Fun And Games · Life in Da City!

If You Are Taking Medical Advice From The Voices In Your Head, You Are Doing It Wrong!

So, TINS©, TIWFDASL©, when we caught a run for a “sick person”. My tales of adventure notwithstanding, the overwhelming majority of EMS runs in Da City were what the personnel called “sickies”. This tale is about one such soul.

We arrived, and things progressed in the usual fashion. Six questions, one command.

  1. “Who’s sick?” (show of hands).
  2. “What kind of sick are you?” (the response generally ran along the lines of “I’m really sick”, or “I’m just sick, that’s all!”) (so much for “History of Present Illness”)
  3. “How long have you been sick, Sir/Madam?” (typical response was some variation of “A good little while.”)
  4. “Do you want to go to the hospital?” (A surprising number of people did NOT want to go to the hospital. Some wanted to be told that they were alright, others wanted to go to some place in West Bumfuck, way, way, way outside of Da City’s service area, or wanted a ride to the doctor’s appointment that they, surprisingly, had made. We did not take folks to their doctor appointments or to BFE Community Hospital. Fire department rules.)
  5. “Can you walk?” (the correct answer is always, “YES!”. Occasionally “No”, but the number of trivially ill/injured folks traveling to ER via EMS was both surprising and disappointing.)
  6. “Where are your shoes?” (Again, a surprising number of folks who presumably had lived in Da City all their lives, and had noted snowfall and freezing ass temperatures arrive each and every winter, did not think to have their shoes staged, oh, I don’t know, NEAR THE DAMNED DOOR, once they had determined that they required ambulance transport to the hospital emergency department for their sniffles or whatnot.)
  7. (Command) Follow Me!”

So, one such soul, seated in the back of the ambulance with me late one night/early one morning, was being interviewed by me. I asked him his allergies. “No, none, not really.”

I asked him his medications. “Well, no, none, I guess.”

That did not sound right. I asked, again, differently. “Does you doctor think that you are taking any medication regularly?”

“I suppose so.”

“What might that medication be, that you suppose that your doctor thinks you ought to be taking?”

“Oh, some nerve pill.”

“Oh? ‘Some nerve pill?’ Why aren’t you taking your nerve pill?”

“Well, the voices in my head told me I didn’t need them any longer!”

“The voices told you that, did they?”

“Oh, yes! They were very clear about that!”

“I bet that they were!”

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Fun And Games

“The Price is Right!”

Once I had departed the employ of Da City, I worked as a RN in one of the little ERs dotting Da City. At that point in time, there were perhaps 18, maybe 20 hospitals big or small serving Da City. I worked at one of the middling sized ones, at that time around 300 beds.

Working midnights in ER, well, you commonly find yourself spending time with folks who make poor life choices. Those of you who have worked nights, or do presently, bear with me. Alcohol is a commonly abused drug. Shocker, right? Moreover, those who use alcohol to excess, commonly also do other, similarly, stupid shit. Said stupid shit, typified by the admonition, “Hold my beer, and watch this!”, places the stupid shit performer at significantly higher risk of ER visitation eliciting injury.

In retrospect, that all makes sense. Well, those of our neighbors who fail to contemplate consequences, readily foreseeable consequences at that, PROSPECTIVELY, well, those folks are why my children slept indoors, ate every day, and got suitable shoes regularly. Thanks for the business, my friend!

Later in the night/early in the morning, the flow of sick/injured tends to slack off. When all the stuff that needed doing, had been done, we got to thinking. From those deliberations arose the night shift game of The Ethanol Is Right!

The goal is to appraise a given patient, without any lab work reported as of the time of the prediction, and then write down your vote for the patient’s blood alcohol level. The vote closest to the lab reported value, but not over, “won”.

Fun And Games · Life in Da City!

Another Winter Tale

One night at Medic 7, Doug and I were whiling away the hours. For this house, in this city, it was a slow night. On the other hand, it WAS winter, and it WAS snowing it’s ass off. I was finishing my Nursing school studies for the next day’s class, and Doug was reading the book he had brought along for slack times.

We caught a run, and off we went. As we headed east on Warren, we noticed a young woman walking back and forth in front of our fire house. Strikingly enough, she was not dressed for the weather. The heels alone presented a slip-and-fall hazard, and that is not mentioning the short skirt she was wearing.

When we had completed that batch of runs, we returned to quarters. The lap walking woman was still there, and had walked a clear circuit in front of the engine doors.

Hours later, another run, same woman parading in front of the house.

Returned an hour or two later, and there she was, still walking circles on the sidewalk.

She was gone when we caught our next run in the wee hours of pre-dawn. I mentioned her departure to Doug. He, being more wise in the ways of the street than I, opined, “Likely, it took her that long to make her quota, so her pimp would let her back indoors!

Fun And Games · Having A Good Partner Is Very Important! · Life in Da City! · Pre Planning Your Scene

“Hey, look! I’m fine!”

Winter in Da City is a special time. The snow, late enough in the season, covers up the litter in the gutters, the layabouts tend to lay about indoors, and generally you can almost convince yourself, if you squint just so, that there is hope for, and in, Da City.

And, then you meet people. Kind of an occupational hazard of being a medic for Da City’ fire department. Most of us held to the TRUTH! Of the aphorism that “sick people suck”. Daily (or nightly- kinda depends on your shift, amirite?) we encountered folks who, well, sucked. Both as people, and at life. Because, after all, the lottery winners infrequently phoned 911 to regale our dispatchers with tales of wonderfulness. Face it: nobody calls the fire department, to gush about he/she just now met The Love Of Their Life, and how this soul brought sunshine into their every day.

So, with that thought in mind, TINS©, TIWFDASL© one lovely wintry afternoon and we (Doug and I) caught a run for a man with a broken leg. Arriving on the scene, we noted the usual choreography of the “He’s In Here!” dance, oh so very popular in Da City.

We entered to find a gentleman on the sofa, ethanol fumes emanating from his every pore. One of the (more) sober bystanders informed us that our guest had fallen while shoveling snow, and broken his leg. I turned to the named patient, and he obligingly illustrated the point by waving his (no shit, notable from across the room, articulated in an unnatural spot between his knee and ankle) leg in the air, declaiming, “Hey! Look! I’m fine! There’s nothing wrong!”

As you may have already surmised, he likely had already been well anesthetized. Then, there was the question: if he broke the shit out of his leg, as he manifestly had, how, and why, had he made his way into the house? And, what parts of this tale remained untold?

I attempted to orient him to current events. “Uh, sir? It sure appears like you have broken your leg. We would very much like to take you to the hospital, to get that fixed up for you!”

“Naw, I’m fine!” was the reply, accompanied by more broke-the-shit-out-of-it leg waggling.

The citizens on the scene were ever so helpful. Or, not so much. They contributed, “He broke his laig! Y’all cain’t leab him here!”

Thank you, Dr. Schweitzer, for your orthopedic consultation. Certainly gonna have to factor that into our clinical decision making!

I looked at Doug, and he looked at me. He handed me the handie talkie, and went to the ambulance to retrieve the cot and assorted helpful goodies. I attempted to elicit something along the lines of allergies, medication and medical history information, figuring that sort of information would be kind of mission critical to our friends in anesthesia. I was certain that a tour of the OR in the presence of the orthopedist was in his future. Oh, and vitals. Vitals would be nice.

Once Doug returned, and I noticed that he had preplanned the upcoming goat rope, including a long backboard, backboard straps, and plenty of roller gauze.

We approached out new friend, and pinned him to the sofa. Doug bandaged his arms…yeah, THAT’S the ticket! Bandaged, not restrained! Once he was hindered from “lending a hand” to the festivities, well, we rolled him onto the spine board, secured him with straps, and, laying a nice wide rigid splint between his legs, secured bandaged them as well.

The foregoing accomplished a couple of things. First, he quit flapping that grotesquely fractured leg around. Secondly, he was a considerably more stable package to carry out to the rig. Finally, all the citizenry was placated by how thoroughly their friend had been splinted. Everybody won!

Once we arrived at TSBTCIDC, and debussed Mr. Leg Fracture, well, the nursing staff couldn’t help but unsecure him, since they simply HAD to evaluate the fracture. That set off an entirely new round of protestations that he, the patient, “was just fine!”, accompanied, again, with the semaphore wig-wagging of the demonstrably unfine fractured leg.

Cool story. I finished my trip sheet, and completed and signed a “Petition for Involuntary Hospitalization”, citing my new friend’s manifest unconcern for a clearly broken leg, documenting his inability to comprehend his need for hospitalization.

All in a day’s work!

Fun And Games · Having A Good Partner Is Very Important! · Pre Planning Your Scene · Protect and Serve

The Leviathian Comes Alive!

So, one time we got dispatched to an unconscious person run on the east side. We arrived to see a number of police officers from DBCPD standing around. One of them pointed out a large slumped soul, leaning up on the steps on a rear stairway of some house.

He was not entirely flaccid, and he WAS breathing on his own, both desirable attributes from my point of view. Even so, leaving him to metabolize towards mobility appeared to be a bad plan, so Porthos and I attempted a hold-him-under-his-arms walking assist. It worked, sort of. Well, it appeared to be working well enough that we could maneuver him to the truck, and thence to TBTCIDC, where he could indeed metabolize to freedom, under the loving and watchful eyes of the TBTCIDC Emergency Department nursing staff. For bonus points, he would then not be our problem.

Porthos and I were making progress, of a sort, toward the ambulance, and the police were doing their police type stuff, when I got the bright idea that perhaps a whiff of an ammonia capsule might energize our guest.

Now, with the wisdom that comes with hindsight, THAT might have a good idea to, ya know, DISCUSS with my partner. That discussion might have elicited several beneficial outcomes, like problem solving IN ADVANCE, and anticipation of ways in which this brainstorm of mine might have turned horribly wrong, for example.

As might have become evident, I did NOT discuss this little plan of mine with my partner, and simply retrieved an ammonia cap from my pocket, snapped it, and allowed Mr. Leviathan to breathe deeply of the healing aroma.

He abruptly, and I mean RIGHT FUCKING NOW! Became considerably less stumbling, and way, way more energetic, shaking loose of my grasp on his arm, and turning on my partner.

This might be a good point in my tale to note that our guest was tall, and big, and outweighed me, as well as Porthos, by a considerable margin. If he should commence to some wrasslin’, well, whichever one of us was the object of his affections, would not enjoy being so objectified.

Porthos had noticed our guest’s reanimation, although he was a fraction of a second slower than I in so noticing, and so King King, our newly energized patient, was advancing upon my partner, hands outstretched, and backing Porthos rapidly into a corner.

I realize that things happen quickly, and it appears that time stands still, nevertheless those officers sure appeared to be statues, while this shambling wreck of a man-mountain was advancing, cornering my partner, presenting a clear and present danger of laying hands on him.

I found my Mag Light in my hand, and advanced, on my toes, behind him. My flash plan was, once he had indeed grabbed Porthos, well, I was going to go for that line drive, featuring his head as the baseball.

So, Ninja like, I was advancing upon Leviathan, Leviathan was advancing on Porthos, the cops were unmoving, and I, catlike, managed to step on his foot.

Good news: he forgot about Porthos.

Bad news: he figured that I was oh, so very much more deserving of his attention than my partner. He began to turn on me, so as to show me some love. Of some sort.

Good news: whatever was the source of his previous lethargy, it slowed his synapses, and so the insight that he would rather be thumping on me, rather than Porthos, took him a not inconsequential amount of time to process, and then to act upon.

Good news: Porthos took that opportunity to zig to Mr. Leviathan’s zag, and begin to beat feet to the truck.

Good news: I accelerated to warp speed promptly, and so managed to arrive at the ambulance about the same time as Porthos.

Good news: our officer friends were, themselves, in motion, and they converged on Mr Leviathan, and dissuaded him from pursuing any further laying-on-of-hands ceremonies.

Indeed, they were so persuasive, that they elected to transport our new friend to TBTCIDC, themselves.

Porthos and I had, well, I suppose you might consider it “a teaching moment” once we were back in service. My ears stopped burning after a couple of hours.

Fun And Games · Overdoses · Protect and Serve

Commercial Quantities of Meds

Thanks to Aesop (https://raconteurreport.blogspot.com/) for the inspiration for this post. See his series of posts, July 10 2019 to July 12, 2019. I write this on 12 July 2019. He may have more: it appears that he is just warming up!

So, TINS©, TIWFDASL© as a midlevel in a county lock up. Our sheriff had a policy of no drugs (I.e, no euphoriants narcotics or sleepers) for inmates. I was told that the rationale was that he did not want inmates to “sleep their sentences away”. Cool story, there were very few occasions wherein I would consider prescribing scheduled meds (euphoriants, narcotics) anyhow.

I was working part time. One morning I came in, and an offecer invited me to step into his office. He showed me a dispenser pack of what looked to be 140 or more tablets, labeled “Methadone 10 mg”. The administration instructions read “take 9 tablets daily”. Holy cow! That’s 90 mg of methadone, equal in pain killing (or sedating) effect to around 1 000 mg of morphine every day. ONE THOUSAND MILLIGRAMS of morphine equivalent, every day! The medical history form related that this had been prescribed for debilitating arthritis.

The officer noted the department’s “No Narcotics” policy, and asked me, the medical authority (Hah!) present, for an opinion. I thought that placing this gentleman in the “detox”/observation cell, and obtaining and recording vitals every hour for the first 24 hours sounded prudent. I also provided a checklist of concerning symptoms to watch or. I provided my cell phone number, and directed that, if certain parameters of vitals or observation were exceeded, send him to ED by ambulance immediately. If any grey area, phone me at ny time of day or night.

So, the officers recorded vitals and made “nurse’s notes” on their guest. I came in early the next day, read the noted, and re assessed the gentleman myself. All nominal, no alarming findings. We repeated this process, now every 4 hours, and, again, the next day, I arrived early and re-re-assessed the inmate. Same nominal vitals, same unremarkable exam. This did not seem to all fit together as it had been presented.

Another day, another 24 hours of vitals and “nurse’s notes”, another benign exam.

After several days of this, the jail command suggested that , with nearly a week of normal vitals and normal exams, perhaps our guest could be moved into general population? It seemed alright to do do, and I seconded their initiative.

So, after nearly a week of no methadone, nearly a week of no abstinence symptoms, my attention wandered to other topics. One morning I arrived, and an officer beckoned me into his office. “Hey, I thought you’d want to see this!”, was his opening conversational gambit.

It turns out that there are surveillance camera throughout the jail. (Who knew?). One had captured the methadone-for-debilitating-arthritis fellow getting into an altercation with another inmate, and whupping same. That’s correct: the “debilitating arthritis” inmate, delivered a whupping onto the person of another inmate.

The officer turned to me, and observed, “I am beginning to think that that prescription is rather more of a commercial opportunity, instead of a medical intervention!”

Fun And Games · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact

“Speck’ ah got it figgerred out!”

So, TINS©, TIWFDASL© at Rural Community Hospital ED one fine summer afternoon, nothing exciting (for me, at least: the folks who were here for sutures, or chest pain, likely thought that their dilemmas were entirely more exciting than they would otherwise desire!).

So, this fellow trotted in, carrying a crying child. He announced that the child had cut his head. Our nurse aid escorted the gentleman to one of the carts, and started to look into the problem. I tagged along.

Quick witted, she promptly determined that stapling this child’s head would likely result in a net minima of drama and caterwauling, so she plucked up a surgical stapler, and some betadine, and began to clean up the lac.

The physician arrived, and she briefed him on her findings. Me? I occupied myself trying to get vitals, allergies/meds/medical history on the child from the (clueless) dad. Doc began to perform his own assessment, as the mother arrived.

This elicited another chorus of wailing, tears, and general drama. Predominantly from the child, although the mother contributed her own share. The physician informed the parents that he was planning to staple the wound, once my friend the nurse aid had completed her task of cleaning things up.

“Is that going to hurt him?” was the mother’s question.

My bad, I answered her truthfully. “Yeah, but it will only be 4 pokes. If we stitch it, there will be 8 or more pokes to numb it, and then another 8 or so pokes to sew it up.”

Likely, it was lost when I used the word “numb”. I suspect that she stopped listening at the word “numb”, and failed to do the math. “Oh, I don’t want him to hurt! Can’t you numb him?”

The aid tried her hand. “Well, yeah, but that will require 8 needle sticks, whereas if the doctor simply staples it, there will only be 4 pokes”.

Mom had One Thing on her mind. “I don’t want him to hurt!”

The physician tried. “Ma’am, nobody wants him to hurt. In fact, if I simply staple the cut closed, he will avoid something like 12 additional punctures, and the discomfort associated with those 12 punctures.”

“Please, numb him up! I don’;t want him to hurt!”

Resigning ourselves to our fate, I collected the lidocaine, syringe and needle, and my friend the aid swaddled the child in a blanket.

The kid promptly figured out where this was going, and he wanted NO PART of this ride. So, I set up the doctor’s suture set and lido, and joined the rodeo.

The kid screamed, and he flipped, and he flopped, and he writhed, and he twisted, and he turned. He shook his head, so I was detailed to seize his head, and immobilize it. Mom, to her credit, laid across her child’s legs, and dad laid across his torso, so the doctor only had to zig and zag over roughly 30 degrees of motion as he was injecting the local anesthetic into the margins of the wound.

Did you know that lidocaine, injected into your skin, burns? Yep, burns like a sonuvabitch, for a minute or two. Now, may I watch YOU explain to an 8 year old, that the burning will go away soon, and then things will be numb? Because, he was not listening to me at all, which, of course, assumes that any earthly creature could distinguish my speech over his screams, and cries, and shrieks, and general high volume protestations. Because, I could not.

So, once the doctor had established that the process was going to be pain free (because, of course, the anesthesia had been SO! MUCH! FUN!), the child was going to lay very still for the suturing?

Totally! And, the Democrat candidates for President are not vying to convince the electorate that they, only they, will be the BEST! At providing free stuff to non citizens, as well as college graduates who find themselves in the food industry.

Of course, no. Just, NO! More rodeo nursing, more Brahma Bull On the Suture Table.

Finally, at long last, we were done. The aid unwrapped the (limp)(sweaty)(hoarse voiced) child from the blanket, and we all stepped away, so Mom could hug the child.

She looked at us all, and said, “That was awful! Ohmigawd! I should have listened to you guys!”

I bit my tongue, and shuffled off to the nursing station, to complete my charting. The aid sat down next to me, and said, “Hey! I did my best!”

“That you did.” I replied. Then, taking on a stereotypical hillbilly voice, I continued. “Hyuck, hyuck! Ah’ve bin doin’ this here ‘mergency nursin’ thang for might’ near six, mebe seven weeks now! Speck’ ah got all figgerred out!”