Customer Service, (SPIT!), Again

For whatever reason, I am a frequent flier at my friendly neighborhood cardiologists’ office. (No, I had this problem before Covid was A Thing)
So, once I noticed that I was having to work harder than I thought was proper, after exertion that I thought was sort of trivial (as in, ascending the stairs with a basket of laundry), I arranged to chat with cardiology.

I saw one of the midlevels in the office, and recounted my present experience, and set that in the context of my previous (atypical presentation) experience with my angina/narrowed cardiac arteries.

That worthy basically said, “Hmm. So, this present experience sort of mirrors your experience with previous cardiac caths, which were associated with significant arterial stenosis. I betcha you would benefit from another cath, which might result in yet another stent to add to your collection!”

And, so was it done.

For those not steeped in The Mysteries Of Cardiac Caths, a long narrow tube (a catheter) is threaded into the left atrium (upper chamber of the heart), and from there into the cardiac arteries (which originate from the left atrium). Once there, x ray contrast dye is injected, and images captured, establishing the free flowing nature of your arteries (or, so one would hope!), or, alternately, the fact of constriction and the degree of that constriction.

Should a sufficient degree of constriction exist, the catheter is threaded into that narrowed portion, and a balloon is inflated (with sterile saline), opening up that part of the artery.

When it works, and the artery remains open, Yahtze! (er, I mean, Score!). The cardiologist moves along to whatever other matter appears to be part of today’s investigation.

If it does not remain open, the doctor will place a stent to keep it open.

By the way, that dye is hard on one’s kidneys. If one is a geezer, as I am, and has marginally performing kidneys, as I do, the doctor has to limit the exposure your kidneys have to this dye. This fact meant that during my Fun! Time! In the Cath lab in August, only the higher problem constrictions were addressed, so as to limit the amount of metaphorical pain my kidneys would experience.

Since there was another artery significantly narrowed, it was medically reasonable and prudent that I have a rematch, once my kidneys had quit (again metaphorically) glowing.

I had that cath, did not require another stent, and we all lived happily ever after.

But, WAIT!

I subsequently, like 6 weeks subsequently, received a letter from my insurance company that asserted that my second stent was NOT “medically necessary”. (as an aside, I am unable to imagine who the frack would have a cardiac cath for giggles. I mean, rilly?!?)

I called the “customer service” number, and the soul who answered me led me to conclude that their call center is located (a) in Bagwanistan, and staffed by (b) retards.

The first chucklehead with whom I spoke, could not grasp the concept that “You assholes told me that my cath was not medically necessary, an opinion not shared by my, oh, gosh, CARDIOLOGIST, who, himself, kind of WENT TO SCHOOL FOR THIS VERY SORT OF DECISION MAKING!

After 10 or 15 minutes of trying to communicate this to Young Bagwanistanian Einstein, I asked to speak to a supervisor. Repeatedly.

Conveniently enough, Einstein’s supervisor was not available, a fact shared with me after several minutes on ignore. Einstein offered to transfer me to “authorizations”, and I requested that he do so.

The next genius made Einstein appear to be a Mensa member. We go to the point of her revealing that her records asserted that I had $2.96 yet to pay on my “individual out of pocket maximum”, and therefore would owe $1789 or some such as my copay for the second, contested, cath.
Ms. Mensa related that we had a family out of pocket maximum of $7,000, and that I had pain $3497 toward deductible and co pays, and The Darling Wife-Mark II had paid $3,500 toward hers.

I asked how it worked that I owed $1789, when my out of pocket maximum was $2.96 short of the contractual amount.

“Well, that is an aggregate amount. Until you have paid your deductible, and your co insurance (read: “co pay”), and the both of you have paid $7,000, you still have to pay your co pay”

I asked Ms. Mensa what the phrase “individual out of pocket maximum” meant? Since My understanding was that I would pay my deductible until my deductible amount had been paid, and thereafter I would pay 20% of the bill, until I had paid my individual out of pocket maximum, which was $3500. At that point, per my explanation of coverage that I received when I signed up for this insurance, I would not pay anything for covered services.

Oh, no, Ms. Mensa corrected me. “Out of pocket maximum” was aggregate, and we would have to pay $7,000, before the “no more out of pocket costs” coverage would begin.

I asked her to tell me what the phrase “Individual out of pocket maximum” meant? And, if there was no non aggregate out of pocket maximum coverage, why would your attorneys include such confusing language?

“Let me place you on a brief hold”.

SEVERAL minutes later, she came back on the line. “That out of pocket maximum is an aggregate. You have to have paid $7,000 for the two of you before your out of pocket maximun applies”.

So, The Darling Wife Mark II got to see That Face When You get to school the insurance lady, on a not particularly obtuse item of insurance coverage, which even the cardiologists’ office as well as the hospital at which my cath took place, are able to understand.

Like the difference between “individual” and “family”, and the different out-of-pocket maximums that contractually apply.

PUBLIC SERVICE ANNOUNCEMENT!

Ladies and Gentlemen! Please strive to live by these six Rules For Living. Endeavor to surround yourself with folks who live by these rules, themselves.

Again, I invoke the Bagwan Rajneesh Farnum’s Aphorism Of The Stupids:  Do not go Stupid places, with Stupid people, to do Stupid things, at Stupid times of day.  Don’t act Stupid, and try not to look Stupid.

IYKYK. Otherwise, please consider it a suggestion.

Myself, I believe I do pretty well. Perhaps, I could improve in the “Don’t act Stupid” part, although geezer level stupid, and young buck level stupid are altogether different.

It’s All In How You Tell ‘Em

Expanding upon my Cat Triage post, allow me to tell you about how properly presenting the patient facilitates proper care.

So, after my cardiac cath, and stent, my cardiologist placed me on anticoagulants (blood thinners). When one is a geezer, as I am, and has, let us say, occasionally has had mishaps, one’s joints will ache from time to time.

I had been in the practice of taking ibuprofen, and my (back)(knees)(elbows) very much appreciated this. On the other hand, when one is taking NSAIDS, such as ibuprofen, one has increased risk of bleeding from the stomach: and, simply to make things more exciting, only 20 % of patient who DO develop bleeding from their stomach, have symptoms.

Remember this.

So, after a couple of months, I asked my doctor if I could take motrin even while taking anticoagulants. I was told yes, and then did so.

Months later, I developed the dizziness with position change, rapid heart rate set of symptoms that I had noted in the referenced post.

Ya know, if you should be tachycardic (fast heart rate) and dizzy, and elderly, and visit your local ER, when you announce to the registrar, “Ma’am, would you please call the triage nurse and let her know that you have an elderly, tachycardic, dizzy heart patient at your desk? Please?”, well, their eyes do, indeed, get THIS WIDE, and the triage nurse not-quite sprints out to see you.

And, you find yourself the proud owner of a BFN type IV. (That would be a Big Freaking Needle, such as the nurse administering your blood infusion will need to have).

Once the lab had reported my results, the ER doctor sat down and told TDW and me that, after she had administered a couple of liters of saline IV (which had beneficial effects on both my heart rate as well as my dizziness), my hemoglobin was around 7. This is unsatisfactory, as normal runs around 13-15.

Oops.

Since I had not had any symptoms of gastric bleeding, everybody was puzzled. There was no puzzlement regarding the future place of ibuprofen in my medication list: NFW, none at all. (No Freaking Way).

Oops!

Dear One And All: I have just returned from a mini vacation, and belatedly realized that I had no post tee’d up at all for last Friday, 6 June.

I apologize.

It is interesting to consider that I appear to have problems keeping up with the leisurely pace that I have assigned myself, that of one post every week.

I suppose this is an opportunity to realize my limitations, and seek to improve.

Or, resign myself to my fate.

I *DO* have a post pending for this Friday, so perhaps I am not a complete loss.

MOVING CATS REQUIRES A PLAN

Last week we had a tornado warning. Actually, a couple of them, simultaneously. Since I have this thing about preparedness, The Darling Wife-Mod II and I had a drill for this: we had picked out a nice windowless corner of the basement to seek shelter in, and a couple of stools to perch upon while we waited out the excitement.

For previous warnings, we had cowered (I mean, patiently waited!) alone. We had discussed the desirability of sheltering the cats and dogs, and, really, the dogs were simple: open the door, descend the stairs, try not to trip on the dogs, settle in, easy peasy.

On the other hand, the cats appeared to not have been briefed in on the plan. Briefed in or not, they were NOT compliant with our version of the plan.

We had thought that we would scoop up Cat One, Cat Two and Cat Three, schlep them into Animal Crate The First, and then carry our happy little group down the stairs, settling the cats near the shelter area. Then, upstairs again, cats Four, Five and Six into Crate Two, tiptoe down the stairs, and return upstairs, secure cats Seven, Eight and Nine (in a manner that we had not thought through, having two animal crates), and gather together with our happy little furry family, snug and sound.

Well, not so much. The first two cats succumbed to surprise, and were easily secured. TDW gathered up cat Number Three, and went to insert same into crate one, which, of course, necessitated opening that crate.

Well, our hunt for Number Three had allowed Cats One and Two to form an assessment of the happenings, develop a plan, and with the audacity of action that would do Special Forces operatives proud, explosively unass the crate as TDW dropped Cat Three therein.

So, that’s one secured, 8 to go.

She cornered two additional cats (NOT the original Cat One nor Cat Two), settled them inside, and, doors secured, we trundled them downstairs to relative safety.

She then secured Cat Four and Cat Five (still NOT among ther original pair), secured them in the crate number two, off we went to the basement.

Simply to provide atmosphere during this party,. the tornado siren from 2 blocks away was sounding, the radio in my pocket provided a running commentary from Central Dispatch regarding the tornado seen ON THE GROUND to our west (storms in our parts travel from west to east), additional Weather Service warnings of severe thunderstorms headed our way, in addition to the second tornado to our south-west.

Fun times.

So, we had 4 cats unaccounted for. Cat Number Six was found under our bed. TDW collected her, we bundled her up in a pillowcase, and she was depostied ever so gently in the crate holding our first two acquisitions. Down to three.

Cat number seven was retrieved from beneath the bed (is this a pattern?), bagged and poured into the big crate downstairs.

Then, the chase was on. Understand, I am an arthritic geezer, TDW has arthritis herself, and neither of us is particularly limber, nor very quick. So, it was like playing “Keep Away”, with claws and teeth, and panicked cats. Every bit as much fun as it sounds.

After several circuits of our house, TDW suggested, “If they are in our bedroom, they will likely be under the bed. That will give them some shelter, and, perhaps just as importantly, we will not be crawling around the upstairs when the Train For Oz calls, ‘All Aboard!’”

Sound plan. We cornered the two remaining cats in the bedroom, closed the door, and settled into our basement paradise to while away the minutes until Dispatch announced all clear.

Fortunately, after around a half an hour the warning expired with no drama. We carried the cats UP the stairs, and released them
so that they could glare at us from corners and from beneath furniture.

And, I got my aerobic exercise in. Fun times.

CHECK YOUR PREPS! THE NEXT GENERATION

Recently, I wrote about an experiment regarding my medic kit. I noted that North American Rescue was selling a medic kit in a hard sided, apparently a Pelican, case. My writing commented upon my experiment, observing that need to collect more information before I called it a success or not.

My conclusion, presently, is that, for me, it is not a success. In the Apache case, it weighs 18 pounds. Now, for the young and fit types, I expect that eighteen pounds is “Meh?”. In contrast, for the not-young, not objectively fit demographic (such as my own), considering that the bag, predecessor to the case, felt like it weighed considerably less, well, 18 pounds is kind of a thing.

Then there is the “wedge it into my vehicle’s back seat” issue. The bag settled in rather nicely, either on the seat or on the floor. The case awkwardly kind of rests on the floor, at an angle, and interferes with laying the seat back. In addition, when I pack for a trip (and I pack A LOT for a trip!), the bag would rest on top of stuff, with relative stability. The case? Wobbly, and appears to repeatedly come to rest in a catty-wampus orientation.

So, here is my “before” and “after” review of my medic kit.

Obscured by masking tape, I have my name and contact information, in the event that I get separated from my kit and some kind soul attempts to return it. I also have the date when I last inspected it.

Inside the top of the lid, I have a CAT tourniquet, a SWAT-T tourniquet, a sharpie, a flashlight and a sandwich bag containing a couple of pairs of gloves.

Inside the main compartment, I have a bag-valve-mask resuscitator (top, left of image), an IFAK (bottom left), two Olaes dressings beneath (“south of”) the IFAK, and, beneath these , sort of “peeking out”, several triangular bandages made of muslin.

To the right, the yellow bag contains bandaging material, featuring 2 inch cloth tape, generic “Coban”, a couple more triangular bandages, and a “space blanket”.

The green bag contains a pair of gloves, a stethoscope, and a blood pressure cuff.

The blue bag contains a set of oropharyngeal airways, some petrolatum gauze, and tongue blades.

The red bag holds Chitosan (a hemostatic-bleeding control-agent), scissors, a guarded razor knife, roller gauze in a sealed food storage type bag, 4×4 gauze pads similarly sealed against weather/oops, some ABD pads (5×9 adsorbent dressings generally employed for vigorously bleeding/leaking wounds) and two more rolls of 2 inch cloth tape.

Simply for clarity, this how MY kit is set up. You may feel a burning need for something else in YOUR kit, and go get u some!. You may determine that you do not want this, or that, or the other thing in YOUR kit. That, also, is fine. My kit is simply an (as in, “one of many”) exemplar of how you might elect to arrange your own kit.

That commercial message aside, how does all that fit into my red bag? (carefully!)

The front pocket holds a space blanket, Vaseline gauze, tongue blades, and duct tape (flat wrapped around an old card hotel key). The top middle pocket holds gloves, and the middle lower pocket holds oropharyngeal airways (see also, tongue depressors). The pocket on the right holds a 4 inch Olaes battle dressing (yellow material peeking out from underneath the flap).

On the left end of the bag, in an end pocket, is a 6 inch Olaes battle dressing, chitosan (a hemostatic), a SWAT-T tourniquet, and (more) gloves.

On the right end of the bag, in the other end pocket, I have a 4 inch Olaes dressing, “paramedic shears”, and a CAT tourniquet.

Inside the main compartment, there is a razor knife secured with a lanyard, to the zipper of the bag. Outside on top is my IFAK. To it’s right you can see a reflective dongle, which should facilitate finding my bag on some dark and stormy night. (we can talk about my obsession with flashlights some other time!)

On the reverse side of the bag is a fairly large pocket, in which resides my blood pressure cuff. Beneath it, transversely oriented, is a smaller pocket, which neatly fits my “road” stethoscope.

THIS iteration of my medic kit weights 9.1 pounds. (recall the 18 pound weight of the Apache case kit). That establishes a considerable weight savings, and for those (like me) who are NOT 25 years old, that additional 9 pounds represents a problem. (a modest problem, but, if I am stopping for a roadside emergency, you can bet that any additional problem, of whatever stature, is decidedly unwelcome!)

There you have it. I hope you found my wanderings useful. As always, I encourage you to get trained, obtain experience (Sayyy! Doesn’t your local volunteer fire department, EMS/rescue need some help? Golly, you could both obtain additional experience, as well as do your neighbors a solid favor, should you volunteer!), and check your preps at whatever interval strikes you as appropriate.

HELPFUL, BUT INSUFFICIENT

Simply so that you know, I work in an urgent care. Surprisingly enough, my service population features a considerable fraction of folks who have communicable diseases.

Recently, I noticed that I was coughing, particularly so when I was laying down. That is suggestive of post nasal drip, and so I began medications intended to suppress same.

Not dramatically helpful.

As a courtesy, I wore a mask at work, in order to limit my success in sharing my pathogens with my co workers, and my patients.

I hope that I was successful in not sharing, because this one day I coughed my fool head off, all night long, and therefore the prospect of driving an hour to work, working all day, and driving an hour home was unappealing. So, I called off.

I had thought that the prospect of receiving a phone call at 0630 would be, itself, unappealing, and therefore sought to both provide suitable notice of my absence without awakening some poor (administrative)(clinical) soul on a weekend, with a pre dawn phone call. So, I sent emails to my immediate superior as well as to my clinical provider partner. And, satisfied that I had done what was needful, went back to bed, and slept.

I was awakened several hours later by my phone. My immediate superior had called, concerned that I had not arrived at work, and had, apparently, not notified anyone. Once I reassured her that I was not crumpled up in an immobile heap in some corner somewhere, we discussed that fact that the maneuvers that I had thought sufficient, were not, and I needed, next time, to call the administrator on call and bring them up to speed on my impending absence, therefore avoiding them worrying, “Reltney is never late, he never simply not shows up, he is kind of geezerly: he must be folded up somewhere without his Life Alert! That could be very bad!”

So, I was NOT crumpled in a heap anywhere, I do NOT have a life alert, and, while I am, indeed, a geezer, I am fundamentally OK. That virus will eventually stop plaguing me and I will return to work, I expect, on my next scheduled day.

Oh: and, once I stop coughing, TDW likely will sleep soundly again.

Avoiding Rookie Mistakes

TDW Mark II and I were on vacation recently. It was mid February, and we had had just about enough of the grey skies, the cold, and everything else that accompanies a winter in The Un Named Fly Over State.

We were walking around St. Augustine, as TDW wanted to tour the old fort, Castillo de San Marcos, on the waterfront. Parking, as it turns out is both rare, precious, and very expensive. Fortunately (for some values of “fortunate”), if you drive a vehicle which requires over 7 feet of head room (as does my truck), you have to park in the oversize vehicle lot. This lot is something like 4 blocks farther from the waterfront than the parking structure. There were an abundance of no shit buses (think tour buses), along with a couple of campers. I parked my truck in an out of the way corner, and looked for an opportunity to pay.

Apparently, there is no payment required. Bonus!

Once we had completed our tour, we walked back to the oversize vehicle lot. Along the way, we encountered a couple. The gentleman asked me where the parking structure was.

Fortunately, I had driven past the structure on my way to the oversize lot. We met this couple approximately 2 blocks away from the structure, and I was able to point it out to him from the corner.

As we walked away, TDW thought out loud. “Ya know, if we were to take a photograph of our truck, along with the floor letter or number, and the lot and adjacent street sign, we could protect ourselves from just that sort of confusion.”

And so, at our next stop, that is just what I did. TDW in front of the truck, beneath the floor/zone sign, and out front of the structure.

Idiot resistant. (with myself cast in the named role).

“Widget….widget…widget…”

I was talking with one of my partners the other day, and we wound up discussing “the portal effect”. This describes the phenomenon wherein a soul (such as me) realizes that he/she needs a widget, said widget being located in, say, the kitchen. This soul will then travel to the kitchen, passing through the kitchen door (“the portal”), and promptly forget what it was that I had entered the kitchen in search of.

I will then return to wherever it is that I had come from, and, reaching that location, realize that I still needed that widget, located, of course, in the kitchen.

I will then return to the kitchen, and, again, promptly forget what the hell I had been in search of, once I was again safely within the kitchen.

If I smarten up, just a bit, upon my return to my point of origin, I will (again) figure out that The Widget Fairy did not deliver a widget to where I needed it, and, THIS TIME, I will go into the kitchen, repeating to myself (hopefully under my breath), “Widget! Widget! Widget!”

Time Allocation Trade Offs

Once upon a time, long ago and far away, I was driving to vacation with The Darling Wife-Mark II. We drive for a couple of reasons: first of all, when I drive, all my survival crap is right to hand. Should I fly, my firearms, medic bag, as well as my backpack full of get-me-home goodness, all stay home. Or, in the parking lot of the airport. Secondly, I am reluctant to outsource my security to (among other folks) the TSA, which seems more and more to stand for Thousands Standing Around. Thirdly, it is in no way reassuring to hear that “migrants” (spelled i-l-l-e-g-e-l a-l-i-e-n-s) are able to fly, on taxpayer dime, with their appearance notice (to appear to adjudicate the fact that they are here, oh, what is that word?….ILLEGALLY) as their board-the-flight ID. Finally, in the event that the flight gets diverted for any of dozens of reasons, well, should my drive be re directed, guess what I have right at hand? In stark contrast to what I have right at hand should my flight be diverted from Fly Over State International Airport, to, say, Seatac?

That’s right: I have, in that scenario, my boyish good looks and sunny disposition. Might be a sort of hard fail, on two counts.

So, there I was, driving along, when TDW-Mark II wondered aloud if flying might be simpler on some levels. I reviewed the above with her, and allowed her that, should we fly, there would be a couple of days we did NOT spend in the vehicle.

Indeed, I suggested that I would not return to work, stop, shocked, and exclaim, “Holy Stool! I could have spent my entire vacation in my vehicle, rather than on a cruise! What was I thinking?”

TDW (of course) looked at me as if I had lost my mind, and asked me what the hell I was saying?

I told her an old story, wherein Scrooge (or whoever) sits bolt upright on his deathbed, lamenting, “Damn! I wish I had worked more overtime when my children were young!”

And that, of course, reminded me of a story wherein the protagonist was stoned as a m-f-er. While laying in a near stupor, he came upon an epiphany, a revelation of The Secret Of Life.

He realized why humans were present on Earth, why The Creator placed us here. This was important, and he struggled to his feet, staggered across the room, and searched out a pen, and paper. Painfully, he scrawled out The Secret Of Life. Satisfied, he re read it, sighed in satisfaction, and went to bed.

Hours later, he awakened, and suddenly realized that he had discovered The Secret Of Life. Better yet, he had written it down.

He leapt from the bed, raced across the room, and found his note. Trembling, he held it up to the light, and read the words he had written there.

“There’s a funny smell in the room!”