Fun And Games · guns · Protect and Serve

Small Town Policing

So, once upon a time, my bad example led TDW-Mark II (The Darling Wife-Mark Two) to obtain her own concealed pistol license. She spent some time at the range with me, and eventually decided that she would carry a Springfield Armory XD pistol in 9 millimeter.

As these stories of mine develop, she was driving about our little town, and one observant police officer noted that she had a brake light out. He pulled her over to explain to her his observation.

Being a good doobie, she announced as part of her opening conversational gambit, “I am a CPL holder, and I have it here in my purse on the floor of the passenger side of the car!”

He acknowledged this tidbit, and invited her to carefully produce her license, registration, and CPL license itself.

She did so, and the officer walked back to his vehicle to run her plates and license.

He returned, and returned her cards to her. “So,” he asked, “What made you select the XD for your carry gun? My wife just took her CPL class, and is considering her own choice of pistol.”

TDW recounted her experience with my array of pistols, finding them overly large for her hands (Glock, Browning High Power), or not enough ammunition in the magazine for her preference (Revolver, Colt Government Model). “When I picked up the XD in the gunshop, it felt just right in my hand, and when I shot it, I did pretty good with it!”

They soon concluded their conversation, and she returned home, excited about her contact. “We simply had a nice conversation about concealed carry, and women’s choices in pistols, and why this or that pistol might be more or less suitable. It was kind of nice!”

Entry number 4,385 in my Catalog Of Why I Love Small Towns.

Fun And Games · Fun With Suits! · School Fun And Games

Nursing School Lessons

NURSING SCHOOL LESSONS

So, TINS, TIWFDASL, years and years and years ago. I was in nursing school clinicals, and working for EMS in Da City. This was so long ago, that HIV/AIDS was not even on the horizon.

One day in clinicals, I was cleaning up an incontinent patient, and my instructor motioned me outside once I was done and the patient tucked in to a nice clean bed, and he, himself, was clean and dry and in a clean gown.

She began: “Mr. McFee, You did very well keeping the patient covered so that he would not get chilled as you bathed him. There is, however, one item I ought to call to your attention.”

“Yes, ma’am? What is that?”

“I noticed that you were wearing gloves. That concerns me, because your patient might feel insulted at your wearing gloves for personal care.”

I responded, “So, you are telling me that the fact that I am wearing gloves to clean a patient who has been incontinent, of stool at that, might be seen as insulting?”

“Yes, Mr. McFee, that is exactly what I am telling you.”

“Well, ma’am, I worked last night, on the ambulance. I spent the night crawling in and out of cars, and over broken glass, removing injured people. I probably have a thousand little cuts on my hands alone. I am pretty certain that any patient of mine will get over their hurt feelings way before I recover from Hepatitis B. But, you are the instructor, and I am the student. Let’s write down your directions for me in this matter, and make a couple of copies. We’ll both sign each copy. That way you will have a copy, establishing what you directed me to do, I will have a copy and therefore cannot claim that you never told me to do what you told me, and there will be no questions moving forward what I am to do.”

She looked aghast. “I am not going to write that down! No way!”

I smiled. “Thanks for the counseling session. I will certainly keep your words in mind, moving forward!”

Duty · Fun And Games · Pre Planning Your Scene

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.)

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.