Fun And Games · Pains in my Fifth Point of Contact · Uncategorized

Random Thoughts III

Story “A”

You may recall my delight at marijuana legalization, correct? Because, “medical marijuana” wasn’t ENOUGH of a cluster f*&k, right? Of course, there is my recurrent delight at the discretion, great judgment, and common courtesy displayed by the genuii who stroll (nay, stumble) about, reefer fumes pouring from every fold of their clothing, if not every pore, in a nigh overpowering display of Poor Life Choices On Parade.

So, TINS©, TIWFDASL© when this braniac arrived, spawn in tow. My poor clerk registered the Named Patient (actually, plural, as in both kids), and then let me know that the chart was ready for me to lay some healing upon them. As if.

So, my first clue that Things Were Not Right, was when the nominally 3 year old child, named Adam, was sitting upright reading some (non picture) book. My second clue was that the nominally 12 year old child, was around 36 inches tall, and appeared to be around 40 pounds. And, did NOT appear critically malnourished.

I asked the reading child, “Please, tell me how old you are?”

The reply was “I’m 12!”

“How old is your brother?”

“Oh, he’s 3!”

I excused myself, and asked my clerk, “Did you know that Adam is 12, and Brady is 3?”

She looked at me, and informed me, “I asked the mother, and asked her twice, which child was which, and who had what birthday. It did not look right to me, but she repeated herself, same birthday both times, for each child. That is what I put down.”

“Well, it is wrong. Please, fix it, and double check it, all over again. Please try to sort out what else she fucked up in registering the kids, please.”

Once the clerk asked the 12 year old for his school id, the mystery was resolved.

My new Life Rule! If you are so stoned that you cannot remember your own gorramned childrens’ birthdays, and you successfully mix the TWO of them up, either stay the Fenomenon home, or WRITE IT DOWN!

Story “B”

Have you heard about Homeopathic Medicine?

What Is Homeopathy?

“Homeopathy, also known as homeopathic medicine, is a medical system that was developed in Germany more than 200 years ago. It’s based on two unconventional theories:

*“Like cures like”—the notion that a disease can be cured by a substance that produces similar symptoms in healthy people
*“Law of minimum dose”—the notion that the lower the dose of the medication, the greater its effectiveness. Many homeopathic products are so diluted that no molecules of the original substance remain.

(from: https://nccih.nih.gov/health/homeopathy )

Let’s keep “The Law Of Minimum Dose” in mind for a moment. So, I work in an urgent care clinic in The Un-Named Flyover State. It’s….quirky. Yeah, let’s go with that. So, our cleaners are some folks who are NOT from some national housekeeping chain. I do not know where the owners hired these folks from, but, well, they are, in keeping with the theme of the organization, quirky themselves.

Over the past several weeks, I have been noticing that the hand soap dispensed from pump bottles, has been appearing clearer, and clearer. Similarly, it has seemed less viscous, and less viscous, from week to week.

In keeping with these observations, it has started to require more and more pumps to elicit enough soap to, ya know, WASH MY HANDS!

One of the MA s clued me in to what is happening.

“The cleaners never pour more soap into the dispensers, they just add water. It’s free, unlike the soap that costs.”

I wondered, out loud, “What happens when it is simply only water in the “soap” dispenser?”

She told me, “I dunno, maybe, finally, they’ll buy more soap?”

I corrected her. “NOPE! We will be told, that this is the latest public health innovation! Homeopathic soap!”

Story C

A long time ago, in a county far, far away, I was working as an ER nurse. I overheard one of the clerks engaged in a telephone call.

Now in this agency, at that time, Administration did not want us providing “medical advice” over the phone. I was on board. My stock spiel, when I was trapped into answering some such call, was along the lines of “If you think you have an emergency, you ought to come to the emergency department. If you do not think that you have an emergency, perhaps your problem could wait until (the morning)(Monday), at which time you could arrange for your family doctor to address it. If you do not think that your problem can wait until (the morning)(Monday), well, at this time of night, your only option is to come in to emergency.”

I, myself, often would be the recipient of some query at that point, along the lines of “Well, how do I know if it is an emergency/can wait until Monday?”

My answer would be “You are there, you have sense (Yeah, I was lying through my teeth!), and only you can make that determination. I am not there, and I cannot see what you can see, since you are on the scene, and I am not.”

So, I heard the clerk speaking to some Brain Truster. Attempting to explain, repeatedly, how and why she could not tell him whether his laceration needed stitching. Mr. Telephone was persistent, and I could tell, from my clerk’s responses to him, that he was saying stuff like “Well it’s (insert length here) long, and about (insert depth here) deep, and it’s (insert some indicator of severity, like bleeding or suchlike here), so why can’t you tell me if it needs to be stitched?”

She finally had had her fill of his idiocy. “Sir, what color blouse am I wearing?”

“How the hell would I know what color blouse you are wearing?”

“So, how am I supposed to have any opinion worth anything about your cut?”

Fun And Games · Fun With Suits!

The Boiling City Ballet, and Gaps In My Classical Arts Education.

This one time, I was nursing on nights in a Rural ED. TDW-Mark I and our little family were living “Up North” in a small town, outside of a little town outside of a middling sized town that served as the commercial center for that corner of the state. Our small town, let’s call it “Boiling City”, had a bar, a short distance from our no-stop-light town center, and their claim to fame was serving as the region’s titty bar. We locals called it “The Boiling City Ballet”, as a snide reference to the exotic dancers that were it’s main draw.

At this point, I had something like a 15 years of nursing experience, as an ED nurse, ICU nurse, nursing supervisor, all on top of my years on EMS in Da City. I was kind of proud of my “been there- done that” self image.

Remember that thought. As well as the ancient aphorism that “pride goeth before a fall”.

So, TINS©, TIWFDASL©, and registration let me know that there was a patient with a knee injury. I meandered up front, collected the chart, summoned the patient, and invited her to join me in the back. I asked her what had prompted her visit to ER.

“Well, I was doing a pole trick, and landed wrong, and fucked up my knee.”

I goggled at her. “Uh, what?”

She giggled. “I was dancing, I did a pole trick, I landed wrong, and my knee gave out on me!”

BTDT fail on my part. “Uh, what is a ‘pole trick’?”

She filled that gap in my life experience. “I dance at the Roadhouse, out side of Boiling City.”

Ahhh! The formal name for the “Boiling City Ballet”!

“And?” I prompted.

“So, a pole trick is where I do something on the pole, like spin around, and this time I just landed with my foot placed wrong, and my knee started to hurt!”

“Uh, OK. Here, here’s a gown, and I’d get the doc so we can get you examined and x-rayed and everything.”

She was having fun with my norminess. “So, you **DO** know what I do for a living, right?”

“Uh, kind of…”

“So, why do I need a gown? I’ll just whip my pants off, right here and now, just like this…”

I backed out of the room, and shut the door. “No, that’s alright! Just put on the gown, and I’ll get the doc…”

Fun And Games · Fun With Suits! · Pains in my Fifth Point of Contact

RANDOM THOUGHTS

RANDOM THOUGHT THE FIRST:

I had seen a soul for some malady or another, and had prescribed an antibiotic. In keeping with our usual practice, I had e-prescribed this medication, sending it off to the pharmacy the patient had identified as his preference.

An hour or so later, the receptionist received a phone call FROM THE PATIENT, asserting that the medication was not covered by his insurance.

I receive these calls frequently. Simply so that you know, the mere fact that any particular medication had been covered by one or another of the hundreds and hundreds of different health insurance plans that are out there, by no means establishes that this medication will be subsidized, today. In addition, each individual health insurance plan has it’s own “formulary”, or list of what medications it will subsidize, and to what extent. These formularies differ from Medicare (and among different medicare plans, as well), to Medicaid (and, again, among various flavors of Medicaid), to assorted flavors of private health insurance. Again, formularies vary from one private insurance plan (say, one particular form of Humana insurance), to another (like, one of the insurance products from Blue Cross).

Therefore, it is not uncommon for these calls to come in. Generally, they are from the pharmacist. Then, the pharmacist, who has access to the insurance company’s formulary, can suggest another similar medication that will be subsidized. I will request it, and we all go on about out lives.

When they originate from the patient, it becomes somewhat of a time sink. What, am I gonna tell the patient what the new medication will be, and the dosing regimen, how many doses to dispense, and so forth, so that the patient can communicate this to the pharmacist? (anybody ever hear about, ya know, PRESCRIPTIONS?)

Occasionally, when I have some sort of wild hair up my ass, I am tempted, briefly, to do just that. “Why, thank you for the call, Mr. X! Please tell the pharmacist that I am changing your prescription from Amoxicillin, and instead I will prescribe Mofeen, one pound, and you are to take ad lib and prn until the heat death of the universe! And, you have a nice day!”

My filter has,thus far, worked without fail. I have never told anybody that…out loud.

Instead, what I do, indeed, say, out loud, is “Please invite the pharmacist to phone me, and he and I can discuss it.”

The Second:

I had occasion to phone another physician’s office, in order to have my patient seen that very day. I generally make this sort of call myself, when I need a same day appointment for my patient, because I can either explain all the particulars of the scenario to my MA, who can then repeat it to the other office’s MA, and then have her seek me out when, inevitably, there is some question that I have failed to explain in sufficient detail, or I can do it myself, explaining things once.

I vote for “Once!”

So, TINS©, TIWFDASL©, and on hold/ignore. Eventually, the other office’s scheduler came on the line, and we had our lovely little conversation about my patient’s malady, and why I felt the burning need that this soul be seen TODAY!

Everything proceeded swimmingly, and I noted the time and address of the particular office my patient was to report to. The scheduler asked my name.

“Reltney McFee, PA.”

“How do you spell that?”

“R-E-L-T-N-E-Y, M-C-F-E-E.”

She read back her note: “R-I-A-L-D-M-A-I, M-A-K-A-S-E-E?”

I had not really slept all that well the previous night, and had several people in the waiting room, eagerly awaiting (DYSWIDT?) my attention, so that they could get on with their own days. I quickly calculated that I could get this chucklehead to properly spell my name on the scrap of paper that she would soon discard, or get this patient the hell out of my department, and on to Higher Level Of Care, sooner.

I (unsurprisingly, I wager) went with option “B”.

“Nailed it!”

The Third Random Thought:

My home state, The UnNamed Flyover State, legalized marijuana last year, for recreational purposes. I have spoken, previously, about my rapture at this development. While I have not, completely, cataloged every single way in which I think that this is a fail of epic proportions, perhaps I have revealed just a little bit of my lack of enthusiasm for this development.

A couple of times.

I have noticed in recent months the phenomenon of idiots (er, I MEAN, children of God) evidently wandering through the world stoned. I reached this conclusion because of the numerous folks who stop by my clinic reeking of reefer fumes.

I do not mean, “Hey! If I pay attention, I can detect a waft of a smell, as if of marijuana, somewhere about this person!” Nay, I mean “Dude! Are Cheech and Chong shooting another movie hereabouts?”, or, perhaps, “Is there some sort of Rastafarian festival in town?”

Indeed, occasionally the smoke is eye wateringly intense, yet the purveyors of the fumes appear unaware of the air quality hazard that they present.

I have wondered about that. I suspect one of two things is in operation here. Either they are so stupid, either at baseline, or due to the deleterious effects of marijuana upon their mentation, (maybe, I should embrace the power of “and!”?) that they simply cannot realize what they are spreading in their wake, or else it is some sort of pheromone, at least in their minds, that attracts The Opposite Sex.

Although, to be honest, anybody who would be attracted by the olfactory cues these folks present, I would not romance with your johnston!

Fun And Games · Life in Da City!

Suburban Community Hospital (or) Be Careful What You Ask For!

Another time, with dispatch whimsically sending us on a scavenger hunt all over Da East Side of Da City, we had occasion to transport sumdood to Suburban Community Hospital. This was a fairly sizable establishment, even by the standards of the day, and the ED was pretty busy upon our arrival.

We handed Mr. Dood over to the nurses, gave report, and began to prep the cot for the next lucky contestant. One of the nurses ambled over, and engaged us in conversation.

“How come you guys only bring us drunks? We can handle anything TBTCIDC can handle!”

Doug spoke up. “Uh, Ma’am? That’s kind of the majority of what we bring to TBTCIDC, ya know? Most of our runs are sick folks and drunk folks.”

She wasn’t gonna let this go. “Aw, c’mon! How come we never get any good trauma! I know you guys take all the trauma to TBTCIDC! Howzabout occasionally bringing us some of the stuff you always are taking to TBTCIDC?”

We mumbled something that maybe could have been taken as assent, and she meandered off to fight disease and save lives, or something.

As Kharma sometimes deigns, our next run was not too far from Suburban Community Hospital. Indeed, the Grin of Kharma must have been epically large, as the next call was for a very drunk, very loud, very combative inebriate.

Once we had him restrained and in the truck, we conferred. Consensus was, we were about to return to Suburban Community Hospital. After all, they had ASSURED us that they could handle ANYTHING that TBTCIDC could handle.

Well, to paraphrase Bill Engvall, “Heeerrreee’s yer patient!”

When the nurses began to chastise us about our patient selection, as well as our destination selection, our refrain was, “Well, you told us that you were perfectly capable of handling anything TBTCIDC could handle! This fine young man, right here, is completely typical of their patient population!”

And, then we scurried away……

Fun And Games · Having A Good Partner Is Very Important! · Pre Planning Your Scene · Protect and Serve · Sometimes You Get to Think That You Have Accomplished Something!

Transfer To Florida

A long, long time ago, in a county very far away, I was a nursing supervisor. I had migrated into supervision after several years as an ER nurse.

One afternoon I arrived at work, and the offgoing supervisor reported that a gentleman had been brought in and admitted for his heart attack. Now, in these far away days, there were no angioplasties, no stents. There was no TPA, no other thrombolytics (“clot busters”). Indeed, the state of the art, outside of referral hospitals, was oxygen, hydration, rest, aspirin, and pain control. We had THAT, in abundance!

So, a couple of days later, one of the CCU nurses took me aside, and informed me that this guy was, to employ her own professional and finely tuned appraisal, “acting kinda squirrely”.

It developed that the attending physician determined that this soul was both having/recovering from a MI (heart attack), but, in addition, was a florid alcoholic, and was entering into DTs. Like, classic, textbook, tachycardic, hallucinating, writhing, pre-seizure tremulous, DTs.

Simply to make everything just nice, the internal med doc that the cardiologist consulted did not believe in using benzodiazepines for alcohol withdrawal. (that would be medications like Valium or Librium, useful both for the sedating effects, as well as their efficacy in protecting the patient from convulsions that might be lethal.) No, he insisted in using antipsychotics, which weren’t altogether effective in addressing his twitching nor his restlessness. Shit.

Well, he survived all this excitement, and, eventually (like, 4-6 weeks worth of eventually) was ready to go home.

Our discharge planner discovered that our new friend was a resident of Florida which we, in The Unamed Flyover State, were not anywhere near. He had wrecked his vehicle in the initial confusion, and therefore had no vehicle to get him home. In any event, what with his MI, and his lengthy stay in Thorazine Land, was in no sort of shape to (a) drive home to Florida, nor (b) master the intellectual challenges inherent in navigating the interstate home, even if he was strong enough to physically do so, Which he was not.

Her investigations revealed that none of his family was in any sort of position to happily drive up here and retrieve him (which of course begs the question of what was he doing here, with his pleasantly confused self, something like 1200 miles from home? And alone?)

So, once the dust settled, he was still our problem, and The Suits determined that springing for a flight home would end the financial drain that he represented, since no insurance company in the Western World would pay for him to reside at the Grand Hotel De Our Little Hospital, once his medical need had resolved. I did mention that he was squirrely, right? Well, our discharge planner hypothesized that his heart attack, and DTs, had trampled his previously marginally sufficient coping mechanisms, and he was, now, fully senile. Therefore, putting him up, unsupervised, in a hotel, would not work out at all well.

So the plan was laid. Our discharge planner purchased a plane ticket. He had specifically purchased a ticket on a nonstop flight, determining that there would be fewer opportunities for him to wander off, and get lost Ghawd Alone knew where. Then, she dumped it in my lap. I called A Competing Ambulance Service, and spoke to a supervisor.

“I have this guy, and we are going to fly him home. He is not altogether there, and so he needs both supervision, and a chain of custody. The flight is at 5 pm, so I want him at the gate at 4 pm sharp. I want your crew to physically deliver him to the boarding gate, physically observe him belted into his seat, and obtain a signature as a receipt from the flight attendant who seats him. Can you do all that?”

“Sure. You just have to set it up with the airline. OK?”

“Outstanding! I’ll set it up, and call you back.”

So, I called the airline. I spoke with a supervisor, and laid out my problem, and my view of the solution. “Sure, no problem. We can do that. Anything else?”

“Yep. Can you get a receipt for my guy, from the folks who pick him up, and then call me with the fact of safe arrival, please? Then, mailing us the receipt would be wonderful!”

“Sure, can do. Gimme your name and mailing address!”

I called the Competing Ambulance Service back, and brought the supervisor up to speed. “Oh”, I added, “One more thing. We’ll hand the plane ticket to your medic, and also hand him or her the chart. That HAS to go with him, and is part of the chain of custody business. OK?”

“OK!”, was the response.

So, on the appointed day, I was at the nurses station awaiting The Competing Ambulance Service crew. Once they arrived, I reviewed all the foregoing. Both medics nodded, and one opined, “Yeah, that’s all according the the briefing we got from the supervisor. Where’s the chart, and the ticket?”

The charge nurse handed both items over. The medic made a show of placing the ticked into the inside pocket of his jacket, turning so both his partner as well as the nurse and I could see it settled deeply into it. His partner tucked the chart beneath the pillow, and they were off!

Around 1630, I got paged to pick up a phone call. “Mcfee!” was my greeting.

“Mr. Mcfee, this is Bob from The Competing Ambulance Service. My crew just radioed me to let me know that your patient is on the flight, seatbelt secured, and they have a signature form one of the flight attendants. So far, so good. That attendant has you phone number, and will phone you once he has been handed over to family at the other end.”

And, as promised, around 1930, the crew from The Competing Ambulance Service arrived, hunted me down, and handed me a copy of their trip sheet, prominently featuring the name, signature, and employee ID number of the flight attendant accepting Mr. Man for his flight.

To frost my cake of WIN!, the next day the night shift supervisor relayed via days, that our patient had successfully, and uneventfully, been handed off to his family at his destination.

Hallelujah!

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

“Little Mary Sunshine is NOT a Force Multiplier!”

Once upon a time, long ago and far away, I was nursing in an ER in a medium sized city. For some reason, I was unable to evade being placed in charge.

Lord Knows that I tried! While I have established that I can be reasonably effective in a supervisory role, I really do not like it. For one thing, it places me in overly close proximity to Suits. I do not enjoy proximity to suits. Hell, my Suit Aversion Disorder led me to work midnights, in the first place! (well, that and shift differential, as well as seven-on-and-seven-off scheduling, to be honest.)

For another, I get subjected to all the bullshit from other departments, which, invariably, appears to consist of interacting with slothlike souls who manifest only one burning desire: skate through their shifts, while expending as little effort as is needed to maintain their receipt of a paycheck. Notice, I did not attribute to these chuckleheads the desire to actually do something resembling their jobs. That wuld be different.

Finally, when in charge, I get to cope with all the malignant and ill considered decisions regarding staffing the aforementioned cursed suits have enacted.

So at this point I was working in a relatively urbanized area, with a sixteen bed ED, in a town with three total Eds of various sizes. We had been short staffed for an extended time. This, of course, made me oh, so very happy. Or, not. I had been bitching, complaining, protesting and generally making known that not only was this sort of staffing insufficient, but, into the bargain, was considerably short of their own goddamned published staffing parameters, written by the goddamned suits themselves, and for which I would be written up should I let someone go home leading to staffing short of these parameters.

Well, as it developed, one of the Junior Suits (our assistant director) was compelled to show her smiling face up to work some of the short midnight shifts. She was, let us say, “entertaining”, to work with. She would “help out” by triaging. Well, when you triage someone, it is helpful if you (1) obtain and record vitals, (2) ascertain, and document allergies, medications, medical history, as well as (3) history of present illness, typically elicited by asking something along the lines of, “So, Mr./Ms/Xr X, what motivated you to come out in the dark of night to join our happy little party?”. You did notice how much fun I seemed to think it was, to, ya know, DOCUMENT, the aforementioned items, right? Sort of like that was, oh, I dunno, a GOOD THING, or something?

So, it develops that Little Mary Sunshine did not document (or even obtain; it was difficult to sort that one out) vials, allergy/med/history, or present complaint information, at least, not consistently. In addition, it seems that an ED physician with, say, a dozen patients, really, really gets petulant if these items are not there in the chart to be found. Slows him/her down, considerably.

Then, there is the part about both bedding the patient, as well as noting such fact on the greaseboard, as well as reporting off to the the nurse who would, oh, I don’t know, maybe BE CARING FOR THAT PATIENT.

Finally, it was established practice to start the needful IVs, collect the blood, and send it to the lab, along with a requisition for the bloodwork the physician was going to be desiring to see. None of which had penetrated Little Mary Sunshine’s cranial vault.

She was no more helpful as a “floor” nurse, Which is to say, she would half ass do things, not tell anybody at what point she had grown disinterested and wandered of Ghawd alone knew where, let alone document anything that she, by some miracle of random happenstance, completed.

As my partner, Andy, opined, “Ya know, she is not really a very effective force multiplier!”

Much more nicely phrased than the tsunami of profanity that was boiling away, waiting for me to spew forth as my OWN opinion of her “efforts”!

So, visiting as she was from the warm climate of Daytime “Suitworld”, Little Mary Sunshine was chilly most of the time. (she might have been warmer, had she been moving about as briskly as the rest of us, but, then….) Andy, once again demonstrating the situational awareness that made him a fine nurse and great partner, noted this fact, and brought it to my attention one long, long night during a missing Mary moment.

He implemented a plan based upon this observation, and turned the department thermostat down to around 60, from the typically balmy 70 where it normally rested.

Well, time passed, Mary Sunshine wandered around, fucking things up, and soon the HVAC system equibrillated at the new set point. Mary zipped up her sweatshirt, and began to complain that it was cold.

Nice of her to notice.

Shortly thereafter, she loudly opined that “You guys seem to have things under control. I’m gonna go back into my office and do some paperwork. Call me if you need me!”

Once she was safely away down the hall towards her (independently heated) office, we returned the thermostat to the baseline setting.

The rest of the night passed as the typical clusterfuck of shortstaffed jackassery, fortunately not exacerbated by halfwit half assed managerial fumble fingering.

Fun And Games · Fun With Suits! · Pains in my Fifth Point of Contact

Random Thoughts

Random Thoughts, Accumulated over a couple of weeks

(1) I know I have led a bad life (Ask The Plaintiff!). Therefore, I know that I’m going to Hell. If Dante Alighieri was correct, those of us going to Hell will experience our own personal, customized Hell.

Several times, it has occurred to me that, in my own personal Hell, I will be the clinician in Hell’s urgent care. There, I will spend endless shifts packed with trivially ill souls, who will take protractd periods of time to NOT answer my questions.

(2) I used to carry a can of CS teargas in my hip pocket, Back In The Day. Department regulations prohibited carriage of a firearm, so, what the heck, tear gas was First Runner Up in the self defense sweepstakes. So, one day I was in class, pursuing paramedic certification, and the top of the can, “safely” packed in my hip pocket, broke off. That left a puddle of corrosive tear gas in my seat. Curiously, there were no tears, which had, let us say, interesting implications for it’s efficacy as a self defense tool.

What there WERE, were sizable second degree burns on my asscheeks. That made for entertaining runs, as my ass slid to and fro while my partner drove our ambulance to emergency responses.

(3) This one time, I was working this one place (Hey! How about that RIVETING! Intro? Huh?) and they staffed the two provider clinic with two folks to work the floor, meaning they had to room patients, make appointments for followup, register and discharge patients, make referrals, answer the (incessantly ringing) phone, do procedures (breathing treatments, perform EKGs, take x rays, perform in house tests), and answer questions from random folks who walked in to ask questions about their bills or try to get their blood drawn (which happened at the lab, two doors down).

Kind of demanding, right? Well, somebody took a minute to call the office manager, suggesting that stuff either wouldn’t get done, or would get done incorrectly due to the pressure of multiple competing demands upon staff.

Her reply, as reported, was priceless. “Clinical medicine is like Zumba! You just have to keep up!”