Should I Stay, Or Should I GO?

Aesop, of The Raconteur Report, recently had an exchange with “B”, the proprietor of the “In The Middle Of The Right” blog

“B” had opined that the advice provided by Sumdood, a “Newspaper Doctor”, quoted in The Daily Mail, was wrong. He then elaborated upon his perspective why, in his area, waiting for their version of EMS was more likely wrong, than not (outside of specific outlier circumstances).

Aesop, who has been an ED RN for many years, presented a contrary appraisal, suggesting an action plan wherein in nearly every single case, calling EMS, and awaiting their arrival was more likely to be a superior plan, than any “snatch ’em up and boogie to the hospital” alternative plan of action. He then enumerates his concerns with that get-up-and-go course of action.

“B” responded, citing his rural setting and the assertion that he, “B”, a civilian, could make the trip in his personal vehicle in an estimated 16 minute trip, compared to his estimate of EMS responding in around 15 minutes, and an estimate time-to-ER adding up to something like 35 minutes. He opines that contrary views seem ”..let us say, city-centric”.

I responded as follows, edited for typos:

“You do make some good points. OTOH, having lived in a rural county (our hospital was the only one in two counties this away, or three counties, thataway), I, as a former medic, can authoritatively state that having your partner drive the ambulance, is orders of magnitude better, from a patient care perspective, than you barreling yonder to your local hospital. There are, of course, exceptions. If you have the expertise to differentiate A from B, or G, then feel free to make that determination. As I told my daughter ref her wheezing child, do you know CPR? Can you perform same in a moving automobile? What’s your notification plan, to warn the hospital that you’re coming in hot with a critical child?

One Weird Trick? Your local medics, at whatever level of licensure, CAN do those things, DO have those capabilities. Yes you likely can phone whoever, WHILE driving essentially “Code 1”, AND wondering how you’re gonna provide care, while simultaneously driving, navigating, communicating, and assessing your patient.

Reflect on the deleterious effects of task stacking, on each one of those mission critical tasks, while under stress that most of us will never have experienced in our lives.

Which one of those tasks are you willing to compromise?

So, yeah, there will be occasions wherein scoop-and-go is reasonable and prudent. In my experience on thousands of EMS runs, and decades as ER RN those are uncommon.

Like, use-a-tourniquet-as-a-civilian uncommon. “

Mr. “B” replied, citing his assessment that his local EMS “was only a transport service”. He asserted that “...even heart attack victims...” received this level of care. Again I responded. 

“TBH, field care of an MI or an ischemic/hemorrhagic stroke is, at best, ongoing assessment, supplemental oxygen. Again, every fraction of a second you are watching traffic is another fraction of a second you are NOT assessing your patient. Conversely, every fraction of a second you glance at your patient, is a fraction of a second for some kid to run into traffic/some granny to bust a red light/other trip stopping additional calamity.

But, you are correct. Aesop’s years in ER, my 2+ GENERATIONS of EMS and ED experience mean nothing, because “city”. Or something.

You indeed DO know your AO better than I do. You, indeed, know the risks you are willing to undertake, better than I do. And, finally (in both senses of that word), you know the risks that you are willing for your loved ones to assume, in this hypothetical situation.

My 2 cents worth of advice, is worth exactly what you paid me for it.

I’ll E-mail you, your change.

I genuinely hope that you never need to field trial your plans. Just as I pray that I never again have to field trial my own plans.”

Another exchange, with my response:

(“B” observes:) “THEN a 16-18 minute drive to the ER (close to 35 minutes) is better than a 16-18 (or even less, yeah, I am that good of a driver with the equipment to match, even under the stress you refer to…I’ve done it once before) minute trip to the ER for a real medical professional to treat is the better option? ”

(Reltney McFee responds) Well a coupla things: in my experience, folks who are in arrest, generally have measurably better outcomes (even if any outcome from an arrest trends toward “dismal”), should they receive, say “16-18 minutes…” of, say, cardiopulmonary resuscitation. Hell, taking your numbers, even 45 minutes of CPR is more likely to produce a “good” outcome (for whatever value of “good” you select) than 16 minutes of anoxic cardiac arrest.

Again, your circus, and you ought to organize your monkees in the manner that you think is best.

Aesop and I are presenting alternate viewpoints, that’s all. In my case, since around 1988, I have been in rural areas as EMT, ER RN, and midlevel provider. Again, in my case, I have carried a pager for my local fire department exactly so that SOMEBODY would show up at someone’s house, who was having the worst day of their lives, in order to attempt to mitigate same.

My opinion derives from 2 generations in the sick people business, in rural areas. No, not Four-Corners-Of Arizona rural, but Upper-Midwest rural.

Should a summary be worthwhile, my baseline is to encourage everybody to become an EMT, at least at the basic level. It’s around a semester at Lansing Community College (to select a venue near to my “neighbor”, Eaton Rapids Joe, aka ERJ), and should you find yourself in hard circumstances, you will NEVER EVER think, “Gosh, I sure wish I had known less about that problem!”

If you have read ERJ’s thought experiments formulated as tales, you have narratives of scenarios wherein basic EMT skills might be life saving. Hell, if you listen to “B” from In The Middle Of The Right, you will hear him describe living in an area where, should YOU! Have basic EMT skills, your family will for a fact be measurably safer than if you do not.

As with anything I tell y’all, (hell, for that matter, with anything I tell my patients!), none of you are in my chain of command. You are, however, in my “chain of nag”, so, consider yourselves nagged to train up. Hard times are looming, and whatever form that they take, you will not ever think “Dammit! I wish I had not known how to respond to that!”, when “that” threatens your child, or spouse, or neighbor.

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High Trust Environments

Not so very long ago, The Darling Wife-Mark II and I went on a cruise. As is common, our cruise stopped at a port, and allowed those interested to disembark, wander around the area, or take excursions (such as snorkeling, visiting attractions, or having a guided tour). We elected to wander about the area adjacent to the pier.

There were interesting things to be seen, including a pretty little waterfall as well as the shops.

The interesting thing, for the purposes of this tale, was documentation of what others have called a “high trust society”.

Others have observed that Western civilization generally functions as a “high Trust Society”. That is to say that folks generally act as if those about them are not out to “get” them, in whatever manner “get” might mean. The classic illustration is the observation that “When I was a kid, we never locked out doors (at night)(when going away)(when out running errands).”

In contrast, “Low Trust Societies” have relatively low levels of interpersonal trust, and lack commonly shared ethical values. (per Wikipedia). Wikipedia continues relating that low trust societies are typically kinship based, which can be reflected in tribal loyalty being paramount (rather than primary loyalty being national in scope). Kinship based society will see folks not among one’s clan, as not to be trusted.

With that said, on to my story. There are many opportunities to take photographs, as you might imagine. Furthermore, at these vantage points, there are throngs of people. What I saw, brings hope about everyday people’s innate goodness and righteousness.

First off, everybody appeared to recognize that, should we all push forward, nobody would get the photo that they wanted. Therefore, we all lined up, a ways back from the vantage point, and took turns walking forward, posing, and getting our pictures.

Secondly, and material to this epiphany, folks simply turned to the visitors in line immediately behind them, spoke for a couple of minutes, and handed them their cell phones, posed, and smiled while these perfect strangers, to whom they had just handed an instrument whose replacement cost could pass $1,000, took their pictures, and, handing the phones back, reciprocated, smiling all the while. So, they got their pictures taken, as well.

Let’s stop and think about that for a second. When I say, “perfect strangers”, I literally mean individuals that the visitors had not ever seen before in their lives, who likely were from another cruise ship altogether, and whose paths would never cross again.

This little social interaction repeated itself over, and over, and over again, as strangers, tanned and pale, old and young, likely well off as well as likely struggling, recreated this little slice of trust and thereby enriched each others’ lives.

Closer to home, we can see this theme again: we trust that the clinician caring for us actually intends to help us, despite likely not being in any way familiar with him/her. We generally assume that the clerk, the waitress, the teller, has our change correct, and give it only a cursory review befor stuffing it in our pockets, wallets or purses.

Trust is the lubrication that facilitates our daily interactions, and eases the coordination of efforts that constitute our very complex economy, to everybody’s benefit.

“The overdose is over there!”

So, TINS (“This Is NO Shit”), TIWFDASL (“There I Was, Fighting Disease And Saving Lives”), one lovely autumn evening in Da City, and my partner, Doug, and I caught a run for an overdose.

Now, at this point in time heroin was very, very “popular”. We had considerable experience with identifying narcotic overdoses, and managing them. (at least, “managing” them as much as we were going to, in a basic life support ambulance, in Da City with all the attendant financial constraints, and in circa 1980) The unbreathing/microscopic pupils/diaphoresis (wringing wet sweat) presentation is difficult to forget, once you have seen it a few…hundred times.

So, we arrived on the scene, and knocked, Our knock was answered by this huge guy, wringing wet (remember: autumn night in the northern tier of states, temp running around 60 degrees in the daytime) and, as I played my Mag Light over his face, I could not see any pupils. I remember thinking, “Jackpot! Only, how come he’s standing yet?”

That was answered when he gestured over his shouolder, as if to direct us, and announced, “The overdose is over there!”

Al-righty, then! We went as directed, promptly digging out the bag-valve-mask resuscitator. THIS fellow was not only wringing wet as well as having microscopic pupils, he was, into the bargain, not breathing at all!

We wrestled him onto our cot, wheeled him out to the ambulance, and coded our way to TSBTCIDAC. (The Second Best Trauma Center In Da City). There, after a brief ceremony featuring the Ghawd Narcan, he arose, figuratively picked up his pallet, and walked (well, ok: more like stumbled) out of the door.

We ate our survival food!

AND LIVED-AND LEARNED- TO TELL ABOUT IT!

Smarter folks than I have deliberated upon food storage, and typically counsel us to lay up that which we eat every day. Under stressful conditions, most folks poorly tolerate additional novelty. I have a tale illustrating the folly of storing that which you have never eaten before.

I have eaten freeze dried foods before, most memorably on a seven day backpacking trip to a National Park. My partners and I deliberated in depth on meal plans, reading widely on the issues of back-country backpacking in the middle of Lake Superior.. Our first night’s meal produced the review that “This mess tastes like salty cardboard!” By the third night, the meal appraisal was that “this mess tastes like salty cardboard. Say, are you going to finish that?” On our final night on the trail (night #6), we agreed that “This mess tastes like salty cardboard. And, they sure are stingy with the portions!” One might imagine that I would take a lesson from this experience. One might be mistaken.

I suppose it was half a dozen years later, circa 1995, that we took one particularly memorable vacation. Money was tight (…in contrast to today, right?), and I had the bright idea that we could save money by a) camping, and b) eating the survival food I had bought as a bachelor, on special, from some mail order survival supply house since closed. My normally clear thinking wife went along with this idea, as I suspect that she herself had had her fill of town living and daily routine.

As per our routine, we packed up, collected kids, and set off for a state forest campground (again, frugal accommodations). We set up the camp and set to fixing dinner. Life Lesson Number One: think through your camping menu. I glibly assumed that I’d open the can of freeze dried beef patties, and we’d have burgers over the campfire. It developed that freeze dried beef requires a bit more prep than “open can: heat meal. Repeat”. For example, if the patties are not re hydrated, they retain the texture of charcoal briquettes. For another, if they are prepared by the freeze dry house with (say) stew in mind, then they will not perform particularly well when you desire them to hold the shape of, for example, a hamburger. Indeed, they will perform just as if they were about to be crumbled into a stew. That likely will prove unsatisfactory to the children eagerly awaiting burgers. I had, foolishly, spoken my mind regarding the possibilities these freeze dried foods had presented. The lesson of managing expectations remained for me to master another day.

In addition, some greater variety in the menu than “burgers” would have been welcome. This would serve both as backup in the event that plan “a” did not meet expectations, and balance the meal. I did neither.

Number One Son, a smart aleck even at that tender age, noted that the patties briquettes were quite flammable. He dubbed them “fire starters”, and proclaimed them more successful at this than as food. This was not especially helpful as Their Mother and I attempted to extemporize a suitable meal within our constraints of time (dark approaching) and money (not much). He, on the other hand, amused himself greatly.

I had thought that I could redeem myself with freeze dried ice cream. Again, think it through. My children typically do not embrace novelty, and freeze dried ice cream was not an exception. The “not ice”, “not cold”, and “not creamy” observations were precursors to Number One Son (again) determining that these were to be known as “pot scrubbers”, due to their resemblance to nylon abrasive pads used for dish washing. Evidently, this resemblance was both in texture as well as taste, although I do not know how he had researched the taste of scrubbing pads. Not a success.

After a night’s sleep, we awakened to face the Breakfast Conundrum. Typically, we would enjoy scrambled eggs, bacon, toast and juice for camping breakfast. Some of these items were snatched from the frig at home. As it developed, I had a can of freeze dried eggs. In addition, I had no clue as to how to transform the yellow dust into breakfast. In short, breakfast fail.

It seems that adding water and scrambling is not a winning strategy breakfast wise. The result, runny yellow syrup, wasn’t especially appetizing in appearance. In addition, it didn’t respond very well to my efforts to scramble it. It never did take on the consistency of eggs, it did not fry up at all well, and (this may be a surprise to you who haven’t been following closely) the children and Long Suffering Spousal Unit (LSSU) were not impressed the least bit favorably. We went with the jelly sandwich alternative breakfast strategy, and moved along with our day (“…there is nothing to see here, folks! Just move along…”).

That evening, the LSSU bravely leaped again into the campaign of canned beef. This time, having learned from my Dinner Fail the previous evening, she created some sort of stew, blending (re-hydrated) freeze dried beef from the can with canned vegetables and seasonings. She thereby created a repast even the eldest child pronounced satisfying and wholesome. A good time was had by all, dishes were washed, and the evening festivities commenced.

In the morning, we awakened. The LSSU evidently was inspired overnight, because she set to breakfast with enthusiasm, wisely chasing me away from the food prep area. Recreating her victory of the previous evening (this time with the freeze dried eggs, christened “Yellow Rain” after our last poisonous experiment), the LSSU adapted the preparation such that food, recognizably scrambled eggs, appeared as if by magic upon our plates along with the toast, sausage and juice denied us the previous day. Another Meal Win for the LSSU.

The years passed, things changed, stuff happened. Eventually, my marriage failed and I found my (teenaged) sons left home alone while I worked two jobs, and my (soon to be ex) wife was out Ghawd Knows Where, without establishing a meal plan for my children. I worked (more!) overtime and purchased a freezer and lots of food to stock it. I cooked in liter lots on my day off, and repacked it in “unit dose” containers, which I then froze. Voila! When the boys called me at work seeking food, I could tell them to snatch a meal from the freezer, microwave it, and dig in. To address the potential for power failure and loss of freeze, I began to purchase extra cans of the food I was using regularly. I expanded my stock to canned meats, so as to have something to make (say) spaghetti with in the event of power failure.

This year, I realized that I had not established a plan to rotate my canned foods. Indeed, I had no idea which cans would out-date at which time. I remedied this problem, and arranged my cans on a modified “first in-first out” system, with the new cans going in the back. I wrote the out-dates on the top of the cans in bold marker (so as to approach idiot resistance). In the process of this endeavor, I noted a couple of cans that were approaching out-date-hood. The years had taught me lessons that I heeded.

First, the canned chicken and dumplings that had looked so appealing in the picture on the can, found new life as a casserole. My clever (if naive and innocent) girlfriend (she is, after all, spending time with ME) whipped up a casserole of the canned dumplings with some canned cream soup, added a little flour and some seasonings from the spice cabinet, and baked it up for about 40 minutes. We enjoyed that for a couple of meals.

That success behind us, we turned out attention to the soon-to-out-date sloppy joe mix. Perhaps it was cheating of a sort, but I thawed some of my (copious) frozen ground beef from the previously mentioned freezer, and whipped up some supper for my two youngest sons. Toasting some (previously) frozen buns, a meal fit for an adolescent resulted for however briefly it lasted in the face of two hungry teenaged boys!

I then turned my attention to the canned chicken nearing its own out-date with destiny. One of our household favorite recipes is Chicken tetrazzini. This is a chicken dish, in a cream sauce served on noodles. The only non-storage food I used was the milk (not dried), margarine (although I keep a considerable quantity in my freezer), and wine. Otherwise, storage food all down the line. It also was a successful effort. I awakened each morning of my boys’ visit to find empty tetrazzini containers assembled in the sink. The one container that I managed to hide from my sons served as my dinner at work tonight.

To summarize the lessons learned: Store what you eat every day. Rotate your stores (ya know, like by eating it). Think through your menu. Recognize that (you or) your children may not embrace novelty. Freeze dried food has a learning curve: travel that curve at your leisure, not under stressful circumstances. Tabasco, as well as other spices, are your friend. If you are going to experiment with new stuff, perform those experiments during good times, not when the county loses power (or during whatever crisis convinces you to eat your survival food).

SOMETIMES, I AM ON THE RECEIVING END OF BLESSINGS

So, TINS, TIWFDASL…..Ok, well, not so much. I had taken a break from FDASL (Fighting Disease And Saving Lives), that which the majority of humanity would call “a vacation”, and was on a cruise. In a breach of my usual practice of formulating pseudonyms to protect the privacy of otherwise uninvolved parties, I will call out this particular cruise company, Carnival Cruises, for EXEMPLARY! Customer service.

TDD (The Darling Daughter, Brenda), of whom I have spoken, had four children, we might denominate them as Ariel, Beatrice, Charlie, and Danielle. She had married a man of whom I vigorously approved, and they (the parents) had forged a partnership of the first rank.

So, Beatrice had been ill last year with a periorbital cellulitis (an infection of the tissues surrounding one’s eye). She had recovered, after a bout of IV antibiotics (which intervention she had NOT approved of) and an inpatient hospital stay.

Something on the order of a month ago (as I write this), it appeared that she had developed a recurrence, and so her mother took her off to ED. These folks treated her with IV antibiotics, but, when things did not promptly resolve, further investigation followed. It appeared that she had an inflammation of her one optic nerve, and this being very (very) uncommon, well, eventually she was transferred from The Mothership Hospital, to The House Of Ghawd. THESE worthies treated her for a variant migraine, (since, she had been on high dose steroids for several days), and sent her home.

About the time TDW-Mark II and I were depart on our vacation, she (Beatrice) returned to ED, since her headaches had not improved. My daughter reassured us, stating that there was nothing I/we could add to things, and it seemed foolish to her for us to forfeit the payments made for this vacation, and that she (Brenda) had things as under control as they were going to get, in the near future.

Since my daughter has a spine of ordnance steel (just as does her mother, The Plaintiff), is smart and has a finely calibrated “This sounds like bullshit” detector, we reluctantly set out. TDW had internet on her phone in this trip, so that updates, if required, could be communicated.

This is where the “Carnival has my business until the heat death of the Universe” part comes in. TDW received a message, relating that another ED visit had resulted in (another) spinal tap, and that this had revealed increased CSF (cerebrospinal fluid) pressure. They (the ED doc) had drained a small amount of CSF, which dropped the pressure, and improved Beatrice’s headache. That was unexpected.

So, the question becomes (a) why does Beatrice have this increase in CSF pressure? (b) Why does she have a headache mitigated by reducing this pressure? (c ) what treatment implications arise from the preceding two answers? And (d) who are the “pros from Dover” to ascertain the above answers?

So, here I am, afloat in the Caribbean, my vehicle no less than 1,000 miles from my grandchild, and no phone service. How might I back up my daughter?

I went to the Guest Services on this ship, and asked if there was some way I could pass along a 24 hour shoreline ships operations number, that my daughter could call in the event that she needed to contact me Right Freaking Now!?

Yep.

The Guest Services rep handed me a phone, told me the “make a phone call to CONUS” code, and invited me to phone my daughter. He stated, “The phone number that will show up on her caller ID, will get her straight to this desk, which is manned 24/7. If she calls, we can find you and get done whatever is needed.” He continued, “There will be a charge, but we will reverse it. Simply tell us once it shows up, we will make it disappear.” He offered us internet, under the same terms, so that we could e-mail back and forth as needed. I thanked him, and told him that presently, we had communications in other than urgent settings, addressed adequately.

Chapter Two, in why “Carnival Cruises Will Have My Business Until The Heat Death Of The Universe”: So, two days later, Beatrice is going home, Brenda has ‘lebenty thousand referrals and followup appointments, and it appears, presently, that things are improving. This Is No Shit, There I Was, lolling around our cabin and contemplating a nap (such is MY exciting life!), when the stateroom phone rang. I picked up, and there was Guest Services on the line, asking how we were doing, how was my grand daughter, did I require any other assistance.

Very, very rarely am I on the receiving end of this sort of care. I am a cynical bastard, and generally am calm in any sort of dilemma. This, well, I teared up and developed a catch in my voice.

And, present reports (as of this writing) Beatrice is improved (sort of), and we have hopes of unraveling this conundrum.

POSTSCRIPT: I just now went downstairs to talk to the supervisor of Guest Services, to give the personnel there an “Attaboy”. The line supervisor requested I (hand!) write a note summarizing my observations. I have three thoughts in this regard: firstly, asking ME to hand write anything is soon to be an exercise in cryptology, requiring skills similar to those employed in deciphering the Rosetta Stone. Secondly, regarding the concept of “summary”: y’all have read my blog: does anybody really think that the phrase “summarize”, and my long winded bloviations, belong on the same page at all? Thirdly, it occurred to me that I have cried, perhaps, 4 times in the past 20 years. This being number 4.

And, Now, The Rest Of Teh Story!

Momma Kitty went on to have another litter, this one beneath our porch. Again, we provided dry food and water. Again, we saw her parading her kittens onto the porch, eventually, and observed them partaking of the dry food.

TDW would from time to time attempt to approach Momma Kitty, and eventually was able to lay on our porch, and have Momma Kitty approach her, and allow TDW to pet her briefly. So, to our surprise, one day when TDW opened the door, and invited Momma Kitty to enter, she did.

Much like the dog who finally caught the car, we were not altogether clear on what to do next. We settled on encouraging Momma Kitty to take her place in the cat crate (and, surprisingly she did take her place therein). TDW then scouted out the location of the kittens, and retrieved them. One has white and black markings, resembling a miniature, clawed, cow. She was named “Bossie” after TDW’s childhood pet cow. The other kitten, tranquilly accepting his transition to house cat, was named “Oliver” (again, olive branch=peaceful).

So, that is why we are over run with cats, and how they were named. Everybody gets along, they take turns grooming each other, and TDW has several Cute Cat Stories for me, each evening when I return home from work.

And Now For Something Completely Different

Well, THOSE were some dark stories! And, now for something completely different.

TDW got a kitten from a friend, whom we named Max.

It developed that Max would laze away the afternoon, gazing out the window. After a while, he started to do this sort of “click-click-click” noise, and move from one window to the next, as if following something. Investigation revealed that this something was another cat, who eventually demonstrated that she had had kittens in our window wells. TDW eventually noted that the kittens were eating the dry cat food that she had been putting our for the new cat, who we dubbed Momma Kitty, and we soon retrieved the kittens: Momma Kitty escaped our clutches.

When we got the kittens inside, we locked them in the second bathroom, providing a crate where they could hide, water and food, and litter boxes. We would enter a couple of times a day to clean up the mess, refresh the water, refresh the food, and attempt to play with them, trying to socialize them into their new lives as house cats.

Took some doing. The one kitten would sit in a corner and snarl at us with all the gravitas a 6 ounce kitten could muster. She was named Henrietta, after the chickenhawk character in the Foghorn Leghorn cartoons.

Another kitten would gnaw at our fingers, then rush to lick and pat the same finger, reminiscent of the big blue “Sullie” character in the “Monsters Inc.” cartoon. A third kitten would lay, tranquilly, in our arms, allowing us to pet her and provide neck scritches, purring all the while. She was named Olivia (as in olive branch, the historic symbol of peace).

The final sister was named Dynamite, since she would nearly explode into a fury of claws and fangs upon any approach. She has since calmed down, although she is not altogether sure about the whole “hold still while Ipet you” thing, and would rather get going after a brief interval of tolerating our petting.

Dressing For Success

One time, my family gathered at a restaurant in Greektown, celebrating one occasion or another. This was in Downtown Da City, and, at this time, there had developed the phenomenon of flash mobs, wherein high spirited youths would apparently spontaneously congregate at one location or another, and in the course of the festivities, civilians, otherwise uninvolved with the group, would be assaulted and robbed.

TDW-Mark II and I spoke of such an event, and the potential for same to develop when our children, and grandchildren were at hand, and decided that this Would Be A Very Bad Thing. We selected our wardrobes accordingly.

It turns out that my son in law, my daughter, and my brother, all feel similarly about this sort of thing, for, when I counseled my sister in law, a very nice (and very naive) soul that, “If a group of folks all enter this restaurant all at once, I will tell you to take the children into the kitchen of the restaurant, and keep them there. Under no circumstances are you, or any of the children, to re enter the dining room, unless one of us physically arrives to escort you out!”

She protested, “But, we aren’t allowed into the kitchen!”

I showed her my wolf grin. “If I tell you to do so, I guarantee that nobody will say a word about you and the children being in the kitchen. The noise will be way, way too loud for you to hear them, if they were to do so!”

She looked puzzled. My son in law explained. “Mary, if Brenda grabs the kids and beelines to the kitchen, two things: do not be left behind, and do NOT get between her and the kitchen door!”

“Why is that?”

“If you are between Brenda and the kitchen door, and one of the ‘celebrants’ starts into the kitchen, he will be shot. Do not be in the way.”

Mary turned back to me. “Why would they try to go into the kitchen?”

I wolf grinned her way, again. “Because I had failed to kill them.”

My son in law chimed in, “I will have missed them, too!”

TDW-Mark II joined in. “Me, most likely I will have run out of ammunition. I do not plan to miss!”

My brother observed, “And, I will police up the stragglers, if any!”

Looking aghast, Mary declaimed, “You cannot believe that anybody would try to hurt somebody at random! I just do not believe such a thing could happen!”

TDW responded, “You just keep on believing that. In the meantime, if The Stretcher Ape tells you to get into the kitchen with the kids, do so right fucking now, pretty please?”

Abandonment, and Trust Issues…

A while ago I had an MA assigned to me. She was (is) capable, focused, intelligent, and engaged; she maintained awareness of what else was occurring in the department, and reacted promptly and appropriately. (She was the protagonist of the tale of the early morning floppy child)

As things developed, she had an opportunity to transition to a day shift, Monday to Friday, 9 am to 5 pm, work-no-weekends-or-holidays job (in contrast to our present work-til-9-pm, every other weekend, every other holiday scenario). And! Get a raise in pay!

Naw, I cannot see why she would entertain such an opportunity for a single second, either.

So, of course, I teased her. “Oh, I see how you are! You would rather spend time with your husband, with your children! Oh, yes, I suppose all that is just fine for you, but what about ME?”

As you might expect, she started her new job, and, occasionally, took some overtime, working with me from time to time. Of course, each time I would tease her. “Oh, I see! Now that you are dead to me, NOW you come back, just as I was resolving my grief at your cruel abandonment of me!”

My partner joined in, observing, “You know, if you came back to work in this department again, you could never break up with him ever again! He has been an embittered husk of a man, since you left!”

(This is the same partner who observed, when I once wore a fleece prominently displaying the fact that it was an item from the National Rifle Association, by means of the 2 inch tall initials “NRA” over the left breast, let me know, “You know, they spelled your name wrong on your coat!”)(My name is “Tom”)

We reached a lull one overtime night, and I renewed my teasing. “You know, I taught you everything I know, while I was standing on one foot, and you abandon me! Oh, yes, you have a ‘HUSBAND’, and you have your ‘CHILDREN’, you have dreams, and plans for your life, but, what about MEE?!?”

She chuckled.

“Warn-A-Brutha”, in action.

So, TINS©, TIWFDASL©, and my MA, let us call her Maryann, exited the room that she had entered, shortly before, to assess and obtain vitals on a child.

“Reltney, this child here is working kind of hard to breathe, and he is coughing a lot: it seems to interfere with his taking a breath!”

I entered the room, and noted a child coughing approx every 10 seconds (and I mean a full throated cough, not some modest little “harrumph!” kind of thing), and, as I observed his breathing, noted a rate of around 60 breaths a minute.

Not so good.

We administered a breathing treatment, and he had kind of, sort of, maybe improved just a little bit.

I finished my assessment, and went to chart, intending to return and re assess him once my (generally 4-7 minute) charting was completed.

I did so, and noted that his breathing had dis-improved (is that really a word?). I invited the physician with whom I was working to lay eyes upon him, briefing her upon my observations and actions thus far.

Once she had assessed him, she was not favorably impressed. She, also, thought he was working kind of hard to breath. She, also, wondered if this was fixing to run him out beyond the end of his reserves, whereupon he would crash, likely biggly, and become a no shit emergency. She wondered if sending him to emergency, prior to that happening, might not be more wise than waiting until he did, indeed, crash.

I agreed.

I wrapped up my charting, once the child was safely on the way, and hunted up Maryann. I congratulated her. “You did good. Your prompt assessment that this child was not breathing right, set in motion events necessary to get him to the appropriate level of care, in a timely manner. Well done!”