open the bathroom door, to release them and seek the next contestants, only to find that there was a feline line up, and next two would walk in, apparently unworried.

We would shut the door, medicate (and chart) these two, and provide their reward/treat. Opening the door, those two would saunter out, and the next two would meander in. Shut the door, medicate cats, treat/reward cats, chart meds, open door, those two exit, and the next one would enter and be medicated, rewarded/treated, easy-peasy.

As the kittens became integrated into the pride, one adopted our older cat. (I told of Henrietta and Max in a previous note) We were surprised to see that, once Oliver was in the pack, he appeared to adopt Olivia, from the previous litter, as if he was her “pet kitten”.

The cuteness mounts!

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THE SUNSHINE RULE: THE OTHER SIDE

It came to pass, we were open on New Year’s Day, and I was on duty. On that day, our waiting room waits were approaching 3 hours. I am not a fan, notwithstanding the fact that generally I have little control over how many folks disembark from The (metaphorical) Bus, when The Bus stops, and disgorges it’s passengers for our treatment pleasure.

As you may imagine, most of us, myself included, do not find it to be a life enhancing experience when I, or they, get to while away the hours in the waiting room, with a dozen or more unknown, snotty, feverish, sick strangers.

On this particular day, it occurred to me that I was oddly blessed. Nobody felt the need to extend my medical education with the results of their internet search, nobody “knew their body”, and, indeed, nobody KNEW! that The! Z! Pack! would resolve their woes.

In addition, nearly everybody was in good humor. Indeed, several folks made it a point to actually thank me for working that day. Specifically, literally, “Thank you for working today!”. Direct quote. No BS.

I had seen one of these folks a couple of weeks previously, and given them my stock spiel regarding treating their post nasal drip induced cough with fluids/inhale steam/Zyrtec/Flonase/Tylenol/follow with family doctor/return if worse. She told me, to my face, that “I got way better once I followed the advice you gave me. I’m still a little stuffy, and cough now and then, but nothing like when I saw you last time!” (today’s visit was for another malady).

Then there were the folks, a majority of the patients that day, who were possessed of a very robust sense of humor. On days when the wait is lengthy, my introductory spiel goes along the lines of “Hello, I’m Reltney McFee, I’m a nurse practitioner. I’m sorry about the wait, and thank you for you patience. I apologize for the abundant opportunity that you had to demonstrate your patience! What can I do for you today?”

Most folks chuckled, and those that did not chuckle, said something along the lines of “That’s ok. I’m here today because of….”

All that is to provide some particulars regarding the first two clauses of my Sunshine Rule: “Everybody brings sunshine into my life. For some people, that is when they arrive….”

KITTEN TAILS, PART II

With regard to the three kittens, Momma Kitty, and their transition from feral cats to indoor cats, well, as you may expect, it was a bit of a tale. TDW-Mark II had determined that the kittens were in another of our window wells, and, judging that they had been weaned, figured that we ought to bring them in, before Momma Kitty drove them off to seek their own fortunes, elsewhere. So, my wife removed the window from one of the window wells, reached out and grabbed Kitten Number One, and placed this kitten into a pet carrier that she had staged nearby.

She reached for Kitten Number Two, and placed that cat into the carrier as well.

So far, so good.

It wasn’t until she reached Kitten Number Three, that it all went wrong. This cat developed into an avatar of Shiva, Destroyer Of Worlds: Bantamweight Division. Exploding into a whirlwind of fangs and claws, Number Three escaped TDW’s clutches, and caromed, cue ball like, about the basement.

And, it was on! TDW attempted to corner the kitten, only to discover that in some kitten academy they teach moves only seen in Kung-Fu movies. Number Three levitated, twirled, and spun away, !!JUST!! out of reach, only to come to rest (relatively speaking) beneath some appliance or another. Once, she had figured out how to access the kitten, she (the kitten) would bolt away, leaping, gazelle like, over another appliance, and then jet around like some furry bottle rocket.

Fortunately, kittens do not have tremendous stores of energy, and therefore, after more swearing and running around (on everybody’s part), Number Three slowed down, just enough, for TDW to throw a towel over her, and wrestle her (the cat) into the carrier.

We settled the kittens into the upstairs bathroom. We figured that accustoming the kittens to our presence would Do Good Things such as reduce the furry superball impressions that they enacted for our benefit, each time we attempted to handle them.

THAT took some time to show any effect. One of the kittens, subsequently named Olivia (due to her peaceful- think olive branch-disposition), rather quickly noticed the humans=food correlation, and even would purr when cuddled, and petted, in TDW-Mark II’s lap. Her twin, named Henrietta (after the chickenhawk character in the Foghorn Leghorn cartoons), soon followed suit, purring up a storm when she was petted and cradled in TDW’s (or my) lap. This, in keeping with her namesake, followed Henrietta’s looking at us, and emitting a kittenish snarl, as if to remind us, “I’m Bad!”

The third kitten, due to her exploding into a whirlwind of fangs and claws whenever one of us approached her, was named “Dynamite”. Dynamite slowly warmed up to us, even, eventually, sleeping on our bed.

That, however, followed our gradually introducing the kittens to the rest of the Cat Farm. We would place them in a wire travel crate, and then settle the crate (and kittens) into one corner of the dining room, where TDW-Mark II and I commonly spend our time. There, we could supervise and, occasionally, referee, the developing acquaintance of the kittens with the rest of the menagerie.

One of the older cats decided that he would wander over to say hello (or whatever cats say in such circumstances). He plopped his large self down near the wire, and spent time looking at the kittens, occasionally reaching in their direction with one paw.

Henrietta, true to her namesake, remonstrated with him, snarling with all the kittenish gravitas that she could muster. Which is to say, nearly silently, and not so very intimidating.

After several days of this, we opened the door of the crate, allowing them (the kittens) to wander. The older cat, Max, appeared to take upon himself the role of mentor/uncle, as, for example, Henrietta would burst into loud purring whenever she had the opportunity to curl up next to Max. He (Max) would play with the kittens, occasionally cuffing them as if to underscore his point of, say, “you are playing too rough!”

Snippets, again

@@ Please, do NOT tell me that Bonine is 125 (or 12.5: she was not speaking clearly) milligrams, over the counter. I happen to know that OTC Bonine is Meclizine 25 mg, the same strength anti vertigo medication I prescribe as Antivert, and I know this for reasons. These reasons include (a) I kinda went to school for this stuff, (b) I prescribe Antivert/Meclizine several times a week, (c) TDW and I enjoy taking cruises, and she is somewhat susceptible to seasickness. Therefore, I am familiar with Bonine in it’s seasickness/motion sickness indication. Therefore I purchase it, OTC. Ya know, like last week. (d) When I acquire a medication, I (pay attention now! This one weird trick will help you manage your medicines!) RTFL. (Read The Freaking Label). (e) I have a functioning memory, not blown out by continuous applications of high serum levels of cannabinoids. Therefore I can remember this stuff, along with other stuff I find useful.

Finally, please, Please, PLEASE! Consider the possibility that I, indeed, am trying to both help you, as well as make your life easier.

The above is my internal monologue, which is considerably lengthier than my first pass response, also stifled, of “Hmm. Weird. Ok, then, don’t take it. Good talk. Have a nice day! Buh-bye, now!”

@@ So, TINS, TIWFDASL, as an ED nurse, long ago and far away. It came to pass that my manager invited me to join her in her office, where she told me that several of my colleagues had come to her, concerned with what they esteemed to be my taking overly long to triage patients.

For those in the studio audience who do not know, “triage”, in the ED setting, is the process wherein a nurse interviews the patient to elicit chief complaint (“What motivated you to come to ER tonight?”), history of present illness (“How long have you been ill? What have you done to address it? How did that work for you?”), allergies/medications/history, and vital signs. In the course of that conversation, the goal is to identify unstable folks, and truck them right back to care, and differentiate them from stable folks (like a broken limb with intact downstream circulation), and invite those folks to be patient.

I asked my manager how long I was taking, on average, to triage? This information ought to be readily available from our electronic medical record system.

“I don’t know.” was her reply.

I asked how my triage times compared to the average of my peers.

“I don’t know.”

I asked if the acuity of the patients I triaged was similar, greater, or less than the average of my peers.

“I don’t know.”

I asked if the complexity of the patients I triaged differed in any identifiable way from my peers (think psych requiring lots of redirection).

“I don’t know.”

I contemplated this for a second. “Wouldn’t it be a lot easier for me to improve, if I understood the manner in which I am falling behind my peers? I had thought that one of the advantages of an EMR was the ease with which just this sort of information could be abstracted.”

@@ In my clinic, folks who are currently afflicted with covid, or who fail the screening interview/temperature taking, get seen as “covid + other” patients. They are invited to wait for their turn in their vehicles (or, in nice weather, outside), rather than in our waiting room. Inasmuch as we are a walk in clinic, there are no appointments, and, if you are at the shag end of “The Wave”, well, you face a lengthy wait.

Some of these individuals drive off, thinking (not altogether wrongly) that a lengthy wait=an opportunity to get other stuff done.

The problem with this plan, is that, should a number of the other folks in line ahead of you, either spontaneously cure themselves, or decide, in essence, “F&@k this, I’m not all that sick”, and depart, your turn may arrive earlier than your errands anticipated. So, when the MA calls you on the phone number you provided today at registration, (a) it might be useful if you answered it, as well as (b) if the phone in question was actually in service.

Among the souls who successfully pass these two tests, there are those who respond, when told that their turn was at hand, and we (the MA) had some questions for them preparatory to actually seeing them in the office, “I can be there in 25 minutes!”

Well, that is kind of a fail. The MA will then tell them, “Sorry, we’ll call the next person on the list, who is here now. You will be at the bottom of the list, since leaving the line loses you your place in line.”