“The overdose is over there!”

So, TINS (“This Is NO Shit”), TIWFDASL (“There I Was, Fighting Disease And Saving Lives”), one lovely autumn evening in Da City, and my partner, Doug, and I caught a run for an overdose.

Now, at this point in time heroin was very, very “popular”. We had considerable experience with identifying narcotic overdoses, and managing them. (at least, “managing” them as much as we were going to, in a basic life support ambulance, in Da City with all the attendant financial constraints, and in circa 1980) The unbreathing/microscopic pupils/diaphoresis (wringing wet sweat) presentation is difficult to forget, once you have seen it a few…hundred times.

So, we arrived on the scene, and knocked, Our knock was answered by this huge guy, wringing wet (remember: autumn night in the northern tier of states, temp running around 60 degrees in the daytime) and, as I played my Mag Light over his face, I could not see any pupils. I remember thinking, “Jackpot! Only, how come he’s standing yet?”

That was answered when he gestured over his shouolder, as if to direct us, and announced, “The overdose is over there!”

Al-righty, then! We went as directed, promptly digging out the bag-valve-mask resuscitator. THIS fellow was not only wringing wet as well as having microscopic pupils, he was, into the bargain, not breathing at all!

We wrestled him onto our cot, wheeled him out to the ambulance, and coded our way to TSBTCIDAC. (The Second Best Trauma Center In Da City). There, after a brief ceremony featuring the Ghawd Narcan, he arose, figuratively picked up his pallet, and walked (well, ok: more like stumbled) out of the door.

Advertisement

Abandonment, and Trust Issues…

A while ago I had an MA assigned to me. She was (is) capable, focused, intelligent, and engaged; she maintained awareness of what else was occurring in the department, and reacted promptly and appropriately. (She was the protagonist of the tale of the early morning floppy child)

As things developed, she had an opportunity to transition to a day shift, Monday to Friday, 9 am to 5 pm, work-no-weekends-or-holidays job (in contrast to our present work-til-9-pm, every other weekend, every other holiday scenario). And! Get a raise in pay!

Naw, I cannot see why she would entertain such an opportunity for a single second, either.

So, of course, I teased her. “Oh, I see how you are! You would rather spend time with your husband, with your children! Oh, yes, I suppose all that is just fine for you, but what about ME?”

As you might expect, she started her new job, and, occasionally, took some overtime, working with me from time to time. Of course, each time I would tease her. “Oh, I see! Now that you are dead to me, NOW you come back, just as I was resolving my grief at your cruel abandonment of me!”

My partner joined in, observing, “You know, if you came back to work in this department again, you could never break up with him ever again! He has been an embittered husk of a man, since you left!”

(This is the same partner who observed, when I once wore a fleece prominently displaying the fact that it was an item from the National Rifle Association, by means of the 2 inch tall initials “NRA” over the left breast, let me know, “You know, they spelled your name wrong on your coat!”)(My name is “Tom”)

We reached a lull one overtime night, and I renewed my teasing. “You know, I taught you everything I know, while I was standing on one foot, and you abandon me! Oh, yes, you have a ‘HUSBAND’, and you have your ‘CHILDREN’, you have dreams, and plans for your life, but, what about MEE?!?”

She chuckled.

Tales From The Nightshift

So, TINS©, TIWFDASL© one night in The Maternal State, years and years and years ago. My father had taken ill, and of the three of us boys (the attorney, the contractor, and me, the nurse), it seemed that I was the best fit for the job of helping Mom take care of our Dad.

Well, that, and I was the one who did not have a family.

So, in order to keep my house and my vehicle, my creditors agreed that it would be nice if I were to continue receiving a paycheck, while I was 800 miles from home, and taking a voluntary leave of absence from my employment. So, I became a travel nurse!

This one night, I was working midnights at Some Suburban Megalopolis Hospital’s ED. It was way, way late, and we had cleared all the souls from our beds, and were engaging in my favorite slack time occupation, Story Hour.

So, one nurse was recounting how her boyfriend was failing to meet performance/behavioral expectations in one way or another. The other nurses (all women) responded, in a sort of choir, with murmurs of affirmation for the reporter. Except for one particular nurse.

This woman’s speech was rich with the cadence and harmonies of Da Islands, with a Caribbean note permeating her pronouncements.

“Aw, naw, ghurl! Ya no haveta put up with dem shenanigans! He gotta go, out de doah!”

The chorus affirmed this pronouncement.

The protagonist in our little Greek tragedy continued with her lamentations of Mr. Unworthy’s misdeeds, and our Caribbean Correspondent again provided her assessment: “Out de doah!”

Again, the call of more misdeeds, again the response from the congregation: “Oh, naw! Out De Doah!”

It devolved into a documentary of The Misdeeds Of Men, and along about that time, I found something I ought to be doing. At the other end of the department.

Gotta Scratch That Itch!

A week or two ago, my MA returned from her lunch, and showed me her parking lot find: a couple of dirty syringes, with bent needles. “I found them on the ground behind my tire”, she related.

My thoughts were, ‘what sort of fool, even among the universe of fools who inject drugs, leaves a freaking needle on the ground in a parking lot, where children come and go on their way to their own physician appointments?’

@

So, just the other day, TDW-Mark II needed to recharge her cash card. Off to her bank we went. The gentleman attending to her transaction appeared to be somewhere in his twenties, whereas I, myself, am approaching 70 (and so closely approaching 70, that 70 has started to tap his brakes, and slow down, in hopes that I would not admire his bumper so closely anymore!).

TDW was making conversation with this gentleman, and he was owning that this sort of transaction was unfamiliar to him. TDW then up and chirps, “It must be hard on poor elderly people, who don’t have computers, or know how to use them! That whole smart phone, and computer banking thing can be rough on the elderly!”

I looked at her for a moment, and spoke up. “Am I not standing right here? You CAN see me, right? Really? I. Am. Right. Here!”

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…

SNIPPETS

To be honest, y’all, I present snippets when the fountain of (I certainly hope…) entertaining stories has run a bit slowly, or I have collected several thought fragments which do not inspire an entire blog post. So, with that in mind, here is my latest installment of snippets.

Conversation with a child of Ghawd: “What makes your cough worse?” “What do you mean, ‘worse’?” (never mind: I now know that the answer is “nothing”.)

My mornings: I set the alarm for 0700, in order to get up, get around, and get to work. Kitty wants to play, at 0600.

I wonder if it would save me a lot of pointless conversation should I get a tattoo on my non dominant arm, saying, “Good talk! Here’s your Z-Pak! Have a nice day!”

Triaging one night as an RN, chucklehead enters bitching nonstop, “Stupid hospital! Stupid doctors! Stupid…” “Yes, ma’am, and I am likely the dumbest one here!” “But, you’re a nurse! You cannot be a nurse, and be stupid!” “Yet, ma’am, here I am, as are you! Now, what brought to us tonight?”

”I am going to prescribe an antibiotic for you. What pharmacy do you use?” “I don’t use any pharmacy. I never get sick.” (sigh) “So, what pharmacy are you going to go to, when you do go looking for your antibiotic?”

Overheard conversation among the MA staff: “So, he and I used to ride the bus together!” (I interject) “Is THAT what you kids call it, nowadays?”

When your MA starts report with, “So this guy, almost a year ago…”, you know that whatever follows is very likely to be some sort of cluster.

One day, I will snap, and I will write the following off work note: “Cletus was seen today in clinic. He is released to return to work after the heat death of the universe.”

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.

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!”

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.)

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….”