Duty · Having A Good Partner Is Very Important! · Life in Da City!

Paying Attention Is Important

So, TINS (c), TIWFDASL (c), and working in Da Corridor. This was Da City’s, well, let us say, in paraphrase of the immortal words of Old Ben Kenobi, “Da Corridor: You will never find a more wretched hive of scum and villainy!” So, not the nice part of Da City.

I was working “The Corridor”, and an academy classmate, let us call him Gordon Lightfoot, was detailed in that day from another house. At this point of time, TBTCIDC was closed, as they were in the midst of moving kit and caboodle to the shiny, new, and in-the-medical-center hospital they had just opened. (Well, it had not been opened, just yet, and that little detail will figure prominently in this tale!) The hospital that was TBTCIDC’s “stand-in” was NOT generally the trauma center, but was in the medical center.

We caught call after call, transported sick (and a lot of not-so-sick) people, and generally saved lives. Our next run was on an asthma patient, and off we went. In fact, this particular address was only a block from the medical center.

We arrived, announced ourselves, and acquainted ourselves with this person’s malady. I brought the stair chair, and we wheeled this soul out to the ambulance, and settled them onto the cot. I had JUST entered the cab, preparatory to a leisurely trip to The Stand In Hospital, when Gordon stuck his head through the window connecting the cab with the patient compartment, and bellowed, “Reltney! He’s arrested!”

I hopped around to the back, and helped Gordon get set up for a spot of in transit CPR. Once he was set, I re entered the cab, and called dispatch: “Medic One, Code One, Stand In Hospital. Cardiac arrest, witnessed. Eta One Minute!”

Dispatch acknowledged. I tuned in the hospital alert frequency, and called: “Stand In Hospital, come in for Priority One traffic!”

They acknowledged, and I started my turn out into traffic, lights flashing, and siren wailing. “Witnessed cardiac arrest! CPR in progress! ETA one minute!”

The nurse on the radio was not clear on the message. “Say your ETA?”

“Open the doors! We’re here!”

Duty · Having A Good Partner Is Very Important!

PROFESSIONALISM, PART II

So, Carmen, my grand daughter, had a couple of additional Magical Mystery Tours of Peds ICU. Brenda, her mom, wound their way through the maze of physicians, and specialists, treating, and attempting to diagnose, what was underlying our recurrent Monday-evening-Grandpa-visits.

Eventually, one of the specialists determined that a surgery would mitigate Carmen’s breathing difficulties, and so a surgical date was set, in a distant Big City Medical Center. Brenda told both of her parents, and her conversation with me went along the lines of “Dad, so Carmen is going to have surgery on (date), at Big City Pediatric Hospital.”

(Dad): “uh huh. I’ll be there.”

(Brenda): “Uh, Dad? So, Mom is gonna be there, too.”

(Dad): “Uh huh. Why would there be any question about that?”

(Brenda):”Well, I know you guys are going through that divorce, and things might be…tense..if you were both in the same room.”:

(Dad):”Well, Honey, your mom is a grown up professional, I flatter myself that I am a grown up professional, and while we are there with you, for that time, what I think about your mother, or what she thinks about me, well, nobody cares. This is about you and Carmen, and nothing else is on my plate for that time. I don’t anticipate any drama coming from either of us. I know I won’t cause any drama, and I am confident that your mother will not, either.”

So, we met at the appointed time, and greeted each other. Carmen received her IV, and was pre medicated, and rested on her mother’s lap, soon falling asleep. I have a photograph, somewhere, of Carmen, relaxedly asleep, on Brenda’s lap, Brenda appearing fatigued herself.

Carmen went for her surgery, and returned, post operatively. Carmen had an uneventful post operative course, and Brenda took her child home. Today, a dozen years later, Carmen is newly adolescent, The Big Sister, and perfectly healthy.

Oh, and my pre and post op interactions with The Plaintiff? Benevolent, professional, and child (and grandchild) focused. No drama.

Duty · Fun And Games Off Duty · Gratitude · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

PROFESSIONALISM

While my divorce was unwinding, I was working midnights in the ED of Mid Sized Hospital in the Adjacent Relatively Big City. I had a seven on/seven off schedule, which worked out pretty well for the week on/week off custody schedule for the youngest two kids.

So, TINS©, TIWFDASL© (well, to be precise, I was standing in my kitchen, looking around to see what I had forgotten to pack for the night to come), when my phone rang. My darling daughter was on the line. “Hey, Dad! How would you like to come over and take a look at your grand daughter?”

“I’m always up to visit my grand daughter, as well as her mother! What’s the occasion?”

“Well, Carmen is having some difficulty breathing, and I’d like you to look at her and tell me what to do.”

“Be right over. Unlock your door!”

A couple of minutes later, I was knocking on her door, stethoscope around my neck. Brenda opened the door, and I heard Carmen wheezing from across the room. “Call the ambulance, right now!”

Brenda was unconvinced. “Dad, if we call the ambulance, they will simply take her to Local Small Town Hospital. They will simply wind up transferring her to Next Town Big Hospital. Why don’t we just drive her to Big Hospital, ourselves?”

Good time for me to collect data. “Honey, do either you or baby daddy know CPR?”

“Um, no.”

“Y’all have oxygen in your car?”

“No!”

“You guys have any way to alert Big Hospital ED that you are coming in hot with a critically ill child?”

“You know we don’t!”

“So, let’s call EMS, who do indeed know all those things, and have all those things, so that they can treat Carmen properly, hmm?”

“We’ll just drive her over to Small Town Hospital, ourselves.”

“NOW, sweetheart. Right now!”

“I just have to…”

“No, you don’t. Get your ass on the way, right freaking now, and no more delay. Now!”

As they cleared the door, I phoned Local Hospital ED, where I had been an ED nurse, and provided a heads up. “Hey, my daughter is on the way with my grand daughter, who is in respiratory distress. Under a year of age.”

“When will they be here?”

“Open your door, now!”

I locked up, and made my way to Local ED. Once there, I saw the staff meeting that was a pediatric critical child. The ED physician was in the room, my daughter and baby daddy, two ED nurses, a respiratory therapist, the lab, and a couple of other folks that I could not make out in the crowd. I spoke to my daughter, and told her that I was off to work, and I’d stop by in the morning to see how things were going.

I called my daughter the next morning, on my way out of work, and met her at the Big Hospital Peds ICU. She told me that, unsurprisingly (to me), Local Hospital had tested, x rayed, oxygen-ed, and IV-d Carmen, and then transferred her to Big Hospital, via Peds Mobile ICU ambulance. Carmen was considerably improved over last night. I could not hear any wheezing, and she appeared to breathing easily within her oxygen tent. I said my hello to Carmen, ascertained if my daughter needed anything from me, and said my goodbyes to return home, and to bed.

Carmen was discharged the following day, and Brenda had a ream of instructions, as well as the opportunity to administer breathing treatments, as well as oral medications, to an infant several times daily. As a civilian, not a nurse.

A couple of weeks later, I was again preparing for work, and, again, received a phone call from my daughter, again inviting me to visit Carmen. “Always delighted to visit. What’s the occasion, this time?”

“She’s struggling to breathe, and the breathing treatment did not seem to help today.”

I instructed Brenda to immediately go directly to Local Hospital ED. “But, they will simply send her to Big Hospital again!”

“Yep, that is entirely likely. As is the fact that they will send her in a peds MICU, with a physician, respiratory therapist, and a couple of paramedics. All of which I highly approve of. Now, get going, right now!”

I, again, met Brenda at our local ED, again Carmen was the center of a veritable staff roll call in the treatment room, and, again, that evening she was whisked as described, approvingly, above, back to peds ICU at Big Hospital.

I stopped by the next morning. Brenda greeted me. “Dad, just like you said, they transferred her by ambulance back here. When we arrived, all the ICU nurses remembered Carmen, and were crying as they brought in the vent, the crash cart, and the intubation cart. Mom was here, and, gotta tell you, I was trying as hard as I could to keep it together for Carmen. The nurses’ crying was *NOT* helping! If mom had not been here, I would have lost my mind!”

I replied, “Honey, your mom is a pretty good nurse, and she keeps her head really well in a crisis. I’m really glad that she was here for you!”

And, at that point, I did the smartest thing I had done in a while. Right then, I shut up!

Duty · Gratitude · Having A Good Partner Is Very Important!

GRATITUDE

My mother died last month. She had passed her 100th birthday, and was living in the house she had occupied for something like 40 years. The immediate trigger to her death was liver failure, occasioned, most likely, by an adverse interaction between anesthetics and a century old liver. She had fallen, a couple of days prior, and fractured her hip. The surgery, fortunately, was for this sort of thing, uncomplicated, and she evidently tolerated the surgery side of the affair pretty well.

That is to set up the following deliberation. Gratitude. My mother was able to spend her last months in her house, because my youngest brother pretty much dropped everything, and moved in with her. The woman who has been his family’s housekeeper for something like a generation (from well before The Plaintiff became The Plaintiff, in fact!), also dropped her comfortable daily routine, and became my mother’s de facto practical nurse. Wordy as I am, I am unable to adequately describe my gratitude to my brother, and (let us call er…) Angelica. I thanked them both, even though my brother sloughed it off, “You would have done the same, if you had been able. Hell, you *did* do the same, for Dad.” Angelica simply smiled, sniffled a bit, and turned away.

Mom was able to live pretty independently in the two years prior to that, due to my middle brother, and his wife, let us call her “Donna”. Due to Donna’s efforts, in particular, Mom was able to live in her own apartment, have her dog with her, and, generally, run her own life. Donna made certain Mom got to her doctor appointments, got and took her medications, had her clothing laundered, had food in her frig, and that the dog got walked. All this on top of running her, Donna’s, own household, and helping her husband, my brother, run his business. Thank you.

Prior to that, well, there are, and were, neighbors who looked in on Mom. Then, there is The Car Service Guy. https://wordpress.com/post/musingsofastretcherape.wordpress.com/431 During one power failure (different from The Car Service Guy story), her neighbors physically took her in, where she stayed at their house, warm due to their generator, eating their hot food, and remained until the power was restored. Without these folks, not a one of whom was any sort of kin to my mother, she could not have lived in the house that she loved, for as long as she did, as nearly independently as she did. Thank you. God Bless you.

Police officers in her town, on a couple of occasions, looked in on her at my, and my brother’s request, and reported back that she had been fine. Thank you.

Several of my youngest brother’s friends, living “only” one state over, would drop in on her a couple of times a year, helping make sure that she was getting on alright, and providing an “eyes on” report to my brother. Thank you, as well.

I have to say, the shriveled vestigial organ where my heart may have once resided, is warmed by the good example of these folks. Not for them the bullshit “You voted for Trump! Demon!, or “You voted for Biden! Traitor!”, pejoratives that seem to pass for political discourse. Simply, good people, watching for their neighbors, and living the admonition, “Whatever you did for one of the least of these brothers and sisters of mine, you did for me.”

Good people, good examples. Thank you.

Duty · Fun With Suits! · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact

“Show Me Some Teeth!”

One afternoon, I came in to my shift as a nursing supervisor, and the director of nursing had, it appears, JUST finished receiving a phone call asserting that somehow, the hospital staff had lost some patient’s dentures. Of course, I was the High Value Target in that particular free fire zone, and I caught the assignment. “McFee! You find out what happened to this patient’s dentures! Do not rest until you find them!”

I promised my best efforts, and was reprimanded. “I do not want your best efforts! I want you to show me some teeth!”

Uh, Ok. Yes ma’am!

I inspected the patient room, freshly cleaned by housekeeping. No dentures. I went to billing, the keeper of the valuables, and searched for property that had remained unclaimed. No dentures.

I interviewed our laundry folks, and inquired regarding foreign objects in the washer or drier. No dentures.

I inspected the patient intake form, cataloging the patient’s property at arrival. Of course, there was indeed a notation that the patient had brought her dentures with her to the hospital.

I took a break, and visited the security supervisor. We chatted for a bit, until he asked why I had not been wandering around, and had not been in evidence that shift.

I told him the Story Of The Missing Teeth, and my efforts to transition that tale into a dental retelling of The Prodigal Dentures: “Rejoice! My teeth, that have been lost, have been found! Kill the fatted calf, prepare the feast!”

Along with my, thus far, horrible fail in accomplishing it.

He sat back, and a thoughtful look crossed his face. “So, Reltney, do you need to find THE teeth, or just any teeth?”

I observed that the patient in question might feel a little, well, odd, wearing somebody else’s teeth.

My friend the security supervisor opened his safe, and extracted some ancient dentures. He then clarified things for me. “See these green teeth, here? Now suppose they were inadvertently dropped outside the door here, in the driveway, and some inattentive security officer, like, say, me, were to accidentally run them over, like, six or eight times? I doubt that anybody would put the shards into their mouth, you could show your boss teeth, albeit broken teeth, and so she would be happy, the complaining patient would get new dentures, so they would be happy, and your boss would stop breathing down your neck, and so you would be happy. How many opportunities do you think you will get to make that many people happy, all at once?”

Duty · Life in Da City! · Pains in my Fifth Point of Contact

Whenever I Start to Think That I am The Smartest Guy in The Room, I am in the Wrong Room!

Another time, I was fighting disease and saving lives as the afternoon nursing house supervisor. Start of shift stuff had been done, I had made some rounds, and arranged for staff to get off the unit to eat. I was piddling around with some paperwork of some sort, and heard an overhead page of “Code Red: 1 East!”

At that time, in this facility, 1 East was our psych unit. I phoned the switchboard, and she told me that there had been a pull station activated on the unit, and I needed to go verify it before she could call the fire department.

Uh, excuse me? WTAF??!! I directed her to call 911 right freaking now, and communicate the alarm at once. “But, our policy is to wait until the supervisor verifies the fire!”

I told her that, employing the telepathy that had stood me in such good stead in years on the Fire Department’s EMS division, I had just this second confirmed the alarm, and she needed to stop dicking around, and call the fucking firefighters.

I hung up, and took off at a trot for the nursing unit, and unlocked the door.

Immediately, I was happy that the alarm had NOT been delayed. The unit was quite smoky, and the smoke was starting to bank down to about shoulder height. I found the charge nurse, and asked her for report. She reported that every patient had been accounted for, and every one was presently in the day room, with two sets of smoke doors between them and the fire room. One of the patients had, somehow, ignited his mattress, and then things got exciting.

The security supervisor and I did another sweep of each room, double checking that nobody was on a floor, or draped over some furniture. Happily, nobody but the two of us was there. Oh, yes: the two of us and the first due engine company.

The firefighters trundled the smoking mattress out of the unit and into our alley, whereupon they performed a sort of urban baptism ceremony, pouring The Healing Waters Of Engine 56 upon the Sinning Mattress.

The next morning I had a stern chat with my boss, and the phrases “NFPA standards” and “fire code for health care facilities” were flung about. Along with the observation that the reported SOP was ABSOLUTELY inconsistent with the prevailing standard of care.

Duty · Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact

Phone calls that make you go”WTAF??!!”

So, TINS, TIWFDASL as a nursing supervisor in a small hospital in Da City. I had checked our afternoon staffing, and accounted for all the staff. I had wandered around, meeting and greeting my staff, and made arrangements such that everybody could eat. I checked in with security, and, as usual, there was nothing happening.

I was back in the nursing office, completing some paperwork or other, and received a call from the switchboard. The operator informed me that Channel 69 news was calling, asking about some patient who had fallen out of a window at our facility. I told the operator to send the call to me, and stat call the security supervisor to meet me in my office, RFN.

The call was odd. (Now THAT is a surprise, idn’t it?) The caller identified herself as a reporter for one of the local stations, and that they had received a report that a patient had fallen from a window, and landed on a roof of part of our building. I responded that this was inaccurate. I knew this to be inaccurate because, in the event that such a thing had occurred, the staff would call me immediately, no such call had been placed, therefore no such thing had happened.

We concluded our conversation, and I turned to my friend the security supervisor. I asked him to immediately inspect our roofs, either in person or with one of his officers doing so in person, and ascertain the absence of anybody (or, any body) on any of our roofs. He hopped right to it.

Next I called each of my charge nurses, and ordered them to immediately, with no delay, personally lay their eyes on each and every one of their patients. They were ordered to immediately call the switchboard to report that they had indeed personally laid eyes on every one of their patients, or stat page me overhead in the event that any patient was not physically on their unit.

One charge nurse protested that she was too busy to perform this task. I noted that this was what we termed “a work order” in our employee handbook, and her options were to get to it, right now, or prepare their soliloquy for 0900 the following morning, wherein they would have the opportunity to convince the director of nursing that they should, indeed, continue their employment at our hospital. Because ANY other response other than “Let me go, so I can get to this”, would result in their being clocked out and escorted from the building, right about now.

Surprisingly, that elicited compliance.

The security supervisor paged me, requesting that I meet him in the cafeteria, that being about the center of the hospital. I arrived and he briefed me: his officers had inspected the roofs, and noticed nothing awry. A couple of his officers had shanghaied the maintenance man, and secured a ladder. They were going to climb up and re-inspect the accessible roofs, to verify what their preliminary survey had suggested. And, nobody/no body had been found.

I physically went to each nursing unit, spoke with each charge nurse, and had them show me their census, along with a report of their actions to inspect each patient. No missing persons. Hallelujah!

I phoned my immediate supervisor, and gave her the short form report. Of course, the long report, in five part harmony, with full orchestration, with circles and arrows and illustrations to fully communicate the entirety of the affair, was waiting on her desk for the morning.

Duty · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

Health Care Stagecraft

So, I see children from time to time. Commonly, they are dubious about the entire “Going to the doctor” thing (yeah, I DO realize that I am not a physician, I am a midlevel. May I observe you explain that distinction, to an anxious child?) With that as a starting point, you can imagine that my approaching said anxious child with a stethoscope, and then with an otoscope (“the ear looking thingy”) might not end well. Yeah, me too.

One of the lessons I learned on Da Street (besides knock from the side of the door, and always have a second way out of any room I enter, and always have a knife, and…well, the important lesson is…..) is misdirection. On the street this manifested itself as changing the topic of conversation, as, on a hostile scene, announcing, “WE have to go and get the stretcher!”, and then both of us doing so, and motoring merrily away from the threatened free fire zone. Returning, if at all, with police.

In a more sedate clinical setting, this manifests itself with my (now) stock spiel for kids.

“This here (hold stethoscope up) is my body tickling thingy. Now, this is really, really tickley, but I only have one, right? That’s not enough to share. So, if you laugh, everybody will know how much fun it is, and they will be sad. ‘Boo-Hoo! (insert child’s name here) got tickled, and I didn’t! That is so unfair! I am so sad!’ Now, we don’t want them to be sad, do we?” (generally, toddler-sober negative head wag) “So, try very hard not to laugh, so that they are not sad! Okay?”

(generally, “ok”)

Once heart and lungs are auscultated, I continue with my misdirection. “You did so very, very well in not laughing, now we move up to the ear tickley thingey! Same rules, try not to laugh so that they do not know how much fun it is, and they are not sad that I cannot share, okay?”

Generally, again, “Okay.” While the child is trying to identify what the heck is so darned tickley about otoscopy, I finish.

One bonus point, is, even if the child screams and kicks and writhes, I can congratulate them. “Wow! You did so very well! I don’t think that they even suspect how much fun that was! You can stop pretending, now! You have successfully finished! Well done!”

Sometimes it is healthcare stagecraft, that lets you complete your job.

Duty · Gratitude · Protect and Serve

Duty.

Occasionally, I am humbled. Sometimes, I am moved to tears.

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, Sheriff and local PD are paid/full time, 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 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 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 21st 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.

Duty · Life in Da City! · Pains in my Fifth Point of Contact

The Reveal!

You may not be surprised to learn that I spend considerable time meeting folks, and some of those folks do not bowl me over with the force of their intellect.

Occasionally, somebody who does not otherwise impress me as being particularly dull witted, appears to decide that The Reveal is needful, NOW!, and therefore proceeds to impress me that they are, in fact, an idiot.

So, TINS, TIWFDASL, and I was interviewing some soul about his particular malady. As is my usual practice, I inquired about what symptoms had precipitated today’s office visit, duration of symptoms, what had been done prior to visiting me to address the symptoms, simply as a beginning.

So, this soul related that his symptoms had been treated on a couple of previous occasions, in the past month, and had transiently improved, and then returned. He had, so he told me, been treated with “an antibiotic”.

“What antibiotic?”

He did not know. “The antibiotic that they prescribed for me.” (as helpful as THAT is….)

“How long did the doctor have you taking that antibiotic?”

“Until it ran out.” (Certainly. Of course.)

I attempted to discern how long it had taken before the antibiotic had run out, since treating Malady “A” might call for a 5 day run of The Z Pak (boo! Hiss!), whereas Malady “B” might be addressed by 28 days of Doxycycline, for example. Ya know, just as if I cared what had elicited this gentleman’s symptoms, with an eye toward, oh, gosh, I don’t know, maybe TREATING HIM EFFECTIVELY, or something.

At this point, he felt it relevant to review some of the high points of his resume. For some reason.

“I’m college educated! I’m not an idiot!” (uh, sir? First, college educated maps poorly onto “not an idiot”. Not a very high correlation. Secondly, in circumstances where you wonder if it might be appropriate to reassure somebody that you are NOT an idiot, it is very likely that you are about to reinforce the impression, that you ARE an idiot. That certainly has been my experience in my own life, you may want to consider if there might be some parallels in your own.)

I somehow got back on track, and began my review of systems. At this point, he revealed that, in his estimation, “You are being dismissive of my concerns!”

HUH? Inquiries about your allergies, medications, and medical history are not “my attitude”. That’s how I attempt to avoid prescribing something to you that you either are allergic to (and you did not mention to my nurse….), or that might interact malignantly with your regular medications. For example, I dislike eliciting a GI bleed (stomach bleed: think bleeding ulcer) simply because you did not think that it was relevant that you take coumadin (a blood thinner), now that you are here for your orthopedic injury. Should I prescribe ibuprofen (popularly known as Motrin), that in combination with your coumadin might lead to a life threatening GI bleed, and I feel that to be a bad thing. Occasionally, that review of systems elicits something kind of important, like chest pain or difficulty breathing, that you forgot to mention, because your ankle pain is the only thing that (for some reason) you are concerned about.

But you are paying me to be concerned about that other, life threatening, stuff, and have the wit to not miss it.