Duty · Fun And Games Off Duty · Gratitude · Having A Good Partner Is Very Important!

Communication Breakdown

So, TINS©, TDW-Mark II had set out, because TSIL-Mark II (The Sister In Law-Mark II) had undergone surgery of some sort, and required assistance in the couple of weeks post operation. TDW does not work outside the home, and I flatter myself that I am sort of self sufficient. So, off she went.

Her journey to Another Fly Over State was unremarkable. She arrived, and notified me of this fact. I cooked up a batch of food, ensuring a supply of left overs for my work day repast. I laundered clothing and suchlike, and folded and hung same. I washed the dishes, and then put them away. I went to work, came home, played with the cats, and generally bummed around.

Just like I was a grown up, and had, oh, heck, maybe, done all this stuff before, right?

So, one evening I had changed into pajamas, hanging my pants and shirt up on the hook in the closet. My routine is that I will, the next morning, retrieve said pants and shirt, and transfer all my whatnot from old clothing, into the pockets of new clothing.

Well, when I do so, and leave my cellphone in my pants pocket, and retire to another room altogether to watch “Battleship New Jersey” videos (highly recommended, BTW!), or The History Guy videos (another enthusiastic Thumbs Up! Recommendation!), well, I cannot hear the ringer on my phone. Since I am not youthful, and do not have a pristine medical record, and, as well, TDW-Mark II is a bit of a worry wart, well, when I do not answer my phone, nor the texts, and this continues for something like a half an hour, well, she gets excited and calls a friend of ours, who also lives in town, requesting that he meander over and verify that I am not folded up on the floor, with the cats poking me and asking when I will arise, and feed them. Or something.

So, much to my surprise, our friend rang my doorbell at something like 2200 hours, and explained the preceding paragraph to me. I retrieved my phone, and promptly called TDW, and reassured her that I was NOT a crumpled heap of geezerhood at the bottom of the stairs.

The ringing in my ear, from the chastisement I subsequently received, has nearly resolved, as I write these words.

Duty · Gratitude · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

Jes’ Folks. Plain, Everyday Folks

Glenn Reynolds, proprietor of Instapundit, wrote an article for USA Today, nearly three years ago. Read it, please. And, reflect on who benefits when we are set at each other’s throats.

https://www.usatoday.com/story/opinion/2019/07/22/fatal-car-accident-reveals-fundamental-american-decency-column/1790753001/

I have had similar experiences, among them one chronicled here. It was as if we had our own “Insert Name Here County First Responders Association” meeting, there on that highway.

Again, this tale recalls a similar event. In this case, folks trudged their happy asses out of their warm, dry, non-windy homes, to help push a nearly (lessee: nought goes into nought… divide by zero…. carry the eight… three guzintas…) 10,000 pound ambulance out of a snow drift, at night, while it was snowing it’s freaking ass off.

So, tell me again who benefits when we are set against each other? If we are demonizing each other, how likely is it that we can ever (a) agree on a list of priority problems, (b) discuss rational maneuvers to address these problems, and (c) agree on any sort of effort to implement these interventions?

Por ejemplo, howzabout covid? Could we have discussed risk vs benefit of lockdowns, of “two years to flatten the curve” (had our governor been honest), or, even, “two weeks to flatten the curve”? Could we have had a real, ya know, two way, conversation about vaccination, efficacy, adverse drug reactions, liberty, personal autonomy (remember “my body, my choice”? Seems so long ago. Good times, eh?), risk vs benefit? Instead, anybody who speaks about any sort of disincentive to accepting vaccination, like, say, severely truncated testing protocols, or, say, known (even if small in magnitude) incidence of cardiac adverse reactions, or any of a dozen (that I can think of off the top of my head) risks genuinely presented by the extant vaccines, gets shouted down, deplatformed, or, worse, fired and hounded. So, I ask, who benefits when that happens?

In stark contrast to the Chattering Class, above cited are first person narratives of genuine Americans who, in a crisis, come together and identify what needs doing, and then, quietly, FREAKING DO IT. These folks identified one of their neighbors, identified that this neighbor was in need, and set to work. No command, no haggling, no bullshit. Simply, “How can I help?”

Tell you what: I resolve to be inspired by good examples. I will try to NOT buy into name calling, and, rather, own disagreements with others, and seek to see those disagreements as honest differences of opinion, where I am able to do so.

I resolve to try to be inspired by volunteer firefighters who interrupt Christmas with their families, in order to respond to a neighbors catastrophe.

If we open our eyes, there are uncounted examples of folks living up to their ideals, even as there are examples everywhere of those who fail. Sometimes fail horribly.

Mr. Reynolds, thank you for reminding me that most of the time, most folks simply try to get through their day, and, maybe, help their neighbor. To paraphrase his thought, I will try to let myself be reminded that, given the opportunity, most folks will reveal their fundamental decency.

Duty · Gratitude · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

Telemedicine: Threat, or Menace?

One fine day, I was at work, FDASL, and received a text from my daughter, let’s call her Brenda. She related that her second child had developed what looked like pink eye, to Brenda’s assessment. She (Brenda) had contacted whoever, and that medical soul had video chatted/e-visited/virtually visited/some other bullshit with my grand daughter, and had prescribed an ophthalmic antibiotic.

Brenda was not altogether certain that this assessment was spot on, and wanted her clinician dad’s take on things.

As you may have surmised, MY take on non patient contact, not in the same room “visits”, is not filled with much enthusiasm. There is something to the gestalt of being in the physical presence of somebody, that provides you with clues that are neither evident, nor are they provided across a video screen of any sort. (Ever smell the fruity breath of diabetic ketoacidosis? Ever smell it over a phone?)

Placing that aside for a moment, I asked for some pix. (I am aware that this amounted to the very same thing I had just, 11 words ago, railed against. Wait for it.) My grandchild’s eye appeared red, and (uncommonly in pink eye), so did the tissue surrounding her eye.

I asked if this grandchild could move her gaze left and right, upwards and downwards, painlessly. Was there any change in her vision?

The response I received was that the vision in her affected eye was “blurry”, as well as “it hurts when she looks up”.

My response text, verbatim, was, “Who is going to see her in person, in the next half hour?”

Brenda took her child to our local urgent care, which clinician, to THIS clinician’s credit, is reported to have entered the room, taken one look at my grand daughter, and turned to her mother, and said “So, I’m not going to charge you for this visit. Do you know the way to Big City Referral Hospital? Good. Do not dawdle. Go directly there, now. Yes, I mean the emergency department. Thank you. Drive safely.”

THOSE folks examined her, CT’d her, and started an IV (a process that Grand Daughter did NOT approve of!), and IV antibiotics, and admitted her for several days. The CT had revealed a peri orbital cellulitis (mild, but, nonetheless…), which responded to the medication.

She is now home, sassy, and none the worse for the experience. Take home points: Brenda demonstrates many, many of the affirmative attributes of The Plaintiff: she is smart, decisive, has a finely calibrated and high functioning “shit don’t sound right” detector, and is a bulldog advocate for her children.

I loathe “telemedicine”.

Sometimes I am both blessed and lucky. This time, to the benefit of my grandchild.

cats · Duty · Gratitude · Having A Good Partner Is Very Important!

KITTEN TAILS PART VI

So, TINS, TIWFDASL….we, uh, no, I was NOT Fighting Disease And Saving Lives, rather, I was at home while TDW-Mark II recovered from surgery. (Thankfully, minor. Well, “Minor” from my perspective. I’m pretty cure that, for whoever goes under anesthesia and awakens with sutures and re-arranged body parts, ain’t no such thing as “minor” surgery!)

In any event, on my multiple rounds on TDW, I noted that there appeared to be two, or three, cats perched upon the bed. Should one depart, one would take station. The others would eat, play, loll about: typical cat stuff. The two, or three, “on watch” all appeared to gaze upon her, that is, if they were not snuggled up against her. Just as if they were, indeed, “on watch”.

Olivia appeared to be the one constant watch-stander. She was perched upon TDW’s pillow, and did not seem to move. Others would appear to rotate in and out, but Olivia was pretty constantly there.

When she (TDW) was up and about the next day, she commented about it. “Every time I opened my eyes, one or more of the cats was there, looking at me. I felt as if I had a couple of private duty, furry little nurses!”

Then she reminisced. “remember that time you had your GI bleed? The two dogs, and all three cats (at one time, my cat crazy was under better control….) were settled in all around you! They would only leave to eat, drink, and go. Then, they were right back.”

At that time, we developed the McFee Critter Triage System: if one animal is sleeping with you, that’s normal stuff.

If two of them, well, likely normal, perhaps not.

If three of them, The Spouse needs to take a closer look at things: it ain’t raht!

Four? When is your doctor appointment?

Both dogs, and all three cats? Call dispatch. It might take some explaining (“Ma’am? Did you just tell me that your emergency is that all five animals are sleeping on the bed with your husband? I…I..don’t understand..?”), but Bad Things are at hand. Do Not Dally.

Fortunately, TDW-Mark II recovered uneventfully.

Duty · Fun And Games Off Duty · Fun With Suits! · Gratitude · Life in Da City!

Snippets Part III

I have a flexible spending account at work, so as to be able to pay my copays, deductibles, and suchlike with pre tax dollars. Late last year, I noticed that the card by which such expenditures were paid for, was getting declined. I assumed that I had spent all the money and thought no further of it.

Then, I began to get messages from the administrators of the account. Finally rousing myself to speak to them, I learned that the card had been frozen, because, I was informed, they required hard copy receipts for 3 or 4 of my expenditures. This included purchases from my optometrist for, oh, gosh, GLASSES, as well as at the podiatrist, for TDW-Mark II’s ingrown toenail.

It puzzled me, Visa, nor Mastercard never had such issues. I assumed that, just like the commercial banks, that the electronic billing that led to the vendor of, say, my gasoline, getting paid, had all the information required, kind of like a grocery store receipt.

Perhaps I was wrong. Or, perhaps, somewhere in this favoured land, folks go to their podiatrist, or their optometrist, when they feel the need for hookers and blow. (I wouldn’t know, myself, and Hunter Biden was not available to comment on that possibility) So, I guess, I will have to remain puzzled.

@@

Occasionally, I am humbled. Just the other day, I had such an opportunity. The lady bringing the pre school aged children in for whatever their complaint that day, was approximately my age (and, I am by no means of child rearing age. Hell, my youngest grandchild is already in primary school!) She reported, in the course of the conversation, that “My husband and I both got them when they were very, very young.”

Just, matter of fact. No inflection, dry fact.

As I was charting later, I noted that the parent was identified as the grandparent.

So, let’s contemplate that. Some of us are anticipating retirement, with few responsibilities, plenty of free time, and no pressing concerns.

Others, around us, are raising a SECOND family, at our ages, and not flinching.

Some of us are facing demands of duty, and stepping up to those demands, and in doing so are protecting, and nurturing, the most vulnerable among us.

@@

So This Is No Shit (TINS), There I was Fighting Disease And Saving Lives (FDASL), long, long ago and far, far away.

Well, okay. REEEAAALLLLYYYY!, I was shopping in Farmer Jack, in Da City, on one of my off duty from EMS days. I was pushing my shopping cart down one aisle or another, occasionally consulting my shopping list, and a fellow approached me.

He greeted me. “Hey! I know you!”

I did not just recently develop my aversion to Humanity. I spent years perfecting it. “Uh, no, you don’t, sir.”

He, on the other hand, was undeterred. “No, I know you! You work for the fire department!”

“You have the wrong guy!”

“No, really! I remember you  You saved my brother’s life!”

“Yep! That’s me! That’s how I spend my days! How is your brother?”

Fun And Games Off Duty · Gratitude · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

KITTEN TAILS, PART THREE

Our Cat Farm grew, as Momma Kitty joined us. One autumn day, TDW-Mark II observed Momma Kitty come onto our porch, and eat the dry cat food we had been placing out for her. TDW opened the kitchen door, on this pleasant autumn day, and verbally invited Momma Kitty to enter, and get acquainted.

Much to our surprise, she promenaded into the kitchen. She next sat herself in one of the windows, and we could not convince her to move. TDW then retrieved our travel crate for the one dog, opened it, and Momma Kitty simply walked in, settled down on the dog bed, and looked at us as if to say, “Well? Do you think you are done?”

We secured the door of the crate, and realized that we now needed to find, and retrieve, her latest batch of kittens.

TDW (perhaps, by now, y’all have realized who is the brains of this operation. And, it’s not me, apparently.) had observed the dogs lingering over a particular potion of the porch, as surmised tha the kittens would likely be located underneath.

So, we accessed the underside of the porch, TDW entered, and passed out the two kittens she found therein. The first kitten, now know as Oliver, was a wee bit, and appeared to have a lesion of some sort on the back of his neck. (this later was identified by our vet as an abscess) The second kitten, now know as Trixie (due to the black and white, “cow camo” pattern of her fur, reminiscent of TDW’s pet cow from her childhood), appeared to have some sort of mucoid material from her one eye. We wondered if the litter had been larger initially, and suspected that the stimulus to bring Momma Kitty in might have been some predator (we have raccoons about) might have attempted to clean out the litter, and these two, and Momma, survived.

We cleaned them up, as a start, and arranged for vet assessment. Oliver got an antibiotic, and his abscess resolved. Trixie was another story.

The vet could not visualize her one eye, and voiced concern that this might be a viral conjunctivitis, and have a corneal ulcer associated with it. She wondered if this would, in fact, heal, or if, once healed, she would have no vision in that eye.

So, we became cat nurses. Trixie got her eye ointment twice a day. After several weeks, she improved. And, since curveballs seem to be my lot in life, one of the other cats appeared to develop pink eye as well.

Since conjunctivitis is wildly contagious, unsurprisingly the other cats developed it. To my surpirse, only 7 of our ten cat herd did so: the three oldest appeared to miss that fun. So, we drew a kitty MAR (medication administration record), and began twice a day sick call.

The bad news was that the biggest of the kittens Was Not Having the medication administration. That led to Sumo Cat “Parenting”, which is every bit as much fun as it sounds. Particularly for those of us who bleed freely. And do not have hind claws. Fortunately, TDW, wise in the ways of Catdom, determined that should we profit from the old aphorism “letting the cat out of the bag”, and place Reluctant Cat into a sack made of two retired pillowcases, his paws and claws would be neutralized, I could immobilize his head, and she could administer the eye medicine.

To Reluctant Cat’s credit, he either did not realize that he could readily gnaw the shit out of us, or else elected to let this insight pass by, unacted upon. In either event, he improved.

The good news is that, soon, we would corral Reluctant Cat, and his escape artist sister (previously referred to as the superball, or the furry bottle rocket), and medicate them.

That task accomplished, we would administer treats, in the form of canned cat food, which they seemed to very much enjoy. Then, we would open the bathroom door, to release them and seek the next contestants, only to find that there was a feline line up, and next two would walk in, apparently unworried.

We would shut the door, medicate (and chart) these two, and provide their reward/treat. Opening the door, those two would saunter out, and the next two would meander in. Shut the door, medicate cats, treat/reward cats, chart meds, open door, those two exit, and the next one would enter and be medicated, rewarded/treated, easy-peasy.

As the kittens became integrated into the pride, one adopted our older cat. (I told of Henrietta and Max in a previous note) We were surprised to see that, once Oliver was in the pack, he appeared to adopt Olivia, from the previous litter, as if he was her “pet kitten”.

The cuteness mounts!

Fun And Games · Gratitude · Sometimes You Get to Think That You Have Accomplished Something!

THE SUNSHINE RULE: THE OTHER SIDE

It came to pass, we were open on New Year’s Day, and I was on duty. On that day, our waiting room waits were approaching 3 hours. I am not a fan, notwithstanding the fact that generally I have little control over how many folks disembark from The (metaphorical) Bus, when The Bus stops, and disgorges it’s passengers for our treatment pleasure.

As you may imagine, most of us, myself included, do not find it to be a life enhancing experience when I, or they, get to while away the hours in the waiting room, with a dozen or more unknown, snotty, feverish, sick strangers.

On this particular day, it occurred to me that I was oddly blessed. Nobody felt the need to extend my medical education with the results of their internet search, nobody “knew their body”, and, indeed, nobody KNEW! that The! Z! Pack! would resolve their woes.

In addition, nearly everybody was in good humor. Indeed, several folks made it a point to actually thank me for working that day. Specifically, literally, “Thank you for working today!”. Direct quote. No BS.

I had seen one of these folks a couple of weeks previously, and given them my stock spiel regarding treating their post nasal drip induced cough with fluids/inhale steam/Zyrtec/Flonase/Tylenol/follow with family doctor/return if worse. She told me, to my face, that “I got way better once I followed the advice you gave me. I’m still a little stuffy, and cough now and then, but nothing like when I saw you last time!” (today’s visit was for another malady).

Then there were the folks, a majority of the patients that day, who were possessed of a very robust sense of humor. On days when the wait is lengthy, my introductory spiel goes along the lines of “Hello, I’m Reltney McFee, I’m a nurse practitioner. I’m sorry about the wait, and thank you for you patience. I apologize for the abundant opportunity that you had to demonstrate your patience! What can I do for you today?”

Most folks chuckled, and those that did not chuckle, said something along the lines of “That’s ok. I’m here today because of….”

All that is to provide some particulars regarding the first two clauses of my Sunshine Rule: “Everybody brings sunshine into my life. For some people, that is when they arrive….”

Fun And Games Off Duty · Gratitude

Dad’s Blood Infusion

So, TINS©, TIWFDASL©…well, while This Is (indeed) No Shit, I was NOT, in this tale, Fighting Disease And Saving Lives. Rather, years ago, I was in The Un-Named Eastern State, visiting the Momette and my father. Dad had had a cardiac arrest something on the order of a year and a half prior, and had, miraculously, recovered entirely intact. Subsequent to that, he was found to have cancer, and THAT had NOT had a miraculous outcome. He had undergone several surgeries, and finally had been referred to hospice.

Let me say this about hospice. These folks, in this corner of that state, were a Gift From Heaven. No shit, honest-to-God, straight up. If I were to be found to have a heart, they certainly warmed it.

Today’s lesson concerns one of Dad’s surgeries. I had taken some time off, and was in The Un-Named Eastern State. Dad had come out of surgery, and we were there to visit him: Mom, My Brother The Accountant, and myself, who, at this point (yeah, my stories sort of jump from one point in time to another, don’t they?) was an actively licensed paramedic, as well as an RN, and nursing supervisor. I had been an ED RN for something on the order of 5 years at the time of this story. In anticipation of there developing a need for me to make a longer term presence in my parents’ home, I had obtained a Nursing license in the Un-Named Eastern State.

So, we were standing at Dad’s bedside, and I noted that he had blood running. As a nurse, we all learn, early on, that from the time that the blood departs the blood bank, until the last drop of hemoglobin rich goodness leaves the bag for your patient’s veins, no more than four hours must elapse. Anything not infused at the four hour mark, will still be in the bag as it is returned to the blood bank.

Idly, I observed that the bag appeared to be half full, and dropping sluggishly. I looked at the blood bank tag, which documented, among other things, the time the infusion had started: approaching three hours previous to my inspection thereof. I inspected the tubing, looking for closed clamps, kinked tubing, or other impediment to flow. On Dad’s hand, just upstream from the IV catheter, I observed a tight bend, something resembling a slight kink in the tubing.

I released the tape, opened the loop a bit, and re taped it, and gave things another looking over.

My mother reproached me. “Reltney, I don’t think you should mess with that. You should call the nurse.”

I was surprised. “Mom, I *AM* a nurse! In fact, I’m even a nurse, in *THIS* state!”

She replied, “Oh, you know what I mean!”

Fun And Games · Gratitude · Life in Da City! · Pains in my Fifth Point of Contact

Random Thoughts Part VI

Assessment of the elderly, sounding confused.

When I am assessing a patient, and ask, in my interview, ref location/day of month/day of week/name/etcetera, when you are not the patient, and YOU answer, talking over the patient, please realize that IDGAF about YOUR mentation, and when you coach the patient, it really, really interferes with my assessment. Plus, it is entirely likely that I myself KNOW the place/day/date/season/etcetera, because, you can bet your ass that if it were NOT Tuesday March the 41st, I would certainly be somewhere else, doing something else, other than attempting to struggle my way through your interruptions of my evaluation of your parent.

In a similar vein, when I ask Jim-Bob where he hurts, probably, when you coach Jim-Bob, admonishing him to “Tell the doctor where you hurt”, you are not really contributing any value whatsoever to the interview. If Jim-Bob indeed comprehends my question, you are only adding noise and distraction and likely, that is NOT helpful. If, on the other hand, Jim-Bob does not understand my query, your repeating it IN THE VERY SAME FREAKING WORDS, neither adds to the information that I require, so that I may care for Jim-Bob properly, nor facilitates timely implementation of that care. So, unless Jim-Bob does NOT speak Engrish, himself, please STFU, and allow me to interview the patient. Or, perhaps, go boil some water, gather a fresh newspaper and some clean shoelaces, right now, please.

Which will, of course, require you depart the exam room and allow me to complete my interview and examination.

Thank you.

Thoughts about Cost vs Price:

Lowe’s “bargain bin” AA battery powered cell phone charger: $10

Having several in your Bag-O’-Tricks at work, so you can hand one to a patient you’re sending to ED via ambulance, whose phone is dead: Kharma.

Having that guy get my cheap-o, bought-on-a-whim charger back to me, with a thank you: PRICELESS!

EMS LAW OF ALTITUDE: Patient’s weight divided by number of floors above street level equals a constant, “K”. Therefore, a 300 pound inert patient on the first floor is roughly equivalent to a 1200 pound patient on the 4th floor. With no functional elevator. And the first due engine company out on a working fire.

(redacted)’s Law: (I don’t have permission to use his name, but it’s not *MY* formulation) When responding to an EMS call, and you are pretty sure that you are on the correct block, but, for some reason, folks in this neighborhood do NOT have any house numbers, seek out the most tumbledown anonymous house on that block, and knock, Your patient awaits inside.

(redacted’s partner)’s Corollary Number One: The one house on the block with ghetto gates (bars on the doors and windows), is your call.

Corollary Number Two: Occupants of the house with the gates KNOW who is performing all the neighborhood B & Es.

Corollary Number Three: There is nothing inside the grilled house worth stealing. The decor is milk crates, cast offs, soiled mattresses on the floor. Even odds that the smell makes the place a haz mat scene.

Final Thought”

Please, please, please! If your physician has ALREADY prescribed a medication for your affliction, take the freaking med, BEFORE your come to my clinic stating that you require treatment for that selfsame affliction! Because, it could happen that my self control may lapse, and I may, indeed, ask you just how exactly I may help you, when you not only were prescribed, but physically picked up, the very medication that I would have prescribed (and, indeed, wound up prescribing) for your problem.

But, OF COURSE, you weren’t here to get a work note! Totally!