DUTY: A RETROSPECTIVE

It is the eve of Christmas Eve as I sit here. The roads were TFA (Too Freaking Awful) today for me to drive the lebenty some miles in to work, so I had called off.

TDW-Mark II had commented that today would be a good day to NOT be taking road calls, and I agreed.

I remembered a Christmas at home, 2 years ago.

So, TINS©, I was lolling around the house on Christmas Day. TDW-Mark II and I were casually surfing the web. I had my handheld amateur radio on, monitoring our county’s fire dispatch. Because, well, I can.

In our county, emergency personnel are generally volunteers. The EMS is paid/full time (such as THAT pay is!), Sheriff and local PD are paid/full time (but often respond from home, off duty, so to speak), but the firefighters and rescue are volunteers, dispatched by pager. The tones dropped for a cardiac arrest, CPR in progress, in the outskirts of the county. Now my county is rural, primarily (by surface area) farmland. The ambulance was called out, as well as the County Seat Volunteer Fire Department (Hereinafter, CSFD).

I heard EMS acknowledge, and the duty fire chief as well. He (the chief) directed that the firefighters respond without him, as he was a couple of miles from the scene and would respond directly.

Dispatch then filled in the dispatch information, beyond the address. A 70-something male had collapsed. CPR was in progress. He was vomiting, and the family was clearing his mouth as best they could. A couple of minutes later (likely that seemed like days, to the folks on the scene, performing CPR on one of their family!), the fire chief called out on the scene “Chief on scene with one firefighter. Sheriff on scene. Dispatch, roll one engine for manpower.”

So, let’s “dolly back”, and consider this. With the possible exception of the deputy (who might also have responded, off duty, from home in his patrol car), all these folks were snug in their own homes, fat, dumb and happy, savoring the anniversary of The Birth of Our Saviour, as well as immersing themselves in the excitement of the children at All! The! Presents! they had received.

They carry pagers because, well, that’s what they do. More likely than not, they do not see themselves as heroic, or making sacrifices, because, after all, in most of America (hell, I suspect in most of the world), the men and women performing these jobs simply see themselves as doing what needs to be done, because they are able to do so.

And therefore, when the pager alerted them, they grabbed their coats, put on their boots, and left their warm and happy homes, heading to somebody else’s home, someplace where, as Chief Dennis Compton of Mesa, AZ Fire once described it, “We are responding to somebody’s worst day of their life”.

So, as I imagine it, the duty chief was enjoying a Christmas with his family, the tones dropped, and off he went. Before he could get out of the door, one of his sons, or maybe a son in law, (or daughter or daughter in law, here in the 21^st century) said something like, “Hey, Dad! Hold up a second! I’m taking that call with you!”

These folks voluntarily immersed themselves in another family’s tragedy. Strove to hold the line, to reverse the evident course. Went to work on Christmas.

When the firefighter came on the radio requesting the sheriff department’s (volunteer!) Victim Support Team, I could call that play. I do not know if I teared up at the family’s terror, at their loss, at the fact that forever more Christmas would not hold happy childhood memories, but, rather, would be “the day grandpa died”, or if I teared up thinking of the folks who, simply “doing their jobs”, had left their warm homes in response to some stranger’s plea for help.

But, I wept.

Please, give a thought to those who respond to those calls, today and every day of the year, all over the world.

And offer a prayer on behalf of those they go to rescue.

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“Warn-A-Brutha”, in action.

So, TINS©, TIWFDASL©, and my MA, let us call her Maryann, exited the room that she had entered, shortly before, to assess and obtain vitals on a child.

“Reltney, this child here is working kind of hard to breathe, and he is coughing a lot: it seems to interfere with his taking a breath!”

I entered the room, and noted a child coughing approx every 10 seconds (and I mean a full throated cough, not some modest little “harrumph!” kind of thing), and, as I observed his breathing, noted a rate of around 60 breaths a minute.

Not so good.

We administered a breathing treatment, and he had kind of, sort of, maybe improved just a little bit.

I finished my assessment, and went to chart, intending to return and re assess him once my (generally 4-7 minute) charting was completed.

I did so, and noted that his breathing had dis-improved (is that really a word?). I invited the physician with whom I was working to lay eyes upon him, briefing her upon my observations and actions thus far.

Once she had assessed him, she was not favorably impressed. She, also, thought he was working kind of hard to breath. She, also, wondered if this was fixing to run him out beyond the end of his reserves, whereupon he would crash, likely biggly, and become a no shit emergency. She wondered if sending him to emergency, prior to that happening, might not be more wise than waiting until he did, indeed, crash.

I agreed.

I wrapped up my charting, once the child was safely on the way, and hunted up Maryann. I congratulated her. “You did good. Your prompt assessment that this child was not breathing right, set in motion events necessary to get him to the appropriate level of care, in a timely manner. Well done!”

Everyday Folks, Everyday Gracefulness

Sometimes in my walkabout daily life, I encounter folks, simply being nice. So, TINS©, I Was NOT Fighting Disease And Saving Lives, rather, simply grocery shopping. I happened to get in line behind an elderly woman (Pot, meet kettle. You ought to talk amongst yourselves, since you have so much in common…) who appeared to not have altogether figured out the entire “One of these is a credit card, the other is your membership card.” thing, as she attempted to pay with her membership card.

The cashier was patient, and collected. She explained that, no, THAT is your card with which you get your discounts and points, and THAT is your bank card, with which you pay for your groceries. They are different cards, for different things.

It took a couple of attempts, but the customer got her points, and successfully paid for her groceries, and wheeled her way out of the store.

The cashier apologized to me for the hold up. I responded, “Ma’am, some things are problems, some things are inconveniences. If this wait is as bad as my inconveniences get, I am in pretty good shape. Oh, by the way: way to be patient and graceful with that elderly lady. Good on ya!”

Once Upon A Time….

So, TINS©, TIWFDASL©…Let me take a tangent, here, for a brief moment. (Yep. “Ooh! Shiny!”) The Darling Wife-Mark II and I were visiting my son and his wife, My Darling Daughter In Law, let us call her Esmeralda, and he (the son) had asked me how work was going. I (of course) replied, “Thing of beauty! Why, I spend my days Fighting Disease, Saving Lives, and Beating Back The Scourge Of Zithropenia!”

Esmeralda did not appear to comprehend the level of sarcasm that is my baseline, because she responded, “So, writing scripts for Zithromax is pretty much your entire workday?”

Sigh.

So, back to my story: there was this soul, once upon a time, in a clinic far, far away, who was on Medicaid (since my agency’s mission statement is pretty much, provide healthcare access to those who otherwise are underserved), and was diabetic. But! Wait!

This soul also had a burn on their extremity, attributed to spilling some boiling water thereon. This had occurred a day or two previously, and looked rather gnarley. (No, that is not, strictly speaking, a medical term.)

For those of us who are not In The Sick People Business, extremity burns generally are considered a reasonable referral to a burn center, because if contractions or scar tissue limit the utility of that extremity, life changing disability can result.

The local wound center could not accept him for the serial assessments, dressing changes, and suchlike that treating his wound would require. (don’t recall the rationale for this clinical decision).

I called the burn center at Tremendous State Megaversity, seeking care for this soul. They responded that they did not participate with his flavor of Medicaid. Therefore, I was told, my patient (remember: on Medicaid, which generally maps pretty accurately onto relatively impoverished) would have to pay kilobucks, out of pocket, for their care.

Of course.

So, please remember that the Venn Diagram of “folks on Medicaid” and “impoverished folks” results in a bulls eye of sorts, wherein the “impoverished” circle, encompasses the “Medicaid” circle.

Therefore, my patient did NOT have, nor have access to, kilobucks. So, did I send him to the local wound clinic, which for whatever reason had already told me that they could not accommodate him?

Nope.

Did I send him to Megaversity Burn Center, who had subject matter expertise in, oh, gosh, er, umm, BURNS?

Nope.

Of course, he returned to our walk in clinic, The World Renowned Center Of Excellence, In All Matters That The Subject Matter Actual Experts For Whatever Reason Cannot Handle, for his wound care and his serial assessments.

Because, I’m not bitter. Nor burned out. Nor sarcastic.

Not a bit.

BATTERY MONTH

It has been said that amateurs study tactics, professionals study logistics. I have attempted to put things aside for rainy days, and, with Mr. Biden at the helm, and Mr. Buttigieg as Secretary of Transportation, well, my achy knees tell me that rainy days are a’coming.

This being November, it is Battery! Month! Semi annually, I inspect my batteries, and assess their charge. I inspect for signs of leakage, I test the strength (using a voltage meter: Radio Shack used to sell them for $10-$20, once upon a time), and contemplate whether I have enough of each size. Unlike ammunition, “MOAR!” is not always the correct answer, for, ammunition keeps nearly forever if kept cool, dry and in the dark. Batteries have a self discharge phenomenon, and both rechargeable as well as alkaline (and carbon-zinc), or “primary”, batteries, will lose their charge over time. (“Primary batteries” are single use, and their charge derives from the chemicals with which they are made. “secondary”, or rechargeable, batteries can be brought backup to charge, after discharge, although after a sufficient number of charge/discharge cycles, they gradually lose their ability to accept and hold a charge.) Therefore, in an ideal bunker, I would have just enough that I would have fully charged batteries in service, and enough fully charged replacements to cycle back and forth, so that no battery would die a lonely, unused, death, way back in the back of my battery shelf.

I am still striving for that level of efficiency.

When I checked this month, to my disappointment, I found that most of my rechargeable batteries had discharged. Once I see if they will accept and hold a charge, I will know if they are in need of replacement, or simply every 3 month assessment.

I have some primary cells, for items that are frequently used. I have an LED penlight fueled by AAA batteries, and another identical penlight, except that this LED emits in near UV. That is handy for illuminating rashes, sometimes revealing luminescence typical of certain strains of dermatophytes. You might recognize the rashes caused, such as “ringworm”, or dandruff, or athlete’s foot, among others. Not all the dermatophytes glow under UV, but when it does, it is an “AHA!” moment.

My SureFire and ITP flashlights ride in holsters on my belt. They are bright, “Light-up-the-yard” lights. There are two, because should one fail, it is likely that the other will function. There are two, because should one fail, it is likely that the other will function. I have spare batteries in my “Bag Of Tricks” (h/t to Felix The Cat)

Our vehicles each have a “torch”, to differentiate the hand held lights, from the headlamp, the light-up-the-interior-of-the-vehicle lanterns, or the LED warning flashers. One is powered by CR-123 batteries, two are powered by C primary cells (the torch, and one handheld flashlight)

The LED flashers are powered by AAA batteries, and are intended to allow oncoming traffic to see that there is something (Me!) in the roadway, in the event of a breakdown, collision, or other night time deviation from normal. It turns out, when you buy “budget” rechargeable batteries, they have fewer charge/discharge cycles in their make up, than quality cells. Guess which will replace the unsatisfactory batteries? Yep: buy once, cry once. Or cheap out, and cry. In the dark.

Each month has it’s own focus, such that I do not spend every single day off in any one month in my subterranean lair, checking off stores against a checklist. If all goes smoothly, I might get my inventory done in an afternoon. As a starting point for those who might be interested, I have included a representative sample of my battery-and-lights checklist.

BATTERIES

EDC: UV Penlight AA x 2

Penlight AA x 2

Surefire CR-123 x 2

ITP CR 123 x 2

Proton Light

Keyring LR 41 x 4

Badge LR 41 x 4

Bedside

Surefire G-2 CR 123 x 2

Ultrafire 18650 x 1

Camper: Lantern Box

Coleman Quad Lantern #1 D x8

Coleman Quad Lantern #2 D x 8

Siege Light #1 D x 3

Siege Light #2 D x 3

Siege Light AA AA x 3

CAR LIGHTS

TDW Car

Torch C x 2

Headlamp AA x 2

LED Beacons AAA x 3 each (6 beacons)

My Vehicle

Torch C x 2

Headlamp AA x 2

LED Beacons AAA x 3 each (12 beacons)

Small Handheld light CR 123 x 2

Large Handheld Light C x 4

Medic Bag Surefire CR 123 x 2

Field Phones

Set #1 (2 phones x 2 D cells each) D x 4

Set #2 (2 phones x 2 D cells each) D x 4

Night Vision

AA x 4

Red Flashlight Toolbox

Mini Mag Lights x 2 (2 AA ea) AA x 4

Ray o Vac x 1 (2 AA) AA x 2

Mini Mag 3 cell AA x 3

Sure Fire Hurricane Light (weak CR 123, holds 12)

CUMULATIVE TOTALS, FOR EACH TYPE OF BATTERY

AA x 24 in service at any one time

AAA x 64

CR 123 x 8

18650 x 1

LR 41 x 8

C x 8

D x 30