Fun And Games · Gratitude · Sometimes You Get to Think That You Have Accomplished Something!

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….”

Fun And Games Off Duty · Having A Good Partner Is Very Important!

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!”

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

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.”