The Heinlein Rule

Perhaps, I ought to initiate another tag, “The Heinlein Rule”. As Heinlein said, “Take a look around you. There never were enough bosses to check up on all that work. From Independence Hall to the Grand Coulee Dam, these things were built level and square by craftsmen who were honest in their bones.” (https://thisibelieve.org/essay/16630/)

I have spoken of Eloise in another post, as well as one particularly heads-up MA and how each of them, professional in their bones, acted on their own initiative and decisively to protect patients.

So, one day, TINS©, TIWFDASL©, when the registrar meandered back to the nurses’ station.

She opened her conversation, “Just checking. This woman reports that she is bleeding, and 3 days out from her delivery. You *DO* want her to go to emergency, right?”

Before I could contribute anything, my MA asked, “Does she look dizzy, or pale? Did she walk straight? Anything else going on?”

The registrar replied, “She looks pink, not sweaty, walked straight, no other complaints when I asked about any.”

My MA stated, “Please direct her to emergency.”

The registrar looked at me. I stated, “What she said. Does she have transport?”

“Yep, She is here with some family member.”

“Outstanding. She should be on her way, please.”

The Lord blesses me with partners who play “Heads UP!” ball.

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Sometimes, I am Humbled

Last week, I got back into my “groove”. I have had the reputation of sending folks to ED with greater frequency than my colleagues. So, this one gentleman arrived, in pretty remarkable abdominal pain. His exam was NOT reassuring, and I wondered if he had a hot gall bladder, or some other variety of intra-abdominal catastrophe-in-waiting.

Now, to be honest, I am not particularly young, nor am I particularly spry. Indeed, for the past several weeks I have been gimping about the clinic, as my one knee is undecided whether it will ache, give out, let my kneecap spin freely about my mid leg, or some unpleasant combination of the three. So, it is apparent to any observer who cares to notice, that my one leg is not making me happy.

Yeah, I know: STBM. (Sucks To Be Me), after a fashion.

So, this gentleman, in no small pain his own self, as a parting conversational gambit on his way to ED, and maybe surgery, wished, “I hope your leg feels better!”

Jeez! Some people! With all the setting good examples of compassion, and empathy!

Makes it difficult, sometimes, to be as cynical as I tend to be.

My “Problems”, Are Likely To Be Other Folks’ Blessings

My “Problems”, may well look like blessings to other folks

I was chatting with the physician with whom I was working last night, as we were working late due to a couple of late arriving folks. He observed that this sort of thing was one of the reasons we were paid pretty well.

Truth. I observed that, from one perspective, this sort of inconvenience, indeed, most of the sorts of things we generally thought of as “problems”, were, to other folks, blessings.

By way of example: “Waaah! It was so busy that I did not get the opportunity to write out and address payments for a couple of my bills at work today!”

Counterpoint: “So, Reltney, you are telling me that you have (insert non essential product/service, here), and indeed, have right this moment, the funds to pay that bill, in full, right now, but your EMPLOYMENT consumed so much of your WORKDAY, that you are now INCONVENIENCED by the need to pay that bill, on time and in full, at home, off duty, at your kitchen table? Rilly? Must suck to be you, amirite?”

Example the second: “Waah! I have a sink full of dirty dishes! Those food stains likely have set, and will be tedious to scrub off!”

Counterpoint: “So, Reltney, you have (a) a home, (b) intact, and (c) have a sink, in which your dishes from (d) your last several meals now rest, which you now have to clean with (e) hot running water, so that they are clean, once again, for when you prepare (f) your next meal, sometime, oh, gosh, TODAY? Did I miss any part of your tale of woe inconvenience? Must suck to be you!”

And so forth, with yardwork, laundry, shopping, fuel for the vehicle, etcetera, off into the distance.

Communication Breakdown

So, TINS©, TDW-Mark II had set out, because TSIL-Mark II (The Sister In Law-Mark II) had undergone surgery of some sort, and required assistance in the couple of weeks post operation. TDW does not work outside the home, and I flatter myself that I am sort of self sufficient. So, off she went.

Her journey to Another Fly Over State was unremarkable. She arrived, and notified me of this fact. I cooked up a batch of food, ensuring a supply of left overs for my work day repast. I laundered clothing and suchlike, and folded and hung same. I washed the dishes, and then put them away. I went to work, came home, played with the cats, and generally bummed around.

Just like I was a grown up, and had, oh, heck, maybe, done all this stuff before, right?

So, one evening I had changed into pajamas, hanging my pants and shirt up on the hook in the closet. My routine is that I will, the next morning, retrieve said pants and shirt, and transfer all my whatnot from old clothing, into the pockets of new clothing.

Well, when I do so, and leave my cellphone in my pants pocket, and retire to another room altogether to watch “Battleship New Jersey” videos (highly recommended, BTW!), or The History Guy videos (another enthusiastic Thumbs Up! Recommendation!), well, I cannot hear the ringer on my phone. Since I am not youthful, and do not have a pristine medical record, and, as well, TDW-Mark II is a bit of a worry wart, well, when I do not answer my phone, nor the texts, and this continues for something like a half an hour, well, she gets excited and calls a friend of ours, who also lives in town, requesting that he meander over and verify that I am not folded up on the floor, with the cats poking me and asking when I will arise, and feed them. Or something.

So, much to my surprise, our friend rang my doorbell at something like 2200 hours, and explained the preceding paragraph to me. I retrieved my phone, and promptly called TDW, and reassured her that I was NOT a crumpled heap of geezerhood at the bottom of the stairs.

The ringing in my ear, from the chastisement I subsequently received, has nearly resolved, as I write these words.

FPC: Phenomenal Phone Company

A long, long time ago, in a state capitol city not so very far from here, I was seated in the basement of The Enormous Hospital System Mothership, where She Who Would Become TDW-Mark II was undergoing surgery of some sort. I was seated next to, well, let’s simply call him my father in law.

At this point in the celebrations, the divorce from The Plaintiff had concluded, and she and I had a week-on-and-week-off child custody arrangement. My adolescent children had cell phones, and had both me and their mother on speed dial.

So, Number Three Son had occasion to call me, but I could not make out what he had to say, and my attempts to re connect with him were for naught.

I did not know if this was generic adolescent ‘gotta call dad’, or something emergent. That latter was very unlikely, but, after all, I have kinda spent my life in the “this is sort of an emergency” business, and therefore considering that possibility is an occupational hazard. Therefore, since I was NOT at home, and, should my children need me, their ability to communicate that to me in a timely manner was mission critical, well, The Phone Company, and their inability to connect a freaking call something like 12 blocks from the freaking state freaking capitol, well, to understate the thing, I found it unsatisfactory.

Father In Law offered the use of his phone, on Another Carrier. I entered the number of my son, hit “connect”, and, par miracle’!, just like that, I was speaking to my son!

We concluded our conversation, since it was a generic “ought to call dad” call, and I asked Father In Law if I could make one more call. He assented.

I then called “customer service” (spit!) of The Phone Company. I explained my problem, and how this was not acceptable. Phone Company Minion asked my location, and I described myself as being one floor down from street level, in waiting lounge of Enormous Hospital System Mothership. Minion then regaled me with a bit of RF theory, to wit: “You cannot reasonably expect a cell phone to have a reliable signal when you are underground!”

I asked Minion, do you have caller id?

Affirmative.

Could you tell me the originating telephone number for this call we are having, right now?

He read back Father In Law’s phone number.

Is that a Phone Company number? If not, what carrier services that number.

Why do you ask?, responded the Minion.

“Because, that is the carrier who is henceforth going to be receiving checks from me approximating $200/month, because my phone, my childrens’ phones, and the phone of every mo$%#r f@!%&er who will stand still long enough to hear this story, will be giving their business to this carrier, whose phone I presently hold in my hand, in this basement, as you and I converse!”

Having said that, I realized that there is no satisfying way to slam down a cell phone. I miss plain old wired phones.

Moar! Random Thoughts!

The other day, I saw some soul, who was vexed by an itchy rash. I interviewed said soul, examined, and prescribed a steroid cream to soothe the rash. My instructions, in the prescription, were “Apply thin layer to rash twice a day”

Later that day, my MA fielded a call from the pharmacy inquiring where the rash was? (as in, I suppose, where on the patient’s body). I therefore had to complete the thought that I was charting on a completely different patient, find the chart for the patient, open that chart, review my note from several hours ago, and answer the query.

Foolishly, I had assumed (…yeah, I know. AssU-ME.) that “the rash” was specific enough, but, it seems, no…

In a similar vein, I continue to receive prior authorization requests. This is maddening, because (a) I typically attempt to prescribe the exact same thing previously prescribed. For, say, asthmatics, that means I attempt to prescribe the-flavor-of-the-month of albuterol inhalers. In addition, (b) years and years ago our Fly Over State Legislature passed legislation mandating substitution of generic, equivalent, medications unless the brand is specified, with the specific instruction of “dispense as written”. Silly me, I had supposed that when I prescribed albuterol, which is the generic name, that this generic substitution law would allow the pharmacist, who has access to the “menu special of the day” that the insurance company will subsidize, could then think, so to speak, “Hmm. McFee wants albuterol, but the insurance company will only subsidize Youcallwehaul brand of albuterol inhaler. Howzabout I simply fix that, and dispense the Youcallwehaul inhaler, just as if it were not a BRAND of ALBUTEROL, but, indeed could be considered equivalent to the generic albuterol inhaler that Our Hero had indeed prescribed?”

Had that occurred, I would not get a paper note spending pages and pages to tell me that the Useless Insurance Company Inc., would not pay for the generic inhaler, but would, rather, pay for the Youcallwehaul inhaler, no doubt reflecting the proud legacy of pharmaceutical excellence that has characterized the Pashmir Valley since January of 2022!

And receive that note several days AFTER my patient encounter.

All the while telling me that they would not pay for a non preferred inhaler until two other inhalers had been employed, and had failed.

So, that means that my patient has NOT had their freaking inhaler for (lessee, now: Friday visit, Monday denial, Thursday, if they are attentive (scoff!), mailing date for the voluminous tutorial on the pharmaceutical excellence of Bagwan’s Pharmacy And Weapons Factory, which I finally see, perhaps as soon as a full week after my patient encounter.) So, something like 8 days, more or less.

Let’s paw through the old chart, and review previous prescribed inhalers, shan’t we? Lessee, there is Ventolin, and then there was that time this soul received…Ventolin, and, of course, the last time when one of my colleagues prescribed…..er, Ventolin. So, imagine my surprise when I prescribed (lessee: what was that stuff?)…Oh, yes. Ventolin!

And I receive the previously described voluminous correspondence detailing why the Behemoth Insurance Company would not pay for the prescription of….er, Ventolin.

I really try to embrace the suck, but geez, ya know…

9-1-1 Follies

So, TINS, TIWFDASL…. er, well, OK: I was NOT FDASL, rather, this was long, long ago, and far, far away, and Doug, my partner, had his car in the shop, and so I picked him up, and we went to headquarters in order to pick up our paychecks.

I was driving him home, and we were chatting about inconsequentials, when I had stopped at a traffic light. Coming from our right, a soul had stopped in order to make a right turn, and once he attempted to make his turn, another idiot (wait for it!) had stepped out in front of the vehicle.

The driver slammed on his brakes, and chastised the pedestrian-idiot (who had not been paying attention), whereupon the pedestrian rejoined with some unwelcome insights about the driver’s mother, and her lifestyle choices.

The driver exited his vehicle, displaying a knife (that was clearly visible from across the street!), and chasing the pedestrian. He (the driver) was bellowing, “You sunovabitch! I could have killed you!”, as the pedestrian retreated around the parked vehicle, retreating for his life.

Just past this dance, was a pair of pay telephones (remember them? Another artifact from my youth!). Doug went to one, and dialed 9-1-1, and I took the other, deposited some change, and called our dispatch Bell line.

My call got answered first. Ronnie the dispatcher answered my call, took my information, and passed it to another dispatcher. Then, he chastized me.

“Mcfee, you DO get, that you are off duty. Right? Why don’t you let the other guys get some excitement, for a change?”

I laughed, said my goodbyes, and hung up.

Doug was still awaiting 9-1-1 to answer his call.

We got back in my car, and drove on.

A DAY LATE….

Memorial Day: The most expensive holiday we have. People paid for it, with their lives. (stolen from comments of The History Guy)

REDUNDANCY.

The other day, I was reading about everyday carry, and one writer was talking about how “two is one, and one is none”.

I recalled one night, nursing midnights in ICU. Now, every single hospital that I have ever worked at, has an emergency generator. These are equipped (or, at least, SUPPOSED to be equipped) with an automatic apparatus, that is intended to identify an interruption in the supply of power from the local power company, and start up the on site emergency generator, and then, once said generator is up to speed and functioning, disconnect the hospital from the shore power, and energize all “emergency” circuits from the generator.

As it developed, on this night, the power went out, and everything went black. We eagerly awaited the onset of generator power, but, alas, such was not to be.

Now, y’all may not know this, but in an ICU, there is an abundance of very, very sick folks. Indeed, several of them are dependent on ventilators to, well, ventilate them, since their illness renders them incapable of breathing adequately on their own.

With that thought in mind, it may not be a surprise that these life saving ventilators require an uninterrupted supply of several things, not the least of which is electricity, in order to function. When the power fails, and the emergency generators do NOT promptly start up, well, things get interesting.

While the ventilators, themselves, do NOT have battery backup, the alarms signaling malfunction, do. In order to respond to these alarms, the nurses, such as myself, need to alight from our chairs, walk around the nurse’s station, enter the room, and identify and remedy the fault eliciting the alarm.

(a) That is considerably easier to accomplish when you can see where the frack you are going, and identify trip-and-fall hazards, prior to, uh, tripping over said hazard, and falling upon your face.

(b) Should you have TWO ventilated patients, you are tasked with reaching each patient, disconnecting that soul from the (nonfunctioning) ventilator, and manually ventilating them employing the manual bag-valve resuscitator kept at bedside for just this sort of problem.

Except, you are one, non elasto-nurse, person.

As it developed, our ward clerk was in nursing school, was intelligent, and had paid attention. She ventilated my second patient, and the on-unit respiratory therapist ventilated Mary Sue’s second ventilated patient.

It only took a couple of minutes (…that seemed like hours!) before we regained power. But, I thereafter took to carrying a flashlight on my person.

Problem solved, right?

Not so right. A couple of weeks later, the power failed, again. The generator failed to generate, again, and I thought, “Voila! I’ll whip out my handy-dandy flashlight, and illuminate the area!”

Problem with that, is that the flashlight had somehow turned itself on, while on my belt, and was deader than disco. So, same cluster…er, hug (yeah! HUG!), same musical ventilation, and same subjective eternity until power came back on.

New! Improved! Plan, was a couple of flashlights, with a regularly (every other month) assessment of function and battery charged-ness. As well as additional flashlights squirreled about my person. So, presently, I have two flashlights on my belt, two in my shirt pocket (one Streamlight Stylus Pro, another that has been customized with a near UV emitter, so that I can use it as a Wood’s Lamp), one on my badge (one of the coin cell lights thrown in with my order from the folks selling me my CR 123 batteries), and one on my keyring (a Streamlight Nanolight). (none of these are any sort of freebie: I bought the Nanolight, and the Stylus, and then bought several more, at retail, because they perform for me what I need doing. Like, illuminate my way when nocturnal dogwalking, allowing me to avoid a dirt faceplant.)

PARENTING STRIPES

Another blog had an entry that reminded me of one of my own parenting moments. As I recollect, Number One Son was misbehaving, and so The Darling Wife-Mark I and I imposed some limits: grounding or some such thing. We observed that a repeat performance would elicit a spanking.

He responded, “Well, I’ll just call the police!”

I smiled. Told him to get his shoes, and get in the car. Now.

We had a leisurely drive to our local small town police department. I asked if I could speak to an officer. The nice desk lady asked, why?

I responded, “This child just informed me that should he require a spanking, and I administer it, he will call the police. I simply do not want to wait. May I speak to an officer, please?”

She bade us sit, and soon an officer arrived. I introduced myself and Number One Son. The officer asked, had I spanked the lad yet?

I replied, no, not yet.

He asked, in what manner would I spank the child?

I responded, with my bare hand, since the point was not pain, nor injury, but, rather, recalibration of his behavior. Once my hand started to hurt, likely my purpose had been accomplished.

So, the officer asked, you intend to spank this child, if other measures do not change his behavior, in order to discipline him?

Yep, was my answer.

“Isn’t that kind of your duty as a parent, to correct misbehaving children? I do not see anything you are describing as actionable by me. You’re simply doing your job as a dad.”

I turned to my son, and asked, “Do you have any other questions for the nice officer?”