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!”

Fun And Games · Life in Da City!

If You Are Taking Medical Advice From The Voices In Your Head, You Are Doing It Wrong!

So, TINS©, TIWFDASL©, when we caught a run for a “sick person”. My tales of adventure notwithstanding, the overwhelming majority of EMS runs in Da City were what the personnel called “sickies”. This tale is about one such soul.

We arrived, and things progressed in the usual fashion. Six questions, one command.

  1. “Who’s sick?” (show of hands).
  2. “What kind of sick are you?” (the response generally ran along the lines of “I’m really sick”, or “I’m just sick, that’s all!”) (so much for “History of Present Illness”)
  3. “How long have you been sick, Sir/Madam?” (typical response was some variation of “A good little while.”)
  4. “Do you want to go to the hospital?” (A surprising number of people did NOT want to go to the hospital. Some wanted to be told that they were alright, others wanted to go to some place in West Bumfuck, way, way, way outside of Da City’s service area, or wanted a ride to the doctor’s appointment that they, surprisingly, had made. We did not take folks to their doctor appointments or to BFE Community Hospital. Fire department rules.)
  5. “Can you walk?” (the correct answer is always, “YES!”. Occasionally “No”, but the number of trivially ill/injured folks traveling to ER via EMS was both surprising and disappointing.)
  6. “Where are your shoes?” (Again, a surprising number of folks who presumably had lived in Da City all their lives, and had noted snowfall and freezing ass temperatures arrive each and every winter, did not think to have their shoes staged, oh, I don’t know, NEAR THE DAMNED DOOR, once they had determined that they required ambulance transport to the hospital emergency department for their sniffles or whatnot.)
  7. (Command) Follow Me!”

So, one such soul, seated in the back of the ambulance with me late one night/early one morning, was being interviewed by me. I asked him his allergies. “No, none, not really.”

I asked him his medications. “Well, no, none, I guess.”

That did not sound right. I asked, again, differently. “Does you doctor think that you are taking any medication regularly?”

“I suppose so.”

“What might that medication be, that you suppose that your doctor thinks you ought to be taking?”

“Oh, some nerve pill.”

“Oh? ‘Some nerve pill?’ Why aren’t you taking your nerve pill?”

“Well, the voices in my head told me I didn’t need them any longer!”

“The voices told you that, did they?”

“Oh, yes! They were very clear about that!”

“I bet that they were!”

Fun And Games

“The Price is Right!”

Once I had departed the employ of Da City, I worked as a RN in one of the little ERs dotting Da City. At that point in time, there were perhaps 18, maybe 20 hospitals big or small serving Da City. I worked at one of the middling sized ones, at that time around 300 beds.

Working midnights in ER, well, you commonly find yourself spending time with folks who make poor life choices. Those of you who have worked nights, or do presently, bear with me. Alcohol is a commonly abused drug. Shocker, right? Moreover, those who use alcohol to excess, commonly also do other, similarly, stupid shit. Said stupid shit, typified by the admonition, “Hold my beer, and watch this!”, places the stupid shit performer at significantly higher risk of ER visitation eliciting injury.

In retrospect, that all makes sense. Well, those of our neighbors who fail to contemplate consequences, readily foreseeable consequences at that, PROSPECTIVELY, well, those folks are why my children slept indoors, ate every day, and got suitable shoes regularly. Thanks for the business, my friend!

Later in the night/early in the morning, the flow of sick/injured tends to slack off. When all the stuff that needed doing, had been done, we got to thinking. From those deliberations arose the night shift game of The Ethanol Is Right!

The goal is to appraise a given patient, without any lab work reported as of the time of the prediction, and then write down your vote for the patient’s blood alcohol level. The vote closest to the lab reported value, but not over, “won”.

Fun And Games · Life in Da City!

Another Winter Tale

One night at Medic 7, Doug and I were whiling away the hours. For this house, in this city, it was a slow night. On the other hand, it WAS winter, and it WAS snowing it’s ass off. I was finishing my Nursing school studies for the next day’s class, and Doug was reading the book he had brought along for slack times.

We caught a run, and off we went. As we headed east on Warren, we noticed a young woman walking back and forth in front of our fire house. Strikingly enough, she was not dressed for the weather. The heels alone presented a slip-and-fall hazard, and that is not mentioning the short skirt she was wearing.

When we had completed that batch of runs, we returned to quarters. The lap walking woman was still there, and had walked a clear circuit in front of the engine doors.

Hours later, another run, same woman parading in front of the house.

Returned an hour or two later, and there she was, still walking circles on the sidewalk.

She was gone when we caught our next run in the wee hours of pre-dawn. I mentioned her departure to Doug. He, being more wise in the ways of the street than I, opined, “Likely, it took her that long to make her quota, so her pimp would let her back indoors!

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

“Hey, look! I’m fine!”

Winter in Da City is a special time. The snow, late enough in the season, covers up the litter in the gutters, the layabouts tend to lay about indoors, and generally you can almost convince yourself, if you squint just so, that there is hope for, and in, Da City.

And, then you meet people. Kind of an occupational hazard of being a medic for Da City’ fire department. Most of us held to the TRUTH! Of the aphorism that “sick people suck”. Daily (or nightly- kinda depends on your shift, amirite?) we encountered folks who, well, sucked. Both as people, and at life. Because, after all, the lottery winners infrequently phoned 911 to regale our dispatchers with tales of wonderfulness. Face it: nobody calls the fire department, to gush about he/she just now met The Love Of Their Life, and how this soul brought sunshine into their every day.

So, with that thought in mind, TINS©, TIWFDASL© one lovely wintry afternoon and we (Doug and I) caught a run for a man with a broken leg. Arriving on the scene, we noted the usual choreography of the “He’s In Here!” dance, oh so very popular in Da City.

We entered to find a gentleman on the sofa, ethanol fumes emanating from his every pore. One of the (more) sober bystanders informed us that our guest had fallen while shoveling snow, and broken his leg. I turned to the named patient, and he obligingly illustrated the point by waving his (no shit, notable from across the room, articulated in an unnatural spot between his knee and ankle) leg in the air, declaiming, “Hey! Look! I’m fine! There’s nothing wrong!”

As you may have already surmised, he likely had already been well anesthetized. Then, there was the question: if he broke the shit out of his leg, as he manifestly had, how, and why, had he made his way into the house? And, what parts of this tale remained untold?

I attempted to orient him to current events. “Uh, sir? It sure appears like you have broken your leg. We would very much like to take you to the hospital, to get that fixed up for you!”

“Naw, I’m fine!” was the reply, accompanied by more broke-the-shit-out-of-it leg waggling.

The citizens on the scene were ever so helpful. Or, not so much. They contributed, “He broke his laig! Y’all cain’t leab him here!”

Thank you, Dr. Schweitzer, for your orthopedic consultation. Certainly gonna have to factor that into our clinical decision making!

I looked at Doug, and he looked at me. He handed me the handie talkie, and went to the ambulance to retrieve the cot and assorted helpful goodies. I attempted to elicit something along the lines of allergies, medication and medical history information, figuring that sort of information would be kind of mission critical to our friends in anesthesia. I was certain that a tour of the OR in the presence of the orthopedist was in his future. Oh, and vitals. Vitals would be nice.

Once Doug returned, and I noticed that he had preplanned the upcoming goat rope, including a long backboard, backboard straps, and plenty of roller gauze.

We approached out new friend, and pinned him to the sofa. Doug bandaged his arms…yeah, THAT’S the ticket! Bandaged, not restrained! Once he was hindered from “lending a hand” to the festivities, well, we rolled him onto the spine board, secured him with straps, and, laying a nice wide rigid splint between his legs, secured bandaged them as well.

The foregoing accomplished a couple of things. First, he quit flapping that grotesquely fractured leg around. Secondly, he was a considerably more stable package to carry out to the rig. Finally, all the citizenry was placated by how thoroughly their friend had been splinted. Everybody won!

Once we arrived at TSBTCIDC, and debussed Mr. Leg Fracture, well, the nursing staff couldn’t help but unsecure him, since they simply HAD to evaluate the fracture. That set off an entirely new round of protestations that he, the patient, “was just fine!”, accompanied, again, with the semaphore wig-wagging of the demonstrably unfine fractured leg.

Cool story. I finished my trip sheet, and completed and signed a “Petition for Involuntary Hospitalization”, citing my new friend’s manifest unconcern for a clearly broken leg, documenting his inability to comprehend his need for hospitalization.

All in a day’s work!