Fun And Games · Overdoses · Protect and Serve

Commercial Quantities of Meds

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

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

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

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

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

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

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

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

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

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

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

“Speck’ ah got it figgerred out!”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fun And Games

“WHY DO WE NEED FARMERS? I ONLY EAT FOOD FROM THE SUPERMARKET!”

Perhaps I have mentioned that TDW-Mark II grew up on a farm. As you might expect, she is familiar with chickens, and the process whereby eggs are acquired. She is, in addition, familiar with the process whereby chickens are changed into roast chicken, and even into chicken nuggets.

Similarly cows, and milk, as with cows and beef.

So, she was in school studying to prepare herself to be a social worker. Of course, she was required to take a course on ecology, or some similar stuff, because, after all, what social worker will be able to mend broken psyches, or minister to the fearful and ill, should she/he not have studied ecology, amirite?

Please understand that, while I did, indeed , “trade up” with the transition from Wretched EX (formerly TDW-Mark Ø), my wife (TDW-Mark II) is very much a non traditional student. This works both from the perspective of her age (she is not a gosling), as well as her having had some life experience prior to college. In addition, she has developed opinions based upon that life experience, and they are not particularly consonant with the stereotypical gosling/kid kollege student opinion set.

In her class, she learned all sorts of wonderful things, such as why corn in general, and corn syrup in particular, are death in a carton/on a cob, and ZOMG! WE! ARE! ALL! GOING! TO! DIE!, because of the presence of corn and corn syrup in our diets. Nice.

So, this one time, the class took a field trip (no, I do not, either, understand the point of a college class taking a field trip, unless is it a paleontology or archaeology class visiting some dig somewhere. This was not such a class!) Since this is Land Grant College Country, and the local Enormous State University is a Land Grant College, well, her little ecology class visited the Land Grant College Agricultural School. To be exact, the University Farms.

Being a farm girl, TDW Mark II dressed accordingly. Jeans, boots, denim shirt, hair up in a baseball cap, gloves in her pocket. No surprises there, right?

Her gosling classmates, not so much. Once she got home (TDW, not the gosling/classmate), she was laughing (TDW, not the gosling classmate).

TDW started off her after action report with a dramatic foreshadowing. “Ohmigawd! I just cannot believe some people! This one girl showed up for the farm tour in nice, dressy, high heeled boots, a nice dress, and a nicer blouse. You had to see her picking her way around the cow pen! And, she had lots of fun on the ladders! It seems that miniskirts are not really designed with climbing in mind, although the guys in class did not seem to mind very much!”

I had spent the day washing clothes, washing dishes, cutting the grass, and suchlike so that we could spend a nice weekend doing something that was NOT chores, so I nodded while finishing the last of the dishes.

It seemed that TDW Mark 2’s classmate had some difficulty meandering around the farm. Farms, after all, are industrial environments, when you stop to think about it. Once the procession had returned to the classroom, Ms Fine Clothes dove deeper into the vat of clueless in which she had evidently immersed herself.

The instructor initiated some sort of discussion, perhaps seeking to tie the afternoon’s travels back into the nominal subject of the class (ecology, or environment, or some such thing). This student observed that she or he had not appreciated how much effort went into raising and marketing animals for milk, eggs, and meat. Another noted the vast difference between the olfactory experience of a farm, and the Styrofoam cleanliness of the supermarket.

Ms. Nice Clothes stood and made her point. “Oh! My! Gawd! I could NEVER eat an egg from a chicken! They come out of their butts! I’m so glad that I only ever have eaten eggs from the supermarket!”

And, TDW Mark II wonders why it appears that I have a tic, consisting of shaking my head and muttering “What the actual FUCK?!?”

Fun And Games · Pains in my Fifth Point of Contact

ETERNITY

From time to time, I reflect upon my life. Surprised, no?

After a series of souls who have “googled” their symptoms, and then promenaded into my urgent care, sharing with me the benefits (such as they are) of their newly fond expertise in All! Things! Medical!, I consider Eternity, and my likely version thereof.

First, the “consultants” who see me. Pro Tip: your clinician is not going to be favorably impressed by the results of your internet search. In all likelihood, he/she has spent a considerable amount of time, money, effort, and lost sleep over many years to acquire the knowledge and (more importantly) the judgment to assess your symptoms, examine you and interpret the junction of symptoms/physical exam findings, in order to reach a conclusion regarding the most likely cause of your particular malady. These self same hard acquired skills and knowledge are then brought to bear in order to establish a plan designed to mitigate your discomfort or cure your problem.

Google does not provide you with the experience, in most cases extending for decades, which allows the thoughtful practitioner to reject irrelevant information, and weigh relevant information, and provide you the benefit of that education and years, nay, decades, of experience.

So, for the love of Ghawd, just DON’T!

Secondly, Eternity. Since I have lived a life of misjudgments and misdeeds (the Plaintiff told me!), I know I’m going to Hell. In keeping with Dante’s view of perdition, it is likely that I will have my own, custom designed Hell. I predict that I will spend Eternity as Hell’s urgent care midlevel, spending my time with an unending stream of trivially sick folks who will not only bring me the results of their own Hell’s Google search of their imagined symptoms, but ALSO, will spend FOREVER to not answer my simple history, medication, and allergy questions. And, Sisyphean, once they swerve into a lane that brings promise of eventually actually, ya know, ANSWERING my Gorammed questions, they will promptly swerve again into circular logic and non sequiturs.

Occasionally, when I have had a particularly lengthy string of such creatures, my staff will tease me. “So, Reltney, you fixing to climb up on the roof and bombard helpless pedestrians with boxes of Z-Pack?”

Fun And Games

The Metric Calendar

So, TINS©, TIWFDASL© as a midlevel in an urgent care, when one of the medical assistants in my office announced that she was going to hit the coffee shop on her lunch break, and canvassed everybody to see if they wanted her to pick anything up.

I told her that the coffeeshop was closed, it was a federal holiday, St. Swithin’s Day.

She looked at me, and turned to her computer, tapping furiously. Minutes later, she emerged from her search, triumphant, announcing, “St. Swithin’s Day is July 15th, this is October, and you are wrong!”

I smiled. “Well, St. Swithin’s day is a European holiday, and in Europe they use the metric calendar. On the metric calendar, it is July, and today is St. Swithin’s Day! You could look it up!”

She did. At length. Repeatedly. The NP who was my partner pulled me aside, grinning large, and whispered, “You rat! You know she is gullible, and you fed her that line of manure! What, you gonna carry on until she is spinning around, biting at her own tail?”

I assumed a faux-hurt look, and lied through my teeth. “Who, Me? I would never do such a thing! How can you accuse me of such a thing?”

She settled back on her heels, crossed her arms over her chest, and replied, “Oh, could it be because I have seen you in action? Multiple times? Just like this? Yeah, that would be it!”

Two weeks later, one of the other assistants teased her about the “metric calendar”, and my friend turned to me, “I blame you! You started all this idiocy about a metric calendar that does not exist!”