IDIOTS

Not so very long ago, I was running an errand for The Darling Wife. I plopped my Liquid Nails on the belt, and asked the teller, “Would you please charge me for a 2 pound bag of ice?”

He blinked at me once or twice. “Do you mean two large bags of ice?”

“Nope, one bag, two pounds, please.”

Again, the slow blink. “So, you want two small bags of ice, right?”

Again, my response was negative. “Nope. I plan on walking out of here with one bag of ice, a small one. Please see to it that I am properly charged.”

He paused, again. “Okay. One bag of ice? One small bag of ice?”

“Yes, sir. That’s what I am seeking.”

“Okay. That will be (total).”

I handed him the money, took my change, thanked him.

When I reached the ice chest, and retrieved my small bag of ice, I noted that it was seven (Yep, *7*) pounds, NOT two pounds.

So, I think we all can discern who the idiot was in this little exchange.

(Tag! I’m IT!)

ONE ENCOUNTER WITH THE GOOD IDEA FAIRY

A long time ago, I was a CPR instructor, and a nursing supervisor. It came to pass that my boss, the director of Nursing, somehow felt the need that I participate in some committee. Since I was a CPR instructor, she directed me to join the hospital’s CPR committee.

There were folks from various departments on this committee, and it was our mandate to orchestrate annual CPR training for our facility. My idea was to train a cadre of CPR instructors, and have those folks train their individual departments, and likewise their shifts, with members of the committee (ourselves) joining in when no other instructor was available, or the number of trainees exceeded those which one instructor could reasonably be expected to teach.

Everybody thought that was a capital idea, and we made short work of arranging for instructor training.

Then, Cletus donned his guise as avatar of The Good Idea Fairy.

Cletus asked, “Wouldn’t it be useful if, say, folks around a code (cpr in progress) knew, say, how to intubate?” (intubate: place a breathing tube into the trachea of an unbreathing person)

The rest of the committee agreed with this thought. Someone explained that this was the reasoning underpinning the decision to have the in house 24/7/365 emergency department physician respond to codes, and (when such was in house) the nurse anesthetist respond as well, so that one (or, perhaps, two) suitable trained and experienced providers could, ya know, manage an arrested patient’s airway by, lessee….INTUBATING THE PATIENT.

Undeterred, Cletus posited a cataclysm, such that the haggard survivors thereof might find themselves running a code in the absence of a physician or nurse anesthetist, and, in such a setting, might it not be useful to have somebody else, such as an employee of Cletus’s department, trained to insert endotracheal tubes?

Everyone else wondered whether or not, in such a setting, other issues might prevent effective resuscitation. Maybe, no electricity?

Cletus had persistence going for him. He asked if it might be good if somebody on the code team was familiar with the medications typically administered to an arrested patient?

They all (except Cletus) turned to look at me. The chair of the committee asked me, “Say, Reltney? Could you speak to that issue?”

Yep. I addressed Cletus. “You know, that is a great idea. In fact, I think that there ought to be formal plans to have somebody who went to school and spent years studying the indications for a particular medication, the interactions of that medication with other medications, circumstances under which administering a particular medication might be contraindicated, typical doses of a medication, and the proper manner of administering that medication, both on the ode team, and at the bedside of the arrested patient.”

I paused for a moment. “I wonder what title we might give to such a clinician? Maybe we could call them…..NURSES?”

Cletus pivoted, again, and wondered about a CPR program of greater scope than basic life support, perhaps called “CPR Plus”, or “Advanced CPR”? In his imaginings, it might include cardiopulmonary resuscitation, as well as the mechanics of intubation, and also the front line medications administered to an arrested patient.

Again, everyone looked at me. They knew I had certification as a provider of Advance Cardiac Life Support (ACLS), the program developed and validated by the American Heart Association to provide a routine set of care guidelines (algorithms) for various types of cardiac arrest.

I voiced the foregoing to Cletus, and observed that such a new program as he suggested might produce problems of liability, lack of clinical validation, as well as being a tremendous black hole of staff time and attention inconsistent with the resources and priorities of a community hospital. Such as the one employing all of us.

He persisted. I suggested that he encourage his department’s personnel to complete an ACLS program, and avoid all this re inventing the wheel bother.

That, it seemed, would not work for (reasons). Rather, this New! Shiny! Untested! “program” would in every way be superior to his staff attending ACLS training.

At this point, the chair said something along the lines of “oh, gosh! Look at the time! Does anyone else have another meeting that they are about to be late for?”

I promptly reported to my boss, and told her that there was no way I would continue to be a part of a committee with Cletus as a member. I in no way wanted my name associated in the slightest way with any harebrained foolishness as he might dream up.

I mean no slight to hares.

History Taking

I had noticed that, in my own time as an RN, I would document a patient’s presenting complaint, and the particulars thereof, along with the medications taken by the patient, and that the physician often would be told different things in response to his own inquiries.

Therefore, since I am now a provider, I ask allergy, medications and medical history myself, even as my MA had documented the answers they had themselves received to those very questions.

So TINS, There I was, Fighting Disease And Saving Lives, and I asked a soul what medications they were taking. They assured me that they were taking, let us say, Youcallwehaul, three times a day as needed for (symptom).

I next asked what they were allergic to.

They looked me in the eye, and reported that they were allergic to Youcallwehaul.

So, what should I take as actual fact in planning my care of this individual?

Thanks-giving

So, here in The Un Named Fly Ove State, it snows every now and then.

I might have mentioned that fact, a time or seven.

Just the other day (as I write this), I had the opportunity to contemplate the intersection of Snow, and unrecognized service.

To be specific, I am grateful for the efforts of the road commission/highway department/road crews who awaken before oh-dark hundred, dress for the weather (and, when it is windy, it can be damned cold. As one comic termed it, so cold that Long Dong Silver turns into Wee Willie Winkie), and drive about, preparing the roads so that the rest of us can get to work, to school, shopping, or whatever.

Simply to make it all nice, these crews are often driving in weather that the rest of us are directed to NOT drive in. In weather featuring blowing snow so thick, that there may not be any visual cues that you are, in fact, even driving on the expressway.

So, while it has been rumored that these road crews earn some sort of super secret overtime for their labors, speaking as a guy who has a 100 mile daily round trip commute, so whucking fut? Thank you, plow and sander drivers, for your hard work. Thank you for getting out of your warm beds at hours when the chickens are still asleep, and clearing the roads so that everybody else can get where we desire to go.