Fun And Games · Gratitude · Sometimes You Get to Think That You Have Accomplished Something!

THE SUNSHINE RULE: THE OTHER SIDE

It came to pass, we were open on New Year’s Day, and I was on duty. On that day, our waiting room waits were approaching 3 hours. I am not a fan, notwithstanding the fact that generally I have little control over how many folks disembark from The (metaphorical) Bus, when The Bus stops, and disgorges it’s passengers for our treatment pleasure.

As you may imagine, most of us, myself included, do not find it to be a life enhancing experience when I, or they, get to while away the hours in the waiting room, with a dozen or more unknown, snotty, feverish, sick strangers.

On this particular day, it occurred to me that I was oddly blessed. Nobody felt the need to extend my medical education with the results of their internet search, nobody “knew their body”, and, indeed, nobody KNEW! that The! Z! Pack! would resolve their woes.

In addition, nearly everybody was in good humor. Indeed, several folks made it a point to actually thank me for working that day. Specifically, literally, “Thank you for working today!”. Direct quote. No BS.

I had seen one of these folks a couple of weeks previously, and given them my stock spiel regarding treating their post nasal drip induced cough with fluids/inhale steam/Zyrtec/Flonase/Tylenol/follow with family doctor/return if worse. She told me, to my face, that “I got way better once I followed the advice you gave me. I’m still a little stuffy, and cough now and then, but nothing like when I saw you last time!” (today’s visit was for another malady).

Then there were the folks, a majority of the patients that day, who were possessed of a very robust sense of humor. On days when the wait is lengthy, my introductory spiel goes along the lines of “Hello, I’m Reltney McFee, I’m a nurse practitioner. I’m sorry about the wait, and thank you for you patience. I apologize for the abundant opportunity that you had to demonstrate your patience! What can I do for you today?”

Most folks chuckled, and those that did not chuckle, said something along the lines of “That’s ok. I’m here today because of….”

All that is to provide some particulars regarding the first two clauses of my Sunshine Rule: “Everybody brings sunshine into my life. For some people, that is when they arrive….”

Duty · Fun And Games · guns · Pains in my Fifth Point of Contact

SNIPPETS

So, TINS, TIWFDASL, and one of the registrars walked back, and informed us, “They say that there is a man out there with a gun!”

My response was to ask, “Is there any reason that you are NOT telling the police this, rather than telling me?”

“Oh, should I call the police?”

“Ah-yep! Right freaking now would be very nice!”

@@@

If you have COPD (emphysema), it is likely not so very helpful to smoke marijuana.

@@@

Me: “So, you’re here for your cough. When is your cough worse?”

Them: “When I cough.”

@@@

Please, after I have explained my plan of care for your cough, which is caused by the irritation caused to your throat by the mucus in your throat, mucus originating in your sinuses, Please do not correct me with the observation that “My mucus is in my throat”.

It is very likely that, when I illuminated and inspected your throat, I DID notice, and, indeed, did comment upon, the tsunami of snot therein. Further, it is likely that every child of Ghawd that I have seen today has, also, snot streams running down their posterior pharynx: their throat.

So, when I explained to you that that mucus is irritating to your throat, since your throat is not well designed to tolerate that event, and that irritation manifests as a sore throat, or a tickle and a cough, or both, did you consider the possibility that the mucus originated, oh, gosh, I don’t know, IN YOUR SINUSES, AS I, INDEED, MENTIONED IN MY DETAILED EXPLANATION OF YOUR MALADY AND MY PLAN TO MANAGE SAME?

So, the nasal steroid that I recommended to you, over the counter, will suppress the inflammation (that I mentioned was the root cause of your woe), and thereby suppress the outpouring of snot which is the proximate cause of your cough, and, therefore, end (or really, really suppress) your cough, which was the ostensible purpose of your visit in the first place.

Fun And Games · Life in Da City! · Pains in my Fifth Point of Contact

My FAVORITE! Things

My FAVORITE! Things

@ When, as part of my assay of History of Present Illness, I ask you how long you have had your (cough, or whatever other symptom motivated you to march you happy butt into my clinic), please, Please, PLEASE do NOT!!! say “a good little while”, or something similarly non responsive to my question. I will simply repeat my question, using the same words, and the same pleasant, inquiring tone, over and over, until you do, indeed, tell me “2 hours” or “2 days’ or “2 weeks” or “2 months” or “2 years”. Simply so you know, IDGAF how long you have had this symptom, on the other hand, it does have some implications for what plan of care I ought to consider in order to, ya know, actually benefit you.

@ Similarly, for the love of Crom, do NOT tell me, in response to my question, “What have you done for (your symptom)?”, that you have “taken over the counter”. Should any of you in “the studio audience” desire to understand just how unhelpful this is, please spend a few minutes on only one freaking aisle of any drug store you wish, and attempt to catalog the dozens of freaking allergy meds therein. By way of illustration, if you have used a nasal steroid, that would be helpful for me to know, since, should that have been unhelpful, I will be required to up my game.

If OTOH, you simply took The Multi Symptom Dreck You Saw Advertised On The TeeWee Last Night, well, I can then recommend some, oh, gee, I dunno…EFFECTIVE OTC medications, instead.

@ I love it when Joe-Bob goes to (St. Elsewhere) yesterday, does NOT pick up his prescribed medications, and swings by my clinic. Because “I’m not any better”.

@ When I direct you to call your family doctor and arrange followup, and you reply, “They always tell me to go to walk in!”

So, you’re telling me that WALK IN prescribes your blood pressure meds, your psych meds, as well as your diabetic meds?

All this is news to me.

@ When I ask, as my review of symptoms, “Have you felt as if you had a fever?”, and you reply, “I don’t have a thermometer”. (how did folks FEEL feverish, before the invention of the precise thermometer by Farenheit in 1714?) Or, alternately, “your nurse just took my temperature, and said I do not have a fever.” (which, of course [a] I already freaking knew, having reviewed the vitals and nursing notes before I walked in the door, as well as [b] NOT answering my freaking question!)

Fun And Games · Fun And Games Off Duty · guns · Having A Good Partner Is Very Important!

THE WISDOM ASSOCIATED WITH HINDSIGHT!

So, the other day, My Best Man and I went to the range together. He had recently acquired a Garand that he had not yet shot, so, by way of introduction, I brought mine, along with some other guns that merited airing out. A good time was had by all, as range time = good times. “Group therapy”, so to speak.

My friend is a bit of a raconteur, so the stories never end. He told several tales regarding the CEO of his employer, and these stories revealed a soul steeped in the tradition of leading from the front, and taking care of your people = taking care of business, which equals, in our line of work, taking care of patients. Well. Taking care of them, well.

From him, with our history, these were tales of high, high praise, indeed. (He is the originator of the observation that “Little Mary Sunshine is *NOT* a force multiplier!”)

Eventually, we had shot everything that we had brought along to shoot, and noted that it had clouded up, with occasional rumbles of thunder to draw our attention. Therefore, we safed the weapons, packed up the ammunition, cased the firearms, and paraded to our vehicles.

Once everything was settled into our vehicles, well, the skies opened. We were at my conservation club range, and so I got the opportunity to exit my vehicle, unlock the gate, open the gate, exit the gate, and relock the gate. This, of course, required that I exit my nice, warm, dry truck, wade through the slough that our driveway had become (soaking my feet in the process. I *HATE* cold, wet feet!), fiddle with the lock, fiddle some more with it as I fail to correctly recall the combination, fiddle with the damned thing YET AGAIN, finally opening it. In the downpour.

As my partner exited the gate, I ran to my own truck, entered it, and realized that I had a poncho therein. I donned the poncho, and attempted to close my door.

As it developed, my truck will *NOT* exit park, and move, until the driver’s door is secured. That required me to remove the poncho from the door, and attempt, several times, to close the damned thing. Finally succeeding, I moved my truck through the gate, and re entered the cataract in order to re lock the gate.

It occurred to me, right about then, that donning my poncho (as well as, oh, I dunno, FREAKING BRINGING MY FREAKING FIRE BOOTS) might have gone a long way towards allowing me to open the gate, close the gate, lock the gate, and then return to my vehicle, without being, you might say, soaked to my damned skin.

Ah, the wisdom associated with hindsight!

Fun And Games · Life in Da City!

RANDOM THOUGHTS, INSTALLMENT NUMBER VIII

@The other day, my MA gave me the typical “thumbnail” report of my next patient. “(sick person of some sort”), (vitals), ….And, you know, he’s older.”

This particular soul was born TEN YEARS after I was!

@ROBOCALLS: I receive telephone calls, from time to time, from unknown numbers. Almost every one is from some computer dialed bullshit. My practice is to say “Hello”, and then begin to count ten seconds. If there is no human being on the line by then, according to my (it’s a robo call: I’m not particularly patient) timer, I hang up.

If there is some human on the line by then, they have, maybe, ten or fifteen seconds to convince me that I have any interest whatsoever in speaking to them.

And, if it’s one of those “we need to speak to you about your computer repair the other day” idiots, it depends: if I’m feeling froggy, I may stay on the line simply to trifle with them and waste their time. If I’m feeling curmudgeonly (which, to be honest, is most of the time), I hang up. In mid word.

OVERHEARD THE OTHER DAY:

Joe-Bob arrives, asking if he could get the work note written for Cletus. The clerk inquired after Cletus’ last name. Joe-Bob did not know Cletus’ last name.

She asked if Joe-Bob knew Cletus’ date of birth? “Nope.”

Cletus’ phone number?

“Nope.”

Cletus’ SSN?

(surprisingly/sarc) “Nope!”

Did Joe-Bob know the date of the visit which elicited Cletus’ work note?

(say it with me, now…) “Nope.”

She wrote down *OUR* phone number, and suggested that, once Joe-Bob rejoined Cletus, perhaps he, Joe-Bob, could invite him, Cletus, to telephone us, and at that point arrangements could be made.

@ Life Lesson: A lesson learned from hard experience: No matter how frequently you look at your watch, in the middle of an awful shift, it is still 3 o’clock!

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

“Reading the Room”, or, Situational Awareness

So, TINS©, TIWFDASL© as an ED RN. At this point in time, the ED employing me (which was Middling Freestanding ED (MFSED) was an entertainment subsidiary of Enormous Hospital System With Delusions Of Grandeur (EHSWDoG).

My subsidiary hospital had the system’s psych ward upstairs, and therefore we appeared to be the psych intake for the three or four county area at which we were the center. So, this one night, an enormous dude, dressed in a three piece suit, perfectly buttoned etc, and BACKWARDS appeared. There were no police accompanying him (so I assume he was not a police psych hold). For some reason, Mr. backwards Suit had decided that he needed to go for a stroll.

As I became aware of the excitement, I noticed a cloud of nurses, as well as several security, negotiating with him to lay back down for assessment, and so forth. Somebody had given him a pen (for Ghawd only knows what reason), and he was appearing to become more excited as time passed. I noticed him only paying attention to the officers, with his (pen holding) hand behind him. He was standing in a doorway from one hallway to another, and I was down the one hall to his right. I strode past him, as if going down that hallway, and, as I passed, I snatched the pen from his hands, and continued down the hallway, as if that were the only reason for my passage.

Mr. Backwards Suit soon de-escalated, was assessed, and (unsurprisingly) admitted for psych evaluation. And, nobody else gave him a pen.

Fun And Games · guns

Small Town Clinics

TINS©, TIWFDASL© in Da Nawth. I was working my weekends off in a rural hospital’s walk in clinic, and, surprisingly, saw folks who walked (and limped!) in to obtain care for their particular maladies. One snowy weekend, a gentleman limped in, with a complaint of bruising and knee pain after rolling his snowmobile.

Once the nurse had finished her interview of our friend, I entered for my share of the proceedings. I introduced myself, and asked him to tell me what happened.

“Well, Doc,” (No, I’m not a doctor, yet folks persist in addressing me as a physician, notwithstanding the fact that every single time I begin an interview, I introduce myself as ‘Hello, I’m Reltney McFee, a Nurse Practitioner. What can I do for you?’), he began, “Yesterday I rolled my snowmobile down an embankment, and it wound up on my leg, pinning me to the road. I rolled it right in front of a DNR officer, and he and one of my buddies rolled it off me. My knee feels pretty sore, even though I can walk on it. I have another bruise, here on my side, I guess from my Sig 365, that I had in my pocket.”

For those in our studio audience who are not “gun guys”, a Sig 365 is a striker fired semi auto 9 mm handgun, with a 10 round detachable box magazine. It is relatively small sized, being just under 6 inches from muzzle to the back of the slide.

I asked him where his pistol was presently, and he responded, “Well, this is in the hospital, so I left it in my car. That’s what the regs regarding my CPL (concealed pistol license) call for.”

I performed my exam, and we chatted about firearms while I did so. I contributed, “My wife is looking at getting another concealed carry pistol, and she has considered the Sig. What do you think about that?”

“Well, I really like my Sig. It carries well, and I am pretty accurate with it. You read about firing pin drag on the primer, and some guys say that the firing pin may break because of that. I haven’t had any problems myself. Just in case, I carry it with the hammer down on an empty chamber.”

TDW bought a Springfield Armory Hellcat. And loves it!

Another, tangentially related, small town story. Several weeks ago TDW-Mark II and I went on vacation. We set our camper up, and decided that this night was a good choice for pizza. We went to the local pizza place, placed our order, and settled in to wait. It was getting on towards dusk, and I noticed that, as I turned on the lights, there did not appear to be any illumination from the passenger side tail light. Since I did not feel any particular desire to explain to Officer Friendly how this light might have failed, nor my plans to remedy this failure (let alone the conversation that begins, “Well, officer, you see, I have my CPL, and my sidearm is on my right hip. How would you like to proceed?” I have had a couple of friendly roadside conversations about carry sidearm choice, but, wouldn’t it be nice to not encounter Officer Friendly as the traffic stop just after he received a soliloquy regarding his mother’s poor life choices?)

So, the next day, TDW and I set off on our day, and detoured to the Rural Town Truck Dealership. I explained my need to the service advisor, and he said that one of the mechanics could set me right, once the present job was complete.

Cool by me.

I settled in for a spell of a wait, and soon met the mechanic, who identified my bulb type, and led me to the parts counter, there to pay for my bulb.

I typically wear a ball cap, and this one is from Freedom Munitions (no payola, simply a satisfied customer). The parts guy asked me if I worked there, and a conversation about The Ammo Drought ensued. We chatted about caliber, about carry choices, and about setting ammunition by for a “rainy day”.

At the end of the chat, my taillight was repaired, I was NOT charged for the mechanic’s time (despite the fact that I asked what I owed for his time!)

The moral of the story is that, as Commander Zero (http://www.commanderzero.com/)often notes, there are Like Minded Individuals all over the place, if you look carefully.

Fun And Games · Having A Good Partner Is Very Important! · Life in Da City! · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

First noc I wore fire boots at work: freeway run, on a snowy night.

TINS©, TIWFDASL©, and going to paramedic school in my off time (this was many, many years ago). In the course of this schooling, I spent some time in clinicals, variously in the local ED in a wretched hive of scum and villainy not so very far from Da City, or with one of the advanced life support crews running calls in the self same wretched hive.

It’s generally educational to spend time with other medics, as their organization’s culture, and lore, is likely to be kind of at a tangent to your home outfit. The education may run both ways. In any event, There I was, (studying) Fighting Disease, and Saving Lives in The Wretched Hive, and one of the host medics came on duty, ferrying his “load out” into the ambulance. I noticed that he tucked a pair of fire boots behind his seat, and asked him about them.

It being winter in The Northern Un-Named State, well, we were susceptible to receiving considerable amounts of snow from time to time. I believe the professional meteorological term is “ass loads”. My host noted that this could result in snowy shoes, and therefore wet feet, and that there were few things so miserable as cold, wet feet, in Da Nawth, in winter. Waterproof boots, that reached nigh up to one’s crotch, served admirably to avert this sort of undesirable outcome. I took notes.

Soon, I acquired my very own pair of “Storm King” (old standard) NFPA complaint boots. So, it happened that I wore them to work one snowy evening, and, early in the shift, Doug and I caught a run for “one down” on the expressway.

We pulled up behind the state police cruiser, and saw a figure prone in the snow and slush. The trooper told us that the patient had been struck by an overtaking vehicle, when the overtaking vehicle did not notice that our patient was bent over the lip of the trunk of his STOPPED vehicle, ON THE SHOULDER OF THE DAMNED EXPRESSWAY!

Our patient did not fare well in this exchange. I pulled up my bunker style boots, so that they reached nearly to my crotch, and knelt in the slush. Doug logrolled the man, and I slid the backboard beneath him, and logrolled him my way, so Doug and I could then center him on our spine splint. We buckled him in, collared him, schlepped him into our rig, and beat feet to TSBTCIDC, which happened to be one exit and a coupla turns away.

I remained dry and warm. If I had never worn those boots another day, that night, in that slush, they paid for themselves!

Fun And Games · Gratitude · Life in Da City! · Pains in my Fifth Point of Contact

Random Thoughts Part VI

Assessment of the elderly, sounding confused.

When I am assessing a patient, and ask, in my interview, ref location/day of month/day of week/name/etcetera, when you are not the patient, and YOU answer, talking over the patient, please realize that IDGAF about YOUR mentation, and when you coach the patient, it really, really interferes with my assessment. Plus, it is entirely likely that I myself KNOW the place/day/date/season/etcetera, because, you can bet your ass that if it were NOT Tuesday March the 41st, I would certainly be somewhere else, doing something else, other than attempting to struggle my way through your interruptions of my evaluation of your parent.

In a similar vein, when I ask Jim-Bob where he hurts, probably, when you coach Jim-Bob, admonishing him to “Tell the doctor where you hurt”, you are not really contributing any value whatsoever to the interview. If Jim-Bob indeed comprehends my question, you are only adding noise and distraction and likely, that is NOT helpful. If, on the other hand, Jim-Bob does not understand my query, your repeating it IN THE VERY SAME FREAKING WORDS, neither adds to the information that I require, so that I may care for Jim-Bob properly, nor facilitates timely implementation of that care. So, unless Jim-Bob does NOT speak Engrish, himself, please STFU, and allow me to interview the patient. Or, perhaps, go boil some water, gather a fresh newspaper and some clean shoelaces, right now, please.

Which will, of course, require you depart the exam room and allow me to complete my interview and examination.

Thank you.

Thoughts about Cost vs Price:

Lowe’s “bargain bin” AA battery powered cell phone charger: $10

Having several in your Bag-O’-Tricks at work, so you can hand one to a patient you’re sending to ED via ambulance, whose phone is dead: Kharma.

Having that guy get my cheap-o, bought-on-a-whim charger back to me, with a thank you: PRICELESS!

EMS LAW OF ALTITUDE: Patient’s weight divided by number of floors above street level equals a constant, “K”. Therefore, a 300 pound inert patient on the first floor is roughly equivalent to a 1200 pound patient on the 4th floor. With no functional elevator. And the first due engine company out on a working fire.

(redacted)’s Law: (I don’t have permission to use his name, but it’s not *MY* formulation) When responding to an EMS call, and you are pretty sure that you are on the correct block, but, for some reason, folks in this neighborhood do NOT have any house numbers, seek out the most tumbledown anonymous house on that block, and knock, Your patient awaits inside.

(redacted’s partner)’s Corollary Number One: The one house on the block with ghetto gates (bars on the doors and windows), is your call.

Corollary Number Two: Occupants of the house with the gates KNOW who is performing all the neighborhood B & Es.

Corollary Number Three: There is nothing inside the grilled house worth stealing. The decor is milk crates, cast offs, soiled mattresses on the floor. Even odds that the smell makes the place a haz mat scene.

Final Thought”

Please, please, please! If your physician has ALREADY prescribed a medication for your affliction, take the freaking med, BEFORE your come to my clinic stating that you require treatment for that selfsame affliction! Because, it could happen that my self control may lapse, and I may, indeed, ask you just how exactly I may help you, when you not only were prescribed, but physically picked up, the very medication that I would have prescribed (and, indeed, wound up prescribing) for your problem.

But, OF COURSE, you weren’t here to get a work note! Totally!

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

Vehicular Extrication

Long ago and far away, I spent my salad days as a street medic in Da City’s EMS. I know, right? Startlement abounds, amirite? Anyhow, this one time, we caught a run. We arrived to find an intoxicated gentleman seated in the rear seat of a four door sedan. Interestingly enough, he was seated upon the floor thereof, with his legs extended beneath the front seat.

We figured that extricating him from the vehicle would facilitate assessment (eg, WTF was his primary malfunction, and what, if any, would be our role in addressing it?). Therefore we started to attempt to move his legs so that he could return to being seated upon the rear seat, and exit the vehicle from there. No joy.

It tuns out that highly intoxicated folks, like our friend here, were not so very good at listening to and following directions. Our entreaties that he fold one leg, and remove it from beneath the seat, seemed overly complex, as he did not successfully implement step one of our process.

So, we tried to move the seat forward, thinking that this would afford our patient enough maneuvering room so as to fold leg “A”, move it laterally, extend it, and repeat the process with leg “B”, and thereby achieve freedom.

Nope. As the seat moved, he shrieked as if we were removing the leg, likely anticipating reattachment on the sidewalk. So, that avenue of approach was foreclosed.

Doug and I consulted with the vehicle’s owner, who had been pacing about, intent that we not damage his baby. Or the patient, I suppose. Doug and I were fresh out of ideas, and figured that our friends in the firefighting division, with halligan bars, K-12 gasoline powered saws with metal cutting blades, hydraulic extrication tools, and similar toys for fun and games, likely could devise several new plans to remove this gentleman from the floor of the back seat.

I shared this thought with dispatch, noting that our patient appeared in no immediate life threat, and perhaps a “Code Three” (aka “Priority Three”, or no red lights no siren) response might be appropriate.

Dispatch acknowledged our request, told us that a squad would be on the way, and “Firefighters never respond ‘Code Three’, always ‘Code One’”.

Alrighty, then.

The vehicle owner overheard all this, and appeared to become considerably more excited. “You called the mother-f*@$ing firemen! They will f*@$ up my car!”

Doug and I agreed with him, that likely there would be some damage once the firefighters had extricated Mr. Drunk And Boneless from his car.

Mr. Drunk And Boneless thereupon became the recipient of a loud, profane, creative, and enthusiastic exhortation that he remove himself from the vehicle so as to greet the firefighters while sanding upon his own two feet, on the sidewalk, rather than seated upon the floor of the exhortor’s car. (Paraphrased). This was accompanied by pulling, pushing, tugging and bending, as the narrator demonstrated the contortions that he believed would facilitate the exit of the drunk and boneless fellow from the narrator’s vehicle.

And it came to pass that, once the squad had arrived on our scene, Mr. Drunk And Boneless was seated, relatively happily and nearly uninjured, upon somebody’s lawn, rather than enmeshed in the seat of the vehicle that had held him securely within it’s embrace.

The squad looked the scene over, returned to service, and our patient told us to bugger off, as he simply wanted to sleep.

Well, bye!