“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.

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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.

“State Employment Agency”. Yeah: About That….

Years ago, I was unemployed. Since I was unemployed, I registered for (surprisingly enough) unemployment insurance payments. THAT necessitated that I register with the state, for assistance obtaining employment.

THAT was a treat! As it developed the folks at the “find this guy a job” office, did not appear to comprehend that I was an RN. Ya know, Registered Nurse. College and everything like that. They persisted in pointing out that they had PLENTY of Nurse’s Aid jobs. “Uh, yeah, about that. I am licensed here in the Great State of The Un Named Fly Over State, as a Registered Nurse. Nurse aids report to the LPNs that work with, and supervise, them. My job is, among other things, when I am working, is to supervise the LPNs. Howzabout you find me a job like THAT, hmm?”.

You might imagine that I did not rely upon them to find me my next job.

Trying to facilitate my return to gainful employment, I observed that I also held licensure as a Physician Assistant. “Oh, yes! Isn’t that like a medical assistant? We have jobs for those!”

Sigh. Another explanation of the collegiate effort required in order to qualify to sit for the board examination. As well as the different responsibilities appertaining to medical assistants, versus physician assistants.

I found employment as a midlevel, through a locums agency. Fat lot of help the unemployment folks were.

Never Fuck Around With A Brooklyn Boy

My Dad was from Brooklyn, He told me, when I was a lad, “Never fuck around with a Brooklyn Boy!”

That is sound advice.

I used to work with a guy who, one time, when his wife was ill, and he was the only income in their two income household, fell behind on some bills. He is an ex street medic, himself, and, well, not in the “shit” business: he did not talk shit, he would not take shit.

So TINS, this one tine he received a call from one creditor, who, once my friend had explained that he, the creditor, would not be receiving money in the near future, and would indeed be paid, once the finances in the household were approaching stabilty, responded (the creditor), “Oh, so you do not think that I can find you?”

My friend paused, and counseled this asshole. “Well, no, I do not think about that issue, one way or the other. But, now that you have brought it up, it is my opinion that, should your luck be exceedingly poor, you just might, indeed, find me. Have a nice day!”

My friend never saw that jackwagon, ever.

Years and years ago, I fell behind on my mortgage. (something about unemployment…) I was in touch with my lender, thinking that absence of surprise would be to my advantage.

Wrong.

I asked about any sort of program for an unemployed soul, whereby I could make partial payments, and have the arrearage added to later payments.

Nope.

Could I miss a couple of payments, and have them added to the tail end of my mortgage? I would continue to pay interest.

Nope.

Well, after buying groceries, and sucklike, gotta tell you that there simply was NOT the money to pay the house payment.

So, one day, a month or two into this niceness, I received a phone call from the mortgage company. The mortgage company asshole on the other end of the line advised me, “We are going to come out to inspect the house.”

“Why are you telling me this? You can drive by any time that you like.”

“Uh, no. We will come in and inspect the house.”

(my response)”Uh, no, you are not. You might make an appointment to come out, when I am home, and it is possible that I might escort one of your personnel to view selected portions of my house, but you are not simply going to ‘come in and inspect the house’. Not going to happen.”

(Mortgage Asshole) “You think you can stop us?”

(me) “Interesting that you should ask that question. Yeah, I know that I can stop you. If you do, indeed, plan to simply waltz in here without my permission, send orphaned bachelors, because whoever you send to walk on in, will be carried out.”

“Is that a threat?”

(me) “Nope, that is a prediction. Let’s consider this: you have just now threatened to have stranger or strangers break into my occupied home, and I have told you that that sort of activity will end poorly, for everyone. You threatened me with a B and E, I told you what my response will be. Your move.”

Oddly, nobody came over to “inspect” the house. What a surprise.

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?”

Snippets VI

The following is a collection of tangents. Please, be tolerant.

I was talking with the midlevel student taking a rotation with me, and, it being her first rotation (…unfortunate soul, to be stuck with The Stretcher Ape as your first clinical!), and was waxing poetic about gestalt, quickie patient assessment, and binary EMS assessment.

I observed that a writer for JEMS magazine, decades ago, observed that there were stages to EMS patient assessment: initially, is the named patient “Big Sick”, or “Little Sick”?

If “Big Sick, particularly in the setting of basic life support services, probably you desired to load that patient, and go.

If “Little Sick”, you likely had time to assess the patient in greater detail, and either rethink your initial assessment that this soul was “Little Sick”, or reinforce that assessment, and then transport in a leisurely and deliberate manner as appropriate.

The application to our walk in clinic, is that should your, or your MA’s snap assessment be along the lines of “That dude don’t look right!” (immortalized as “DDLR”), perhaps you ought to look into expediting that soul’s transport to ED, perhaps via EMS. I told her that “DDLR” is probably The Primary Vital Sign.

Another Story

One night, we had cleaned out the ED, and done all our housework. This was long, long ago, and far, far away, back in my halcyon days in Da City. I was a staff nurse in our ED, and we had “story hour”, many a night when there were no patients, and nothing to clean or restock.

Somehow, the conversation turned to threatening patients. One nurse volunteered, “You know, I have something in my purse that might be a conversation starter with such a soul, with the conversation trending towards, “How do I get my ass out of here, before this crazy nurse kills my ass?”

Another offered, “Hmm. Such a sad sack might, or might not, find himself in a cross fire, not that I would know anything about that sort of thing, myself!”

Another thought out loud, “I wonder why it is that I always place my bookbag in the med room? Could it be that there might be something there that would trigger a reconsideration of life choices, in some bad actor?”

One of my buddies, still on the road, laughed when I told him that story. “Really? Don’t you realize we all on the street know your ED is the most heavily armed ED in Da City?”

A Thought Experiment

If you were married to Nancy Pelosi, and was faced with the choice of having sex with her, or finding a homeless psychotic gay guy, what would You do?

Recounted conversation:

Patient: “I don’t believe in covid!”

Me, responding to my partner who had just quoted said patient (faux-Russian accent) “Da, tovarisch, but, covid believe in YOU! (stifle your cough, and wear your damned mask!)

Bob Marley Tribute Band

Cletus and Jane-Bob came in the other day, accompanied by their spawn. The nominal adults smelled as if they had just sat in with a Bob Marley Tribute band. The children were clean and inquisitive, and engaged readily with me as I inquired about their symptoms.

The childrens’ ear infections were readily identified, instructions provided, and they were off and on their merry way.

With these poor life choices as their life exemplars, I wonder how long the children will remain clean, or inquisitive, or engaged with the world?

Another opportunity to bask in the wonderfulness of legalized, recreational, marijuana.

Once Upon A Time….

So, TINS©, TIWFDASL©…Let me take a tangent, here, for a brief moment. (Yep. “Ooh! Shiny!”) The Darling Wife-Mark II and I were visiting my son and his wife, My Darling Daughter In Law, let us call her Esmeralda, and he (the son) had asked me how work was going. I (of course) replied, “Thing of beauty! Why, I spend my days Fighting Disease, Saving Lives, and Beating Back The Scourge Of Zithropenia!”

Esmeralda did not appear to comprehend the level of sarcasm that is my baseline, because she responded, “So, writing scripts for Zithromax is pretty much your entire workday?”

Sigh.

So, back to my story: there was this soul, once upon a time, in a clinic far, far away, who was on Medicaid (since my agency’s mission statement is pretty much, provide healthcare access to those who otherwise are underserved), and was diabetic. But! Wait!

This soul also had a burn on their extremity, attributed to spilling some boiling water thereon. This had occurred a day or two previously, and looked rather gnarley. (No, that is not, strictly speaking, a medical term.)

For those of us who are not In The Sick People Business, extremity burns generally are considered a reasonable referral to a burn center, because if contractions or scar tissue limit the utility of that extremity, life changing disability can result.

The local wound center could not accept him for the serial assessments, dressing changes, and suchlike that treating his wound would require. (don’t recall the rationale for this clinical decision).

I called the burn center at Tremendous State Megaversity, seeking care for this soul. They responded that they did not participate with his flavor of Medicaid. Therefore, I was told, my patient (remember: on Medicaid, which generally maps pretty accurately onto relatively impoverished) would have to pay kilobucks, out of pocket, for their care.

Of course.

So, please remember that the Venn Diagram of “folks on Medicaid” and “impoverished folks” results in a bulls eye of sorts, wherein the “impoverished” circle, encompasses the “Medicaid” circle.

Therefore, my patient did NOT have, nor have access to, kilobucks. So, did I send him to the local wound clinic, which for whatever reason had already told me that they could not accommodate him?

Nope.

Did I send him to Megaversity Burn Center, who had subject matter expertise in, oh, gosh, er, umm, BURNS?

Nope.

Of course, he returned to our walk in clinic, The World Renowned Center Of Excellence, In All Matters That The Subject Matter Actual Experts For Whatever Reason Cannot Handle, for his wound care and his serial assessments.

Because, I’m not bitter. Nor burned out. Nor sarcastic.

Not a bit.

Lessons Learned From Other’s Experiences

Another blogger posted a recounting of his experience, recently, at a public range (I believe he is in Canada). He cited Elisjsha Dicken, the armed civilian who stopped the Greenwood Indiana mall shooter, hereafter referred to as Some Asshole In Greenwood, within 2 minutes of the crime beginning, and, according to Dicken’s attorney, from a distance of 40 yards.

Speaking only for myself, and throwing no shade one way or the other, I attempted to recreate Mr. Dicken’s accomplishment, with my EDC sidearm, and no time/life threat pressure. I failed, miserably. My personal take home, is “Moar! Range! Time!” If you get advice to practice, practice, and practice some more, that is sound advice, and we all should do so.

Other reports that I recall seeing, assert that Dicken’s girlfriend, a student nurse, responded to care for casualties, once the shooting had stopped.

THAT reminds me of everyday carry. As is often asserted on the blog, Gun Free Zone, if you carry a sidearm in order to put holes in bad people, should the need to stop such arise, then you ought to anticipate that these selfsame bad people may put holes in you, yours, or other innocents. Therefore you (and I) ought to be ready to address that problem.

There are many ways to address that need. I carry a CAT tourniquet in an ankle holster, as well as a SWAT-T elastic tourniquet in my pocket, all the time. There are two exceptions: when I carry TWO CAT tourniquets, or when I am swimming.

While it is worthwhile to carry a medic bag, suitable to your own training, getting that training is JOB NUMBER ONE! I betcha that I can finagle trauma dressings from at hand materials, faster than I can learn, in the first place, what sort of thing is immediately needful to care for a trauma patient.

Of course, I have something approaching 50 years (not a typo) of experience in this business, so, there is that going for me, I suppose.

If you wonder what you ought to pack for bad times, look over my blog post, here. Or, you could see what Aesop has to say. He is controversial, but, regarding medical matters that I have the experience to have an opinion about, he is spot on. No crap, straight up. He recently posted a set of links to his “greatest hits”. I direct you to peruse same: there’s GOLD in them thar hills!

So, I will attempt to let my preachin’ end, here, for a while. Thank you for riding along.

Proud Poppa Moment

Thank you, ERJ, for the inspiration for another blog post. One of your commenters to your post about the fiscal consequences of “kicking the (payroll and benefits) can down the road”, and the implications of same for actually MAINTAINING a given level of government/police/fire/EMS services, presented the following:

“I suspect another reason for services eroding is lack of employees.
I know that many police departments have openings for lack of qualified candidates, as do many county agencies. Whether their qualification requirements are reasonable is another question. I know that some places intentionally understaff so that existing staff can easily justify overtime, occasionally to a ridiculous degree.”

This ties in, very neatly, to a conversation I had with The Darling Daughter the other weekend. She was talking to somebody with whom she works, this somebody being involved in some manner with providing EMS services. This Somebody (hereinafter referred to as “TS”) was sharing with her the difficulty of obtaining personnel to staff ambulances, in the numbers required to provide ambulances, 24/7/365/surge capacity in the event if BFD emergency.

The Darling Daughter (to be referenced as “TDD”) pointed out that she spent her childhood in the household of a medic, and noted to her correspondent that “You DO know, that McDonalds is paying more than you are, right?”

That elicited an observation about insurance company reimbursement for ambulance transport (TL:DR: meager), and the difficulties that provides in paying personnel more.

TDD noted that for mothers who might contemplate a career Fighting Disease, And Saving Lives, child care, and in particular child care after 5 pm, is AN ISSUE.

Her correspondent, TS, was reported to have metaphorically waved his hands, responding “I KNEW you were going to bring up child care!”

I agreed with TDD, noting that should a crew pick up a transfer to, say Ann Arbor at something like 3 pm, (the drive alone is on the order of 90 minutes, one way, from, oh, let’s pick a town at random: Eaton Rapids, and Sparrow Eaton Hospital. Not mentioned is unload time, as well as the drive back, restocking the rig, and tootling home.), then Our Heroine is looking at being, maybe, in the parking lot of University of Michigan Medical Center, heading home if she is fortunate, just about the time that her day care provider is beginning to blow up her phone with warnings of five-dollar-a-MINUTE late charges for EACH of her children, now that she is late.

At a pay that compares, sort of, with minimum wage.

So, hell YEAH, child care is an issue.

She (TDD) then noted to TS, that there does not appear to be any sort of career ladder for EMS. So far as she knew, it went something like

Basic EMT–>Paramedic–>Do Something Else.

She relates that this sort of issue might adversely affect retention. Which will, as a readily foreseeable follow on effect, “thin the herd” of individuals entering that pipeline. Leading to just this conversation.

Another Proud Poppa Moment!

Gotta Scratch That Itch!

A week or two ago, my MA returned from her lunch, and showed me her parking lot find: a couple of dirty syringes, with bent needles. “I found them on the ground behind my tire”, she related.

My thoughts were, ‘what sort of fool, even among the universe of fools who inject drugs, leaves a freaking needle on the ground in a parking lot, where children come and go on their way to their own physician appointments?’

@

So, just the other day, TDW-Mark II needed to recharge her cash card. Off to her bank we went. The gentleman attending to her transaction appeared to be somewhere in his twenties, whereas I, myself, am approaching 70 (and so closely approaching 70, that 70 has started to tap his brakes, and slow down, in hopes that I would not admire his bumper so closely anymore!).

TDW was making conversation with this gentleman, and he was owning that this sort of transaction was unfamiliar to him. TDW then up and chirps, “It must be hard on poor elderly people, who don’t have computers, or know how to use them! That whole smart phone, and computer banking thing can be rough on the elderly!”

I looked at her for a moment, and spoke up. “Am I not standing right here? You CAN see me, right? Really? I. Am. Right. Here!”