The Cookbook Story

So, This Is No Shit, There I Was, Fighting Disease And Saving Lives…., well, I was off duty, and rolling through household chores. This was years and years ago, and TDW-Mark I was in RN school, and so I was up to bat with the kids, with dinner, with laundry, and all the other stuff that goes along with running a household.

My mother had presented me with a book of household recipes, and it did indeed include several of my very favorites. I had turned to it frequently over the years, but, in our recent move across The Un Named Flyover State, it had become misplaced.

I had asked her about it, had searched for it, and all to no avail.

So, on this particular evening, she was in class, and I was searching for one particular pan in order to cook whatever it was that she and I had agreed was to be tonight’s repast. As I searched in the recesses of one cabinet after another, I happened to see THE COOKBOOK.

TDW-Mark One had teased me about that book, suggesting that I cared more for that book than I did her. So, having found it, and, kids fed and cores completed, I figured that I would give her a “Found the cookbook of Saint Mother!” welcome home.

I set it on one of those book reading stands, on the kitchen table. I arrayed candles about it, and dimmed all the lights. Once I saw the headlights from her car enter the driveway, I lit all the candles, and prostrated myself before it, as if worship.

She entered the door, calling for me. She glimpsed me on the floor, kneeling as if in prayer, and dropped her school stuff, asking me what I though tI was doing?

“Sweetie, I found Mom’s cookbook, and am simply providing it the veneration it deserves!”

She was not particularly amused.

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WARN-A-BRUTHAH!

I was on vacation, early last year, and saw a t shirt, with the Warner Brother’s logo, and the script, above and below the shield, admonishing the reader, “If ya see da poleece, WARN-A-BRUTHA!”

https://www.topseasonshirtz.com/view/114/if-you-see-the-police-warn-a-brother–t-shirt

(this will be relevant soon. Be patient.)

The other day, I was watching our grease board, where the registrars enter each patient’s name, and a summary of their complaint. I was (unpleasantly) surprised to note one fresh entry, asserting that the named patient, an infant, had “difficulty breathing”.

I directed my MA to go see that patient, and assess this complaint.

He promptly entered one of the exam rooms with this child, obtaining vital signs, and telling me, “Reltney, I think you want to see this kid, next!”

I entered to see an infant, with audible rhonchi (coarse breath sounds). The heartrate wasn’t awful, the respiratory rate was sort of elevated, and the oxygen was 94 %. Not perfect, but OK. This child was retracting wherein the skin beneath the lower margin of the ribs was being drawn in, a little, with each inspiration. We administered a breathing treatment, in hopes of resolution of the rhonchi, and less effort of breathing.

After the treatment, the rhonchi had improved, just a little, and the retractions might have maybe, sort of, kinda improved. I asked the parents to hold on a while, to see how the child progressed.

I rechecked in another ten minutes, and the retractions had definitely gotten worse. Vitals were still not awful, but one of the principles of treating children is that they generally tend to do OK when ill, until, abruptly, they do not. I was concerned that this child was running out of steam, and approaching a crash. So, I called ED, gave report, and sent the child over.

Subsequently, I was talking to the registrar supervisor, and told the story with which I started this story. I amended it to read, “If you or the mother think that the child is sick, warn a brotha!”

And, in this scenario, my pale ass is the “Brutha” in question.

WHY?

TDW-Mark II and I are amateur radio operators. A couple of weeks ago, we heard one of our small town’s EMS units dispatched to a “woman fell and injured her face” call.

We listen to Fire/EMS dispatch, because it provides an insight into the events of our town, and perhaps distant early warning of spicy times.

In any event, the crew called on the scene, and, very (VERY!) shortly later, got back on the radio, requesting police.

Dispatch inquired, “On the double?”, and the medic replied, “Yes, on the double”.

They next called for another ambulance, and the fire department for manpower. Soon, we heard fire crews negotiating an entry, and one of the medic units transporting one to The Local Trauma Center, as a priority.

That assemblage of folks, all volunteers except the police (the medics get paid so little, that they might as well be volunteers!) led me to contemplate Duty, and the mindset of those who run toward the sound of trouble.

May I present a rerun? Here is the original post from 2019, and a link to the website entry that inspired me.

http://counterjockey.blogspot.com/2019/09/weapons-wednesday-service-smiths.html#comment-form

Why do MEN (and, nowadays, more and frequently, WOMEN) willingly go in harm’s way?

Why do folks bunker up, suit up, gun up, whatever, and run toward the sounds of trouble?

Counter Jockey has gunned up, and sought out the source of those sounds. As have thousands and thousands of others.

Yesterday was The Eleventh of September in the Year of Our lord 2019. Eighteen years ago,  343 members of the FDNY died, doing their duty. 60 police officers lost their lives. 8 EMS personnel died, not employees of the City of New York.

They died attempting to save some of the 2977 people who would wind up dying that day.

“Duty” is the simple answer, and we all are, or ought to be, thankful for our neighbors who see their duty, accept their duty, and pursue their duty.

But what makes someone see such a thing as “My duty”?

What makes someone say, “So help me God.” ? Those who have so sworn, know. Someone has to stare down predators, and say, in effect, “You stop, right here, right now.” Someone has to stand, and hold that line. Otherwise, the dependents behind those stalwarts will lie vulnerable to the heartless. And, those who have selected Duty, will not allow that.

343 members of the FDNY died, that beautiful autumn day, doing their duty. What sort of folks run into a burning building, a building which had already been sized up be one of their own with the prediction, “Some of us are gonna die, today”?

Read the “Never Yet Melted” blog, about Rick Rescorla. Brit born, naturalized US citizen, Director of Security at Dean Witter/Morgan Stanley (https://neveryetmelted.com/2019/09/11/colonel-cyril-richard-rick-rescorla-may-27-1939-september-11-2001-3/) He is credited with saving 2794 of the 3000 employees working that day. He, his deputy, and three other of his security staff were among the exceptions.

So, here’s what I leave you all with. Look for your duty. Do your duty. try not to flinch, try not to step back. Because, you, and I, all of us, are standing in the shadows of Great People. Imagine, if you will, that they are cheering us on, looking over our shoulders, and expecting that we will not falter. Because, they have left us a legacy of honor, of Duty, of doing their jobs, that make it possible for all of us to be here, today, to have the opportunities that we enjoy. Let us not let them down.

Regarding that day an entire generation ago, let us tell of the Heroes who raced into a building, knowing it was to collapse. Let us tell our children of the Heroes, civilians all, who sacrificed their own lives, that others would not die at the hands of the heartless. Let us tell each other of the Heroes who dwell among us, unknown to us, perhaps unknown to themselves, who will rise up to the demands they face, and risk all to save another. Let us measure ourselves against them, and be grateful they dwell among us. Let us hope we can measure up, should our time come. God Bless those who stand in harm’s way, on our behalf.

Another post, from another website

Bad Dancer (commenting at Gun Free Zone blog) says:

October 21, 2022 at 9:50 am

Thank you for the article and links Reltney McFee I’ve read it several times and will go through it again to make notes soon. I appreciate you sharing your experience and advice.

I’m building a few kits as Christmas presents this year. Are there any supplies you recommend added for a family that has a 1-2 year old?

Thank you for reading. Outstanding question! With regard to families that have toddlers (or infants), my first pass suggestions would sound very much like, “What did you want on your last camping trip, that you did not have?” along with, “what sort of comfort item does your child love?”

If I were to add to that, I would look to my own “Grand Kids Are Here: What Might I Need RFN?” (GKAHWMINRFN) supplies. Now, remember, I’ve been a paramedic, paramedic instructor, ED Registered Nurse, and mid level provider since Jimmeh Cahteh was the HMFIC (OK: President).

On the top of my “GKAHWMINRFN” bag is a pediatric BVM (Bag-Valve-Mask: commonly referred to as if they were all branded as Ambu Bags). You might be happy with a pediatric sized rescue breathing mask of some sort, or, easier to pack, mastery of mouth-to-mouth resuscitation.

Near the top would be comfort items, so as to both distract the child, as well as help the child “buy in” to the procedures to be performed. Blankets, pacifiers, stuffed animals: whatever floats the child’s boat.

Remember that children, particularly infants and toddlers, are NOT simply pint sized adults. Due to differences in body surface area, kidney function, maturity of their livers and other factors, they may metabolize medications quite differently from adults. So, just slapping some QuikClot on Little Johnnie’s wound may be a problem. OTOH, here is what I did find in a reference that I use, myself, clinically every day:

“Compared with standard sponges, the use of the kaolin-impregnated sponges in 31 infants undergoing the Norwood procedure had a significantly lower intraoperative use of blood products and lower incidence of perioperative bleeding requiring return to operating room for hemostasis (0 versus 41 percent) [44].” (source: https://www.uptodate.com/contents/overview-of-topical-hemostatic-agents-and-tissue-adhesives?search=quick%20clot&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2249912903

That means, better bleeding control. THAT suggests that a kaolin-impregnated sponge (QuikClot), at least, is not inappropriate for use on bleeding in children that is not otherwise controllable by dressing, direct pressure, and (in extremis) tourniquet-ting. So, small (2×2, 3×3) dressings impregnated with QuikClot appear to be reasonable.

Splinting materials for fingers, limbs, or whatever, are going to be a challenge, both because children do not, as a rule, comprehend the entire “lay still while I splint you” thing, nor the bit about “do not wiggle about, you will work you way out of this splint, and your injured (whatever) will hurt, and be injured further.” So, however much tape or gauze you THINK that you will need, you are wrong, and will require considerably more than you guessed. Unless, of course, you have made it a habit to secure IV armboards to infants and toddlers, several times a day, for the past several years. If you have done so, and done so successfully, please tell me when/where your classes will be, and save me a seat.

Another tangent from adult IFAK/Jump Bag/Holy Fertilizer kits, and child directed emergency care, is that children will both dehydrate, as well as become hypothermic way, way more rapidly than adults, and, once they have burned through their reserves, will crash and burn, often irretrievably. The axiom is that children generally do OK with their injuries, until they don’t. And, when they don’t, they crash biggly. Adults generally slowly decline, until they die. Therefore, measures to protect a child from heat loss are important. That means blankets and knit caps in appropriate sizes. The foil “emergency blankets” are a mixed bag: they are not going to get saturated in whatever bodily fluid is present (good thing), but they are not going to trap heat in a maze of air pockets formed by a Mark 1, Mod Ø fuzzy/fleece/wool blanket. (and you will notice the difference). Select thoughtfully.

Another feature of kid injuries, particularly infants and toddlers, is that they are top heavy. Their heads are a greater proportion of their body weight than adults, and that means that their initial point of impact may be more likely to be their heads, than their hands/wrists/forearms. Therefore, when you are in the hot seat, you need to be suspicious of the possibility of a head injury, when children fall. You have learned to spine board/cervical collar/secure for transport, head (and that is often spelled N-E-C-K) injured patients, right?

Right?

Another needful skill, that you pray is never needed.

That is it for my off the cuff, just got home from work and warmed up my laptop, answer to your question.

Thank you for the stimulating inquiry. Gonna be food for more rumination!

Reltney McFee