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

If You Take Care Of Your People, Your People Will Take Care Of Business

A long, long time ago, in a city so very far away, I was an afternoon shift nursing house supervisor. In the course of my shifts, I would receive call offs from midnights, and attempt to discern that point at which nights would be short, and I would have to attempt to backfill their staffing.

One such evening, I had determined that nights would, indeed, be short. I started on the unit that was short, and called up. The first nurse I spoke with was the recipient of my stock spiel.

“Ms. Smith, golly, have I got an opportunity for you!”

She was amusedly skeptical. “Oh, you do? What sort of opportunity might that be, Mr. McFee?”

“Ma’am, I have the opportunity for you to make eight hours of time and a half, right this very night! What a deal!”

“What might I have to do, to earn this time and a half?”

“Why, simply keep your same assignment, and ride home in the morning glowing in the satisfaction that comes from a job well done!”

“Suppose I don’t have a ride home in the morning? I carpooled with Ms. Diaz, and she is completely uninterested in OT.”

I had an answer to that problem. “In that case, I’ll trot up there with a cab voucher for you!”

She was surprised. “Can you do that?”

“It certainly appears that I can, as I have the cab voucher right here in front of me!”

“But, I did not bring anything to eat later!”

“No problem. What would you like? We have KFC, pizza, Burger Biggie, and others not so far away.”

“But, I did not bring any money!”

“Who asked you for money? You’re working over, I will be sure that you eat, and have a way home. Any other concerns?”

“But, who is going to pay for the food?”

“Not you. Beyond that, not your problem!”

She sighed. “OK, let me call my husband. I’ll get to keep my assignment tonight?”

“Yep! I will so advise the night supervisor!”

“Thank you, Mr. McFee!”

“Ms. Smith, you are welcome. Thank you for being flexible!”

I caught up with the security supervisor, and asked him if one of his officers could make a chow run. I handed him a $20 dollar bill, asked for my change and the receipt, once Ms. Smith had her food.

The next day, I took my receipt to my boss, explained how I had negotiated coverage for night shift, and presented the receipt. She wrote out a petty cash voucher, and sent me to the cashier to get reimbursed.

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

Cross Country Adventure

So, TINS, I was NOT FDASL. Rather, youngest brother and I were driving a rental truck full of my mother’s earthly possessions back to The Un-Named Maternal State. She had died, and we were consolidating her possessions so as to end paying rental on a storage locker, once we had each kept a few items as keep sakes.

In any event, we had departed early in the afternoon, and therefore were NOT going to make the trip in one go. Gotta admit, the allure of driving through the night, well, had faded with the years. Neither of us were thirty, anymore.

As it started to get to about midnight, Youngest Brother had searched for, found, and reserved a room at a hotel something on the order of 1/3 of our way There. This hotel was described as “near the airport of (fairly large city)”. Now, I have flown a time or several, and have some expectation, expectation that I feel is not unreasonable, that there would be, ya know, SIGNS, announcing the presence of something as large as, oh, gosh, I don’t know, AN AIRPORT. Signs, no less, on the adjacent interstate highway.

Notwithstanding my expectations, I managed to drive a considerable distance past (fairly large city), and began to wonder out loud where the freaking airport, and, with it, our hotel, might be. Youngest Brother did a bit of internet searching, as well as phone map application searching, before he announced that I had managed to drive past it.

Score, ME!

So, we reversed course, and drove back, finally observing a sign announcing the airport, set way, way, way back off the side of the highway, obscured by shrubbery. We only saw it, because, unlighted, another vehicle’s headlights momentarily illuminated it.

I guess that these folks believe that if you do not know how to get tyhere, already, you don’t belong there in the first place!

Once we arrived, Youngest Brother entered, and registered us, obtaining a pair of key cards. We trundled our crap up the elevator, and found the room. This hotel used proximity key cards, and (I supposed) placing the key adjacent to the door locking mechanism would trigger the door to unlock, and we would stumble into sleepy time bliss.

Or not. The lock blinked a persistent red, and there was no whirring as of, say, unlocking, to be heard.

Youngest brother returned to the desk, there to explain the problem to the clerk and elicit a replacement, functioning, key card. He returned to report the following.

He told the clerk that the cards did not function at our lock.

The clerk asked him, deadpan, “Did the light turn green?”

Brother’s answer: “Nope!” (while thinking, ‘Of course it turned green, you idiot. The door popped open, and right now my brother and I are sitting on the sofa, eating our dinner!’)

I suggested an alternative answer. “Yeah, it turned green. And I looked all around, and never did see the butler who is supposed to open the door, turn down my sheets, and unpack my luggage! What sort of low rent establishment are you running here, anyhow?”

We did, in fact, receive a new set of keys, which worked.

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

THE WISDOM ASSOCIATED WITH HINDSIGHT!

So, the other day, My Best Man and I went to the range together. He had recently acquired a Garand that he had not yet shot, so, by way of introduction, I brought mine, along with some other guns that merited airing out. A good time was had by all, as range time = good times. “Group therapy”, so to speak.

My friend is a bit of a raconteur, so the stories never end. He told several tales regarding the CEO of his employer, and these stories revealed a soul steeped in the tradition of leading from the front, and taking care of your people = taking care of business, which equals, in our line of work, taking care of patients. Well. Taking care of them, well.

From him, with our history, these were tales of high, high praise, indeed. (He is the originator of the observation that “Little Mary Sunshine is *NOT* a force multiplier!”)

Eventually, we had shot everything that we had brought along to shoot, and noted that it had clouded up, with occasional rumbles of thunder to draw our attention. Therefore, we safed the weapons, packed up the ammunition, cased the firearms, and paraded to our vehicles.

Once everything was settled into our vehicles, well, the skies opened. We were at my conservation club range, and so I got the opportunity to exit my vehicle, unlock the gate, open the gate, exit the gate, and relock the gate. This, of course, required that I exit my nice, warm, dry truck, wade through the slough that our driveway had become (soaking my feet in the process. I *HATE* cold, wet feet!), fiddle with the lock, fiddle some more with it as I fail to correctly recall the combination, fiddle with the damned thing YET AGAIN, finally opening it. In the downpour.

As my partner exited the gate, I ran to my own truck, entered it, and realized that I had a poncho therein. I donned the poncho, and attempted to close my door.

As it developed, my truck will *NOT* exit park, and move, until the driver’s door is secured. That required me to remove the poncho from the door, and attempt, several times, to close the damned thing. Finally succeeding, I moved my truck through the gate, and re entered the cataract in order to re lock the gate.

It occurred to me, right about then, that donning my poncho (as well as, oh, I dunno, FREAKING BRINGING MY FREAKING FIRE BOOTS) might have gone a long way towards allowing me to open the gate, close the gate, lock the gate, and then return to my vehicle, without being, you might say, soaked to my damned skin.

Ah, the wisdom associated with hindsight!

Duty · Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact · Protect and Serve · Sometimes You Get to Think That You Have Accomplished Something!

Sometimes, The Pucker Could Squeeze Diamonds

So, TINS, TIWFDASL at an urgent care out in Flyover Country. It was a typical afternoon, featuring a parade of sniffles, coughs, and poison ivy. Our clinic was on the south side of the road, east of Middling Sized City, and the Big Time Big Deal Hospital And Trauma Center. In other words, to get the the BTBDHATC, one would exit our driveway, and turn west (that is, LEFT!)

Abruptly, the registrar summoned me. My MA and I walked over, to behold a limp toddler. Very Not Good!

The MA escorted the male carrying the child to an exam room, and began to collect vitals. I examined the child, discovering a heartbeat (Crom be Praised!) and spontaneous respirations. The registrar collected demographic information, and I asked the adult what had happened, prior to arrival.

“Well, he started shaking, and then he stopped. He just wouldn’t wake up, so I brought him here.”

Well, the “wouldn’t wake up” part was still descriptive of the child, and I noted that I would have to call an ambulance immediately, because this could have several causes, none of them good. Indeed, “floppy child” is right up there in my Triage Catalogue Of Very Bad Things.

The adult male paused at this. “I don’t want to send him by ambulance. I’ll take him myself!”

I was surprised. I noted, “So, you *DO* realize that several of the things that caused this, could reappear, and he could stop breathing or his heart could stop. EMS is trained and equipped to deal with those things, should they occur. You, while driving, are not, right?”

He persisted. “I’ll drive him myself”.

We directed him to go there immediately, with no delay nor detour. We explicitly directed him to exit our driveway, TURN FREAKING LEFT (that is, west), and not stop until at the ED.

He stated that he understood, and would do so.

He scooped the child up, and exited the building. I sat down to chart, as well as call BTBDHATC, in order to provide them with forewarning of the sick, sick, sick child coming their way. That is, until my registrar called me, excitedly, to report that this sunovabitch had turned EAST! (exactly away from the hospital) upon exiting our driveway.

WTAF!

I had the clerk print a face sheet, and called emergency dispatch. I related the above information to dispatch, along with my concern that a critically ill child was *NOT* being taken to the ED. I provided the street address we had received, as well as the contact information.

I next called the child protective services emergency number, to report the above. I was assigned a report number, which I charted, and my own name and contact information was taken.

Several hours later I received a telephone call, from a gentleman asserting he was from CPS. I asked him to confirm the report number, the child’s date of birth, name and address of our record. He did confirm all these details.

He queried me about the particulars of the child’s presentation. I supplied the requested information. I asked how the child was. The worker paused, and said, “Well, I am not allowed to provide information regarding an ongoing investigation, particularly one where the child in question has been hospitalized. I’m sorry. “

My response? “Yeah, it’s too bad you couldn’t tell me if the child had been hospitalized or anything. I understand. Thank you.”

Fun With Suits! · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Interview Skills

A long, long time ago, in a Galaxy not so very far away, TWWWBTP (The Woman Who Would become The Plaintiff) had graduated LPN school, and was starting her LPN-to-RN studies, and I was seeking a change of employment. I was looking to add ICU to my resume, since the grad school I had my sights on required it. This one hospital was recruiting, and proclaiming that nurses who accepted positions in their ICU, would receive a $10,000 sign on bonus.

I investigated, and learned that one half of this bonus would be paid upon completion of one year of employment, and the second half would be forthcoming after completion of the second year of employment. Sounded good to me, and so I arranged an interview.

Since TWWWBTP, at that point TDW-Mark I, thought that it would be problematic should I accept a job requiring me to drive halfway across the state, as this position would, perhaps she should investigate employment (and schooling) opportunities there, as well.

Sounded good to me.

On the appointed day, she and I arrived for our interviews. I learned of the position, and they told me, “You do know, don’t you, that we require a two year commitment from nurses in order to qualify for this bonus, right?”

I acknowledged that I did, indeed, comprehend this aspect of the arrangement, and stated, “Yep, I expect that I can wait two years before going to grad school!”

They acknowledged my comment, and we proceeded.

So, we concluded our interview, TDW-Mark I and I, and we sat in the lobby, awaiting their offer(s). We were summoned, and received the news: TDW-Mark I was offered a PART TIME, LPN job. As for me, well, I did not receive an offer. They informed me, “We are looking for nurses who want to come here, and settle down here, in our community. With your grad school plans, well, you do not appear to be a good fit for that sort of longevity.”

Cool story. We drove home, TDW-Mark I composing her “Thanks but no thanks” letter in her head, and I remarked, “Ya know, honey, I believe that I have figured out what I did wrong!”

She replied, with some side-eye, “Oh, really? What was that? Other than being truthful about your higher education plans, I mean?”

“Well, you see, I should have walked in there, paused just inside the door, and, James T. Kirk like, spread my arms in an all encompassing gesture, slowly turned, taken in a deep breath, and declaimed, “I…I..feel, I feel as if I have come….HOME! I….I want my children…to grow, TALL, under these…these Blue ! Skies!…I want to spend my days….Breathing! This! Clean! Air! I…I want…my..bones, to rest…to, REST…beneath …these green hills! I…I feel as if…I am…at..HOME!”

I looked over at my bride. She smiled, and responded, “So, you are telling me that you should have lied your ass off, right?”

“Of course, right!”

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

Above and Beyond

So, TINS©, TIWFDASL©…. Well, OK: REALLLLYYYYY!, I was holding up the counter, and awaiting my next patient, when one of the registrars came up and informed me, “Reltney, I’ve got this sick lady out in the drive up, and I really think you need to see her! Like, right now!”

To set the stage, my urgent care has (surprisingly!) urgent care patients, as well as folks who arrange to be tested for Da Rona. This latter group makes their appointment, drives up, telephones in to announce their arrival, and my registrar gowns up, registers them (now, THAT is a surprise, amirite?), and one of the MAs gowns up, strolls out, tests them, and hands a sheet of instructions (prominently featuring the admonition to quarantine for ten days, or until negative results are forthcoming) to the patient.

This particular soul had not made it past the whole “registrar registers them…” part. This particular registrar, let us call her Eloise, has been doing this for several months. She is one of those quiet, efficient, takes-care-of-business folks that make things in general, and our agency in particular, run. She is not a nurse, not an MA, may not have any “medical training” whatsoever.

Nonetheless, Eloise had appropriately identified that this patient, nominally here for coronavirus testing, was way, way, way sicker than (a) coronavirus testing was gonna help in a clinically relevant timeframe, as well as (b) way, way, way, way! too sick to be driving around. So, she came and got me.

I went to the patient, shortly afterwards followed by an MA who had overheard Eloise’s pronouncement. I was impressed by the fact that this woman reported chest pain, nausea. left sided neck pain, left sided jaw pain, as well as being unable to tell me her allergies, or medications, or medical history, and could not state the name of her boyfriend (whom she wanted called to retrieve her vehicle) as I shortly had determined that this nice lady was going to shortly be the recipient of over 50 years of pre hospital emergency care wisdom and experience, as well as diesel therapy. (ambulances nowadays generally run on diesel).

I told Eloise to get an ambulance, and the MA hopped in, to clear a room for this patient. Eloise evidently had delegated that task, as she returned promptly with a wheelchair, and I noted another MA on the phone to dispatch, as Mrs. Chestpain was wheeled in.

As I assessed this soul, engaging in conversation all the while, it struck me that her ability to track the conversation was deteriorating before my eyes. Not a good thing.

Soon EMS arrived, packed her up, and set about their own part of her care.

I called report to the local ED, explaining the above.

I then went in search of Eloise’s supervisor. I informed this worthy that, in my opinion, Eloise had saved this woman’s life. Had she not had her head in the encounter, had she not noted “chick don’t look right” (the fundamental item of nursing assessment), had she not sought me out and had she not compellingly made her case that this was a SICK person, well, Mrs. Chestpain might have driven off, to die from (her heart attack)(her stroke)(a collision from her impaired ability to navigate), or (all three).

For some reason, I had occasion to speak to my physician supervisor around that time. I repeated the foregoing story, as well as the foregoing analysis, to her.

“Well, you know, Reltney, you also saved her life!”

“Ma’am,” I responded, “I have dozens of years of schooling, decades of emergency and clinical experience to enable me to do that sort of thing: it’s kind of what you are paying me for! Eloise, on the other hand, has none of those things. You are congratulating me for doing my job. I’m applauding Eloise for thinking outside of the box, outside of her job description, and acting effectively to get this woman the help she desperately required. Thank you, but Eloise went above and beyond her job. She is what made everything else happen.”

As a side note, here’s what the preceding paragraph looks like, when your cat helps you:

“Ma’am,” I responded, “I have dozens of years of schooling, decades of emergency and clinical experience to enable me to do that sort of thing: it’s kind of what you are paying me for! Eloise, on the other hand, has none of those things. You are congratulating me for doing my job. I’m applauding Eloise for thinking outside of the box, outside of her job description, and acting effectively to get this woman the help she desperately required. Thank you, but Eloise went above and beyond her job. She is what made everything else happen.”pppppppppppppppppppppppppppppppppppppppppppppppp

Thanks, Kitty. i do believe that I have this under control.

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

“Reading the Room”, or, Situational Awareness

So, TINS©, TIWFDASL© as an ED RN. At this point in time, the ED employing me (which was Middling Freestanding ED (MFSED) was an entertainment subsidiary of Enormous Hospital System With Delusions Of Grandeur (EHSWDoG).

My subsidiary hospital had the system’s psych ward upstairs, and therefore we appeared to be the psych intake for the three or four county area at which we were the center. So, this one night, an enormous dude, dressed in a three piece suit, perfectly buttoned etc, and BACKWARDS appeared. There were no police accompanying him (so I assume he was not a police psych hold). For some reason, Mr. backwards Suit had decided that he needed to go for a stroll.

As I became aware of the excitement, I noticed a cloud of nurses, as well as several security, negotiating with him to lay back down for assessment, and so forth. Somebody had given him a pen (for Ghawd only knows what reason), and he was appearing to become more excited as time passed. I noticed him only paying attention to the officers, with his (pen holding) hand behind him. He was standing in a doorway from one hallway to another, and I was down the one hall to his right. I strode past him, as if going down that hallway, and, as I passed, I snatched the pen from his hands, and continued down the hallway, as if that were the only reason for my passage.

Mr. Backwards Suit soon de-escalated, was assessed, and (unsurprisingly) admitted for psych evaluation. And, nobody else gave him a pen.

Having A Good Partner Is Very Important!

“Do what you you think is best…”

A long, long time ago, in a little burg so very far away, I was married to The Plaintiff, and we were living in conjugal bliss.

No! Really!

I was (and am) an amateur radio operator (“a HAM”), and was relatively new to the hobby. So, this one time, I was perusing QST, which is the magazine published by the national association of amateur radio operators (said association known as the American Radio relay League, a name rich in meaning regarding the early days of radio). Therein I came across an advertisement for a new radio, which, after reflection, I desired.

Now, mat that time, The Plaintiff and I had an agreement, wherein larger expense items would be presented to The Spouse for approval. Therefore, I went to The Plaintiff, and showed her the ad.

“Look at this, Honey! It will do all this neat stuff, and I can use that neat stuff when I do public service events with the HAM club! Remember that one time we all went to that bike-athon, and I couldn’t hardly reach net control? Well, this radio will cross band repeat, so I could have parked the truck a little ways up the hill, reached the truck with my hand held radio, and then been repeated into net control!”

She took the magazine from me, perused the advertisement, and noted, “It even receives weather band! That would be handy, like that time we were camping, and the severe weather alert went out!”

Excitedly, I agreed. “Yep! And, since it is dual band, notice that it can receive VHF on both bands! So, I could monitor both fire department diapatch, as well as the local severe weather net!”

The Woman Who Would Become The Plaintiff looked up at me, and asked, “So, how much does a radio like this cost?”

I thumbed to the back, showing her another ad, from an amateur radio shop. “Look! Right around $700! And, I have nearly that much in my ‘toy fund’!”

She appeared thoughtful, for a moment. “So, it’s what, July, now?”

I was agreeable. “Yep!”

“Hmmm. Ya know, buying the kids’ school clothes will cost us around $600, you know.”

I was surprised by what appeared to be a tangent. “Uh-huh?”

She handed the magazine back to me. “Honey, you do what ever you think is best!”

Well, her head did not start to spin around, and spew out nasty green stuff, so, THAT was nice…..

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

“From the mouths of babies…”

Last week I worked with a resident. She had recently completed a rotation at The Big Pediatric Hospital, in the ED. One of her stories involved a child with a fracture. She related that, as she was showing this child her fracture on the x ray, the child exclaimed, “That’s the broken part, isn’t it?”

This stimulated me to recall a tale of my own (for, does not nearly EVERYTHING, stimulate me to recall a story?). Long ago and far away, I was working urgent care at a distant clinic. In this facility, my MA was an x ray tech, going to school for MRI. One day, a family brought in the matriarch, who had hip pain after a fall. Indeed, this elderly woman was pained by the movement elicited by the cracks in our flooring (our flooring was in very good repair!) Well, (let us call my MA…) “Ashley” determined that there was an x ray in this lady’s future, and figured that one movement onto the x ray table might be superior to a move into the room, an exam, another move into the x ray room, and THEN onto the table. Good call.

Ashley took only one image, before exiting the x ray room, at speed, and summoning me. “Reltney, you need to see this film”.

“Oh? Is it interesting?”

“Well, I believe you will be irate if you delay another minute before you see this film. I think that it will have a serious impact on your medical plan of care!”

Well, alrighty, then!

I had previously casually mentioned the concept of “the ophthalmologic fracture”. That is a break so obvious, so lacking in radiologic ambiguity, that should an ophthalmologist happen by, that physician would stop in his/her tracks, do a double take, and exclaim, “Hey! That looks broken!”

This lady had a ophthalmologic fracture of her hip. I had Ashley copy this image on a CD, and had my clerk summon EMS. I called The Local Trauma Center, and described the events to the attending physician. Once EMS had arrived, I invited them to view the film. They were, as well, impressed. She was backboarded, and transported to the hospital for further evaluation and care.

My physician colleague (remember her? She led me into this tale, after all!) nodded. I concluded, “You, doctor, have just introduced me to the concept of “the pediatric fracture: a break so obvious that a child can identify it”!

Having A Good Partner Is Very Important! · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

Neighbors

One fine day, TDW-Mark II and I were at home, doing some sort of chore or another. Our doorbell rang, and I answered it, to find the neighbor girl, a seven year old classmate of Grand Daughter Number Two, standing there with her three year old younger sister, hands clutched one in the other.

“What can I do for you?” I asked.

“My grandpa fell, and he hurt himself, he’s not moving. Can you help us?”

I hollered, “Honey! Emergency at the neighbors!”, and headed out the door, TDW-Mark II watching me turn the corner into their yard.

The girls led me into their home, where I saw an elderly gentleman (now, THAT would be the pot calling the kettle over-the-hill!) prone on the floor, at the foot of the stairs, with a pool of blood about his head. The girls stood by, anxious appearing, until TDW-Mark II appeared, and led them into the kitchen, and attempted to distract them from the front of the house drama.

I asked the gentleman if he was OK, and his answer did not inspire confidence. Looking over the scene, multiple bad scenarios played out in my imagination, all leading to the conclusion that I did not want to manage this scene alone, and I really, reeally wanted EMS here, pronto.

I dialed up dispatch, and abruptly realized that I did not know the house number.

Fortunately, all those years of Street! Medic! Experience! started to pay off, as I realized that the house would have the number displayed prominently on the front. I walked out front to familiarize myself with that little detail. Oh, yes. AND the name of the street one block East of my residence.

You don’t have to say it, I already know. Bad Stretcher Ape! Situational awareness fail!

So, anyhow, I shared my new-found wisdom with dispatch, and summarized what I knew. She assured me that our little town EMS would be on the way, and then proceeded to start into pre arrival care instructions. I played along, until she paused, and I observed, “So, I’m an ER nurse. he is breathing, he is speaking, sort of, and I am reluctant to move him in any way, because it appears that he fell down the stairs.”

“Oh. Right. Well, if things change, call us right back!”

“Yes, ma’am, will do.”

The medics arrive shortly thereafter, and I reported the little that I knew. The one medic was surprised. “You don’t know any of his history?”

“Nope. We’re the neighbors. The little girl came over and got us, when he fell.”

At about that time, the mother returned home, and TDW-Mark II filled her in on what we knew. We turned the kids over to her, said our goodbyes, and departed.