School Fun And Games

Career Goals

So, once I graduated from PA school, we moved to Rural Ville. I had a job in the ER 
of the local hospital, so the kids went to the local school. Surprising, no?

My kids were in 8th grade and 9th grade. There were the usual transition rough 
spots, but they adapted soon enough. 

One day the school had a career day, and everyone got to describe their career 
plans. There were the the nurse wannabe-s, and future farmers, and prospective 
engineers. 

My one son had physics research in his sights. The other was less particular: 
"Not nursing!". 

My youngest came home after the career day, indignation oozing from every pore.
He couldn't contain himself. 

"So, we all have our little spiels. This one wants to be a baker, that one wants to be 
a nurse. Another wants to be a farmer. One kid said only this: 'Ahmgondrahvtruck!", 
and sat down. 

"Not 'I'm going to drive a milk truck", or 'a grain truck', or 'an over-the-road truck'. 
Nope! Just 'truck.' 'Ahmgondrahvtruck'. Where do they find these people?"

I had no answer. 


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Fun With Suits! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Yet ANOTHER Tale of Public School Wonderfulness!

When She Who Must Be Obeyed, and I, and our family had moved to another school district, we, surprisingly enough, registered our children in that new school district. We were provided a sheaf of paperwork to be completed, and, in leafing through my homework assignment, noticed a physical form for each child.

I examined it, and noted that, at the bottom, it required the signature of a “Licensed Health Professional”.

I pointed this out to SWMBO, and she asked me what I intended to do with this insight.

“Well, I’ll perform physicals on our children, document them, and sign the forms. Save us the hassle of a doctor office visit!”

She protested that I was an RN, and that they meant for a doctor to sign the form. I invited her to point out where, on the form, it so stated.

She turned it this way and that, and, finally, was compelled to admit that it did not so state explicitly, “but that is what they meant!”

“Perhaps, that is what they should have said!”, and I went off to retrieve my stethoscope and children.

I performed all the diagnostic maneuvers required, documented my findings, and, at the bottom, where it called for the “signature of a healthcare professional”, I signed it Reltney McFee RN, BSN.

Several days later I took the kids to school for registration and walked into the office. The woman there told me she needed some documentation of address so I gave her a utility bill. She needed some ID for me, and I provided my driver’s license. She needed a phone number, and I provided it. Next she asked for the School physical forms. She examined them, and asked, “Who is this?”, indicating the signature.

“That’s me!” I said. She asked me if I was a physician, and I replied, “No I’m not. I’m an RN.”

“You cannot sign this form!”, she informed me. I leaned over the counter, pointed at my signature, and observed, “Yet, it certainly appears that I have signed it!”

“But, you have to be a doctor to sign this form!”

“No”, I corrected her, “it requires the signature of a licensed health professional. I am a registered Nurse, and am therefore a licensed health professional. Hell, I’m even licensed by the Bureau of Health Professions!”

Unswayed by my logic, she informed me, “Nurses aren’t health professionals!”

I picked up a phone book. “Oddly enough, the Board of Nursing seems to think that nurses are health professionals. It’s a local call: why don’t you call the Board of Nursing in the state capitol, and straighten them out? I’m sure they’d enjoy having you correct their little misunderstanding!”

And then I smiled.

She stuttered a little bit, looked flustered for a little bit, went into the back office and then came back out and said “We’ll take it this time.”

I smiled and said thank you and went on my merry way. Next year the kids came home from school and had these physical forms that need to be filled out. I looked at them: there at the bottom of them it said “signature of Nurse Practitioner, MD, DO, or Physician Assistant”, none of which I was.

My nursing school instructors would have been so proud of me! I was an agent for change, and the school system had changed their forms at my instigation!

Fun And Games Off Duty · Fun With Suits! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Fun and Games In The Public Schools!

So, my daughter, Brenda, had injured her knee in gym class at middle school.  
We lived about a mile from the school, and, once she had told the teacher about
her knee injury, did that teacher, or any other official of the  school, call her 
mother, the nurse?  To quote Eddie Murphy, in his persona of The Ganga 
Teacher, "No, no, noooo, no!"

Did they phone her father, the nurse?  Again, "No, no, noooo, no!"

Did they have a teacher drive her home, so that she would not have to walk 
home on her injured knee?  As you might have anticipated at this point in my 
rant, "No, no, noooo, no!"

Did they put her on a bus, again, to prevent her walking home on her 
demonstrably injured knee?  If you have read this far, sing along with me:
 "No, no, noooo, no!"

Instead, of course, they sent her home, walking, on her injured knee, around 
a mile from school to her home. 

As you may have guessed at this point, I was not favorably impressed. Nay, 
I was pissed. 

I wrapped her knee, applied ice, elevated it, after identifying no marked 
instability.  It did hurt her with walking (which, of course, the idiots at the school 
had required her to do to get home, since they had NOT called her father, or 
her mother.  But, perhaps, I had already told you that little detail) 

I dosed her with ibuprofen, and put her to bed. I wrote her a no physical 
education note, and retained a copy for myself. I signed it, 
"Reltney McFee, RN, BSN".

In the morning she appeared  improved enough to return to school. Therefore, 
in consultation with She Who Must Be Obeyed, we decided to send her to 
school. We drove her. Ourselves. To make sure that she did not have to walk. 

So, that afternoon  I was surprised to receive a phone call from the phys ed 
teacher.  This worthy told me that he required a note FROM A DOCTOR, in 
order to keep her out of class. I pointed out that he had, in his hand, a suitable 
note, that I had written, directing him to keep my child out of gym class until 
further notice. 

He replied that, absent a note from a physician, he would require my child to 
participate in gym class. 

I gave this a second's thought, and brought him up to speed. "So, let me see if I 
am understanding you.  You have a note, in hard copy, in your physical 
possession, written by me, her father and a Registered Nurse, directing you 
to keep my child out of gym class due to an injury she suffered on school 
property, and notifying you that, should she participate in gym class she may 
sustain additional injury.  You, in your medical judgment, have determined that 
you know more of this sort of thing than I, and will contravene my explicit 
instruction, in my capacity as her father and a registered nurse of 20 years 
experience.  Cool story.  I'm certain that the jury at your lawsuit will be very 
impressed.  Perhaps impressed to the tune of several hundred thousand 
dollars."

He sputtered, "You cannot sue me!"

"Really? Is that what your attorney told you?"

"I do not have a lawyer."

"Well, what do you know?  I DO have a lawyer, and you can, too!  Once my 
lawyer serves you with the papers he will prepare to hold you personally 
responsible for my daughters crippling injury, suffered through your willful 
and wanton negligence, ignoring the specific instruction that I, her father and 
a registered nurse, have provided you. In writing. Right about that point, 
I wager you will find yourself a lawyer!"

He sputtered a while longer, and noted that he would, sooner or later, require 
a note from a physician. I told him that I would obtain one, at my earliest 
convenience. And, I'd provide him a copy. 

The call terminated. 

Once I had my daughter in my vehicle, outside the school, I asked her how 
gym class had gone.  

"Fine, Dad.  They sent me to study hall, and for some reason, the teacher 
seemed pissed about something."

I smiled, and replied, "Well, it might have been something about sending 
you, and our attorney's kid, and his attorney's kid, as well, to a very nice 
college!"

She looked puzzled at that, but, what the hell, I wasn't going to be able to 
put things over on her for very much longer, and I ought to savor the few 
remaining opportunities. 
Fun And Games Off Duty

‘Snow Joke!

A couple of years ago, I was working in Vermont on a winter locum tenens contract. (that’s kind of like travel nursing, for doctors, PAs, NPs, CRNAs and such) Since Mother Stretcher Ape resided a state or two over, I finagled a long weekend, and drove off to visit her.

Now, perhaps you had realized that Vermont, and all the states around it, are northern tier states. So, in the winter they get some snow. Nay, they receive abundant snow. With my formative years spent in Michigan, snow is no big deal. Still, even we hardened northerners need to pay attention, so as to avoid turning into corpsicles.

When I was first driving up there, the administration spoke of their concern that I understand the snow situation in their neighborhood. “So, you know, here in Vermont we get a lot of snow.”

“Yeah, I had heard that was so.”

“You *do* know how to drive in snow, don’t you?”

“You looked at my resume, right? You did notice the part about working all over Michigan, for years at a time, right? Including in the winter. My children were born in Michigan, and have grown up in Michigan. I think I know what snow looks like, and that I have driven in snow, a few times.”

(mumbling on the other end of the phone) “Oh, yeah. Right. You probably know how to drive in snow.”

“Yeah. Kinda.”

So, one wintry weekend, I set off to visit The Maternal Unit. Now, I say “One wintry weekend”, but that was by the calendar only. This particular January weekend, the temperature was in the 40-s to 50-s, low overcast, drizzle filling the air. Nice. I took off across Vermont, into The Neighboring State, and then southerly toward The Maternal State.

Once I crossed over into The Maternal State, it began to flurry, with the temperature dropping below freezing. As I continued, entering into The Megalopolis, it began to snow. Big surprise, right? January, northern states, snow. Who knew?

As I stop-and-go-ed my way across The Megalopolis, on the parking lots laughingly called expressways, the snow picked up. By the time I was on my way out of The Megalopolis, with only another hour of stop and go before me, it was snowing it’s ass off (Yes, that is a northern Michigan meteorological term). While the street department of The Maternal State in general, and The Megalopolis in particular, are no slouches in snow handling (having abundant experience), this specific storm was more muscular than the norm. Indeed, snow was collecting at such a pace that both it outpaced the highway department’s ability to plow it away, as well as limiting visibility. When you consider the fact that snowy roads lengthen your stopping distance considerably, couple that with, say, 50 yards of visibility, and you really start to feel the need to slow down. Waaayyyy down. Personally, I was going around 30 mph, and feeling daring at doing so. More high spirited souls than I were passing me, and more power to ’em. I had resolved that, should they wind up in the ditch, I was gonna drive my happy fuzzy electrician ass right on past ’em.

So, driving in the snow, transformed a three hour drive into something on the order of 6 hours. When I wasn’t wondering just what sort of fiery hell would send me to my judgment, I gradually formulated the Stretcher Ape Four Stages of Snow Emergency Scale. I share it with you, now.

Level 4: wear your damn boots

Level 3: bring a coat, bring a shovel and a scraper

Level 2: do the s#!t you have to do and go the hell home

Level 1: Ermagerd! French toast by candlelight!

I figured that I was driving at that time though a “Level Three Snow Emergency”, and resolved to arrive at The Maternal Manse, and consider myself the hell home. I really was pretty happy with that insight, and strong in my resolve in accomplishing it.

Then, roughly 30 minutes (I hoped!) from my destination, I saw flashing lights ahead. I slowed down even more. Approaching the scene, I observed flashing lights as of several police cars. Several fire trucks appeared to be in the gaggle, if their lights were as I figured them to be. Closing the distance, I noticed lights as from a highway department plow truck, although they seemed strangely out of position.

I crept past the scene, and realized why the lights appeared out of position, on the plow truck.

When a plow truck is on it’s side in the ditch, that would be a clue. Almost as if it was a Sign From Ghawd. A Sign, as if Ghawd were telling me, “slow your dumb ass down, go the hell home, and set your ass in a chair and stir not from that chair, until I tell you otherwise!”

My reply? “Sir, Yes Sir!”

My car slithered into Mother Stretcher Ape’s driveway, and settled several inches once I stopped. Looked as if the driving part of Ghawd’s admonition, would be easy to comply with.

I clumped into Mom’s house, trying not to track too much snow inside. We spent a couple of pleasant days watching the snow fall, shoveling snow (well, *I* shoveled snow!), and shoveling snow, and shoveling snow, and shoveling snow yet again. On the plus side, there was the home cooked meal part of things to enjoy, and the visit with your mother part, as well.

In summary, I leave you with two insights:

Insight The First: The Stretcher Ape Four Stages of Snow Emergency Scale.

Level 4: wear your damn boots

Level 3: bring a coat, bring a shovel and a scraper

Level 2: do the s#!t you have to do and go the hell home

Level 1: Ermagerd! French toast by candlelight!

Insight The Second:

When a plow truck is in the ditch, that would be a clue. A clue that you do NOT belong on the damned road.

Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pre Planning Your Scene

Are We Ever, Really, Off Duty?

Are you ever off duty?

I had spent some time praying at The Altar of The Overtime Fairy, and with the proceeds had decided to take The Long Suffering Wife on a cruise. Now, one of her idiosyncrasies is that she is allergic–VIOLENTLY, anaphylaxis, throat swelling, red faced allergic, to tree nuts. Remember that. It will return to feature prominently in this “war story”.

The cruise line we selected had gotten our business previously. The personnel are unfailingly pleasant, professional, attentive, and on their game. The food is excellent, the accommodations are pleasant, the cabin stewards are magicians who ghost in and make the beds and change the linen without our seeing them. There are reasons that we are repeat customers.

We select the formal dining room each time. There are large tables, so we get acquainted with fellow cruisers, the food is outstanding: as good as, and generally superior to our own home cooking. On this cruise we joined two folks from Minnesota, a contractor and his girlfriend, and two other couples, the men both volunteer firefighters from a small town in Canada.

Firefighters are part storyteller, as am I (surprising, no?). It develops that our other two companions were storytellers, as well. So, mealtimes were fun, great food, round robins of telling tales, and no workaday cares.

Now, it seems that, for some reason, we had failed to make clear to the serving staff my wife’s allergy to nuts. (likely, because we had failed to, ya know, TELL THEM!, or something.) So, one evening, when my wife took her first bite of the chicken that she had ordered, she chewed it for a moment, then spat it out, turning to me with a peculiar look on her face.

I asked her what was the matter, and she told me, “I don’t know, but my mouth is burning as if I had just eaten a nut.”

From the corner of my eye, I noticed our firefighter companions in still life, forks immobile in mid air, as Mrs. Stretcher Ape and I had our conversation. I asked her how her breathing was, and she told me that was fine, but that the burning was concerning. I agreed.

She keeps an epi pen in her purse, which, of course, presently was in our cabin. She did have benadryl on her person, and I directed her to take two, right now. She did so, and we all watched her for a moment. I then directed her to give me a third capsule of benadryl, which I opened, and poured onto her palm, directing her to “lick that up, now!”

One of the firefighters shuffled his chair back a bit, as if clearing for lift off, and asked me if I needed any help. Our contractor friend, with whom we had gone on shore excursions, observed that I was an ex medic, ex ED nurse, and presently a Physician’s Assistant. I looked at the firefighter,  perched on the literal edge of his seat, and his partner, similarly (not so very) relaxed, and said, “It looks like things are OK for now, but I’m anticipating the possibility of that changing. Let’s give it 20 minutes to see how things develop. Thanks for the back up.”

I turned my attention back to my wife, and pasted a fake, but encouraging, smile on my face. “How you doing, Honey?”

She thought for a second, and answered, “OK so far.”

The waiter had noticed our diorama like table, and the absence of conversation, and walked over to see if he could assist us. I briefed him on the foregoing, and our suspicion that the chicken may have been cross contaminated with some sort of nut in some manner. Alarmed, he told us he’d look into it and be right back.

He was. Along with the Maitre D’. Both assured us that there were no nuts whatsoever in the recipe for my wife’s selection, although it was possible that there were some nut oils remaining on the surface upon which the chicken had been prepared. Effusively, they both asked after my wife’s well being, and apologized for this occurrence.

By this point, she reported that the burning was receding, and no swelling nor shortness of breath, as well as no itching was present.

I noticed that everybody else at the table, finally, resumed their meals.

Once I was convinced that her symptoms were, in fact, receding, and appeared likely to continue doing so, we retired to our cabin for the night. She, and I, thanked our companions for their vigilance, and reassured everyone that it appeared that her reaction was on the way to being resolved.

So, the question: are we ever REALLY off duty?

Protect and Serve · Uncategorized

Patient Care Is Everywhere!

I had the opportunity, a couple of years ago, to speak with an police officer who 
personified the “Protect and Serve” mindset. An elderly, very confused 
gentleman, with a baseline mentation deficit, was brought in to the hospital 
at the instigation of the officer. 

Having been dispatched for a "welfare check", he found this soul confused, 
and in the officer's estimation, "looked sick." We evaluated the patient, and 
tried to (start to) fix his medical issues.  While waiting for the lab results, the 
officer and I chatted. The officer related to me that he was an officer, 
“not for the attorney with a 150,000 dollar car and a nice house: he doesn’t 
need me. That guy, over there: he depends on me to do the right thing. 
He is why I took that oath.” 

Once we had finished caring for the gentleman, and were ready to discharge 
him, another officer from this same (yeah, rural) department came and took 
him home, seeing him safely into his apartment.

Another occasion, same rural police department, same officer. This time he  
accompanied an EMS transport. This soul was in custody, so the officer parked 
himself outside the room, to keep an eye on his charge. During their stay, in 
the room across the hallway, was a child, who was very dubious about the 
entire "going to the hospital" thing. This officer was approached by the fearful 
child, who momentarily had his fears overcome with curiosity about a 
live-and-in-person police officer. This officer was very engaged with the child, 
producing wide eyed interest as the boy lectured the officer on the ins and outs 
of frogs, and minutiae of their lives in the wild. He (the officer) offered a few frog 
insights of his own, and the two of them had an animated conversation there in 
my ED hallway. 

The rest of my encounter with the boy was made considerably smoother, when 
the officer asked the boy, "Are you behaving for my friend Reltney?  Yeah, he 
may be a doctor (well, a PA at this point, but, ya know...), but he's pretty nice.  
Give him a chance, wontcha?"

My point? There has been come conversation of “Officer as social worker” 
becoming part of the police toolbox. This theme is not new, although it used 
to be called "walking the beat, and knowing your beat". Some officers, who 
are each a credit to their profession, have been employing that tool for a 
long time. And, in some regards, to steal a phrase from the American 
Nurses' Association, "Patient Care is Everywhere!"  Some of the practitioners 
are not formally licensed in health professions. And, some of us simply see 
it as being a good neighbor. 
Pre Planning Your Scene

Small Town Hospital Fun And Games

 

TINS. TIWFDASL in a small rural ER somewhere, and the local EMS had brought in Sumdood who had sustained some sort of injury, that necessitated placing him on a long backboard, and cutting off his clothing. Said Dood subsequently, and contrary to my exhortations, removed his backboard straps, ripped out his IV, exited the cot, and started trying to assault another patient. I overhead paged “security stat to ER” (try not to hurt yourselves laughing), and the reporting officer ran back in, and took down my crazy, naked, lunatic wannabe fellow patient assailant.

Mr Naked was trying to cold cock the cop, the cop was trying to cuff Mr. Naked, and it looked to me as if more hands were needed, on The Good Guy’s side. I grabbed Mr. Naked’s off hand, and it was on.

So, the three of us were rolling around on the floor. Neither the officer nor I was making much progress, because Mr. Naked was sweaty and (shockingly enough) uncooperative. In addition, and simply making my day so very much better, he was bleeding enthusiastically from the site from which he had ripped his IV. Nice.

One of the nurse aides came over, and asked, “Is there something I can do to help?”

I replied: “Go over to the phone, dial 9 to get an outside line, dial 911, and tell the nice dispatcher that you are at Rural Community Hospital ED, and you have an officer in trouble. Repeat that, over and over, without stopping, until you hear the sirens. Now. Now would be very, very good!”

Long about this time, one of the (male) floor nurses, having determined from the overhead page that This Was Likely To Be Bad, had gotten another floor nurse to watch his patients, and trotted into the fun and games. So, by the time that the first backup officer had arrived, there were FOUR of us rolling around on the floor. In the blood. And sweat. And, every bit as much fun as it sounds to those of us who really, really do not like to exchange bodily fluids in the middle of the ER. On the floor.

Well, it soon developed into a Public Safety Roll Call. Every officer in our rural county screeched to a stop in our parking lot. There were city cops, there were county deputies, State Police officers rolled in. I even think that the county’s Department Of Natural Resources officer joined in the festivities. EMS showed up, firefighters clumped in.

Mr Naked was subdued, and cuffed. The offices went to pick him up by his cuffs and feet, and I suggested that they were much less likely to hurt their backs, should our friends from EMS place him on a backboard, and transport him to the pokey in their truck.

On the way out of the door, the ER physician asked the medics to pause a moment, and the doc asked the patient if he, the patient, desired to be evaluated for any injury or illness. Mr. Naked responded with an oration on the peculiar mating habits of the physician’s mother. We took that to mean, “Why, Doctor, how thoughtful! No, thank you very much, but these nice officers and I have made other arrangements! Y’all have a nice evening!” (or, something like that)

I retired to the nursing station, to write a nursing note that looked like a Take Home Essay Final on “Emergency Nursing in The 20th Century: Issues and Answers”. It ran on the order of 2500 words, and I made certain that this narrative was filed where I could find it should the need arise.

So, out of the blue, maybe 5 years later, I received a phone call from the Prosecutor’s Office for Rural County. I was asked if I remembered Mr. Naked Guy. I replied that I did, indeed, remember Mr. Naked Guy. I was asked if I could recall the events that I just finished recounting, in slightly altered fashion, above. Why, yes, I replied, I certainly could.

She continued. It seemed that Mr. Naked Guy was now out of jail, and was alleging that the responding officers had employed excessive force in subduing him. Did I recall anything that might relate to Mr. Naked Guy’s allegations?

I asked her if she had read my nursing notes? She had not.

“Ma’am, why don’t you read my nurse’s notes, and, if you have any more questions after that, call me back.”

She told me that she would do so.

I never heard another word.