Fun And Games · Life in Da City!

RANDOM THOUGHTS, INSTALLMENT NUMBER VIII

@The other day, my MA gave me the typical “thumbnail” report of my next patient. “(sick person of some sort”), (vitals), ….And, you know, he’s older.”

This particular soul was born TEN YEARS after I was!

@ROBOCALLS: I receive telephone calls, from time to time, from unknown numbers. Almost every one is from some computer dialed bullshit. My practice is to say “Hello”, and then begin to count ten seconds. If there is no human being on the line by then, according to my (it’s a robo call: I’m not particularly patient) timer, I hang up.

If there is some human on the line by then, they have, maybe, ten or fifteen seconds to convince me that I have any interest whatsoever in speaking to them.

And, if it’s one of those “we need to speak to you about your computer repair the other day” idiots, it depends: if I’m feeling froggy, I may stay on the line simply to trifle with them and waste their time. If I’m feeling curmudgeonly (which, to be honest, is most of the time), I hang up. In mid word.

OVERHEARD THE OTHER DAY:

Joe-Bob arrives, asking if he could get the work note written for Cletus. The clerk inquired after Cletus’ last name. Joe-Bob did not know Cletus’ last name.

She asked if Joe-Bob knew Cletus’ date of birth? “Nope.”

Cletus’ phone number?

“Nope.”

Cletus’ SSN?

(surprisingly/sarc) “Nope!”

Did Joe-Bob know the date of the visit which elicited Cletus’ work note?

(say it with me, now…) “Nope.”

She wrote down *OUR* phone number, and suggested that, once Joe-Bob rejoined Cletus, perhaps he, Joe-Bob, could invite him, Cletus, to telephone us, and at that point arrangements could be made.

@ Life Lesson: A lesson learned from hard experience: No matter how frequently you look at your watch, in the middle of an awful shift, it is still 3 o’clock!

Life in Da City!

Questions Above My Pay Grade

A long, long time ago, back in Da City, I had left EMS, and was employed as a nursing house supervisor. In the course of my rounds, I stopped by ER. The staff chatted with me, revealed that things appeared to be under control, and they needed for nothing at that time.

One of the staff nurses drew me aside, and murmured, “Check out the ER doc that they sent us!”

I asked, of course, “Why?”, and was told, “Never mind! Once you chat with him, you will know!”

I approached him, introducing myself, and asked how his night was going. I was struck by the fact that he appeared to have several freckles about his face, each with a glint as of metal. Each, in fact, about the size of a pin head. I figured that was odd, concluded my conversation, and moved on.

I subsequently encountered one of the ER nurses in the cafeteria. “What did you make of Dr. Pins?”

“Couldn’t tell you. Never seen anything like it, before!”

So, a little later that night, I cruised through ER, again. (part of my “management by wandering around” strategy). The doc asked me if he could speak to me, in private. That was odd, but, sure, whatev’s.

So, back in the physician’s office, he began to describe a patient. I mean, as in how a resident (or a midlevel) would staff a patient with an attending. He wound up with his query: what did *I* (remember: the NURSING supervisor, with no provider chops whatsoever at this time) think that the patient ought to have done?

I tried not to stutter: I really, really did. I suspect that I failed, but I did manage to observe that other physicians had ordered this, or that test, and not uncommonly had discharged the patient with a prescription for this, that, or the other thing.

The following afternoon, my boss, the afternoon Nursing Director, and I had a chat. A lengthy chat. About Dr. Pins.

Life in Da City! · Pains in my Fifth Point of Contact

The Sunshine Rule, Revisited

As you may recall, my go-to principle is that everybody brings sunshine into my life. Sometimes, that is when a soul arrives……

So, TINS©, TIWFDASL© one sunny Saturday morning, and my very first child of Ghawd rolled his eyes when I asked, “do you have any allergies to medication?”, which is part of my Mark I-Mod Ø interview question set.

My inattentive friend responded, “Of course I have allergies! My nose has been stuffy and runny for a week!”

I tried it, once more. “Do you have any MEDICATION allergies?”

“I dunno”

(sigh) “Are you taking any prescription medication?”

“Yeah….”

“Can you tell me what medication you are taking?”

“Nope. Cannot remember.” (eye roll)

I concluded that further interview would waste my time and annoy this gentleman, further. And so, a surly exam followed.

COMMENTARY: Simply so you know, IDGAF what you are allergic to, nor do I care what medication you are/are not taking, despite your physician’s goading, instruction, entreaties, or hectoring.

I *DO* care, very much, that I do *NOT* prescribe prescribe a medication that will cause your immune system to turn you into a fireball. Similarly, I really, really do *NOT* want to prescribe a medication that, in concert with whatever the (expletive) you are, indeed, taking, will perhaps form a binary explosive in your bloodstream. Because you could not/would not tell me whatever else you are, indeed, taking.

So, to me, this sort of thing is kind of important. Please, try to keep up.

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.

Life in Da City! · Pains in my Fifth Point of Contact

Random Thoughts, Part VII

EROTIC STORY SITES ON THE WEB, ARE *NOT* GOOD SOURCES FOR ADVICE ON HOW TO LIVE YOUR LIFE.

A young lady came in to the clinic, and related that her visit today was occasioned by the fact that “My girlfriend’s boyfriend told her that he had (GC/chlamydia/herpes/syphilis/aids/hepatitis/the fuglies), and I slept with him, too.”

I was unclear on the timeline. “*After* you knew?”

She was not. “Yep!”

Sigh. Another round of “test for everything”, and pray that it all comes back negative.

LET’S FOCUS ON THE IMMEDIATE PROBLEM, SHALL WE?

So, TINS© (This Is No Shit), TIWFDASL© (There I Was, Fighting Disease And Saving Lives), and Jim Bob wandered in. In the course of his registration, as well as his rooming, he revealed difficulties voiding. Indeed, my MA related that, once she had requested that he provide a sample of urine so that I might use it to determine what sort of “urine problem” he had, he responded that “I can’t pee”.

In my clinic, there is no catheterization capability. In my not inconsiderable emergency experience, both as RN as well as provider, such a soul requires a catheter, both in order to obtain the urine sample that will guide further care, as well as to decompress the ailing soul’s urinary bladder, as such a condition can become very uncomfortable. Which ignores potential damage to one’s kidneys.

I told my MA that Mr. Cannotpee would have to go to emergency, where, indeed, they had both the ability to place a catheter, as well as labs and imaging to determine what might have caused this problem.

She returned moments later, reporting that he had considered the prospect of a urinary catheter, and thought that he might be maybe able to produce a little bit of urine, perhaps.

His sample was inconsistent with inability to urinate. My appraisal was that IDGAF about this guy’s pharmacologic mis-steps. His stupid life choices that might be revealed by a urine drug screen, a screen that I had no interest in performing let alone contemplating the results of, were his kharma and would impact his life.

And, good luck with that!

LIGHTING UP MY LIFE

Another day, another Child of Ghawd. Soul reports a rash, kinda-sorta itchy, started here, now here, and here, and here. No exposure to suspect plants, no new cosmetics/detergents/soaps/shampoos.

There is a thing, known as a “Wood’s Lamp”, which produces light in the near-UV portion of the spectrum, accompanied by some visible violet (surprising enough!) light. Some itchy rashes will fluoresce (glow, generally a pale yellow-green, occasionally a pale, “coral” red/pink) under illumination from a Wood’s Lamp, and in such cases, it is a dermatophyte that is causing your rash. Treatment is an antifungal, such as clotrimazole (you may recognize the brand as “Lotrimin AF”), or selenium sulfide (the active ingredient in the anti dandruff shampoo, “Selsun Blue”).

This individual described trying multiple creams, lotions, and sprays, none of which effected any improvement. I attempted to elicit a duration of use, and was told, “It just didn’t work!”

Alrighty, then!

For those in the studio audience who do not already know this, dermatophytes are slow growing organisms, and therefore they find themselves in that portion of their growth and reproductive cycle wherein they are vulnerable to treatment, at relative long intervals. For this reason, treatment is relatively prolonged compared with, for example, a boil or other skin infection from a bacterium like staph or strep.

Sigh. I directed my patient to employ Selsun Blue as a body wash, and to continue it for a couple of weeks.

This person looked me dead in the eye, and asked, “Aren’t you going to do anything for my rash? Shouldn’t I use a cream or something?”

Sigh, again. Repeat, verbatim, the care instructions I finished providing, oh, like TWO FREAKING MINUTES AGO. In English. To a native English speaking patient.

Duty · Life in Da City! · Pains in my Fifth Point of Contact · Protect and Serve

Two More Tales

Once upon a time, Da City was “The Arsenal of Democracy”, heavily industrialized, and a place where a reasonably hard working high school graduate could graduate, and, within a year, have a solidly middle class lifestyle working in a factory. One auto company had established an industrial complex just outside Da City, and on an island in this complex, had established forges, stamping plants, and coking ovens. Even across the river, the smell had to be experienced to be believed.

I worked with one guy, back on EMS, who had worked, pre-fire department, for one of the private ambulance services. They had caught a run for some emergency or another on this island, and, this being the days of 24 hour shifts, my friend fell asleep, letting his partner, who was driving, take care of things.

He related, “I was awakened when the ambulance stopped. I looked out, at the gas flaring off, and the chemical smell of sulfur heavy in the air. The area aroiund us looked like a hellish war torn moonscape, and I thought, “Oh my f@@king Ghawd! He’s wrecked the ambulance, I’ve died, and this is Hell!”

Another story, from a slightly later time, had me working with Doug and Rob, at a house in the far western area of Da City. We were dispatched to an assault, and met the cops on the scene. Upon entering the house, a gentleman (looking to be something like 6 feet and some change tall, probably running probably 220 pounds) reported that the woman of the house, who, herself, looked to be like 5 feet 2 inches, maybe 120 pounds, had assaulted him, striking him with her fists. He reported that he needed to be “checked out” due to his (non evident) injuries. She interjected that she had not assaulted him, he had, rather, assaulted her (and inflicting no perceptible injury in that process). He responded, loudly, and it was on. The Great West Side Debating Society Quarterly Meeting began.

While “the adults” were yelling etc, I noticed, in corner of the next room a perhaps 5-7 yo little girl, crouched in corner, mouth open, fists clenched as in a silent scream. While cops refereed “the adults”, I crouched down in front of child, attempting to verbally soothe her. One female officer noticed, and came over. I introduced the officer to the child, “This is my friend, Officer Evans. She would like to talk to you for a while. Is that OK? She, and the rest of her friends will keep you safe.”

We disengaged, everybody signed no transport forms, we went in service. As Rob finished the trip sheets, he paused, and commented, “You know, I think we may have just witnessed a watershed moment in that little girl’s life.”

Bastard. I fear that he was right.

Fun And Games · Having A Good Partner Is Very Important! · Life in Da City! · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

First noc I wore fire boots at work: freeway run, on a snowy night.

TINS©, TIWFDASL©, and going to paramedic school in my off time (this was many, many years ago). In the course of this schooling, I spent some time in clinicals, variously in the local ED in a wretched hive of scum and villainy not so very far from Da City, or with one of the advanced life support crews running calls in the self same wretched hive.

It’s generally educational to spend time with other medics, as their organization’s culture, and lore, is likely to be kind of at a tangent to your home outfit. The education may run both ways. In any event, There I was, (studying) Fighting Disease, and Saving Lives in The Wretched Hive, and one of the host medics came on duty, ferrying his “load out” into the ambulance. I noticed that he tucked a pair of fire boots behind his seat, and asked him about them.

It being winter in The Northern Un-Named State, well, we were susceptible to receiving considerable amounts of snow from time to time. I believe the professional meteorological term is “ass loads”. My host noted that this could result in snowy shoes, and therefore wet feet, and that there were few things so miserable as cold, wet feet, in Da Nawth, in winter. Waterproof boots, that reached nigh up to one’s crotch, served admirably to avert this sort of undesirable outcome. I took notes.

Soon, I acquired my very own pair of “Storm King” (old standard) NFPA complaint boots. So, it happened that I wore them to work one snowy evening, and, early in the shift, Doug and I caught a run for “one down” on the expressway.

We pulled up behind the state police cruiser, and saw a figure prone in the snow and slush. The trooper told us that the patient had been struck by an overtaking vehicle, when the overtaking vehicle did not notice that our patient was bent over the lip of the trunk of his STOPPED vehicle, ON THE SHOULDER OF THE DAMNED EXPRESSWAY!

Our patient did not fare well in this exchange. I pulled up my bunker style boots, so that they reached nearly to my crotch, and knelt in the slush. Doug logrolled the man, and I slid the backboard beneath him, and logrolled him my way, so Doug and I could then center him on our spine splint. We buckled him in, collared him, schlepped him into our rig, and beat feet to TSBTCIDC, which happened to be one exit and a coupla turns away.

I remained dry and warm. If I had never worn those boots another day, that night, in that slush, they paid for themselves!

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!

Duty · Having A Good Partner Is Very Important! · Life in Da City!

Paying Attention Is Important

So, TINS (c), TIWFDASL (c), and working in Da Corridor. This was Da City’s, well, let us say, in paraphrase of the immortal words of Old Ben Kenobi, “Da Corridor: You will never find a more wretched hive of scum and villainy!” So, not the nice part of Da City.

I was working “The Corridor”, and an academy classmate, let us call him Gordon Lightfoot, was detailed in that day from another house. At this point of time, TBTCIDC was closed, as they were in the midst of moving kit and caboodle to the shiny, new, and in-the-medical-center hospital they had just opened. (Well, it had not been opened, just yet, and that little detail will figure prominently in this tale!) The hospital that was TBTCIDC’s “stand-in” was NOT generally the trauma center, but was in the medical center.

We caught call after call, transported sick (and a lot of not-so-sick) people, and generally saved lives. Our next run was on an asthma patient, and off we went. In fact, this particular address was only a block from the medical center.

We arrived, announced ourselves, and acquainted ourselves with this person’s malady. I brought the stair chair, and we wheeled this soul out to the ambulance, and settled them onto the cot. I had JUST entered the cab, preparatory to a leisurely trip to The Stand In Hospital, when Gordon stuck his head through the window connecting the cab with the patient compartment, and bellowed, “Reltney! He’s arrested!”

I hopped around to the back, and helped Gordon get set up for a spot of in transit CPR. Once he was set, I re entered the cab, and called dispatch: “Medic One, Code One, Stand In Hospital. Cardiac arrest, witnessed. Eta One Minute!”

Dispatch acknowledged. I tuned in the hospital alert frequency, and called: “Stand In Hospital, come in for Priority One traffic!”

They acknowledged, and I started my turn out into traffic, lights flashing, and siren wailing. “Witnessed cardiac arrest! CPR in progress! ETA one minute!”

The nurse on the radio was not clear on the message. “Say your ETA?”

“Open the doors! We’re here!”

Duty · Life in Da City! · Pains in my Fifth Point of Contact

Whenever I Start to Think That I am The Smartest Guy in The Room, I am in the Wrong Room!

Another time, I was fighting disease and saving lives as the afternoon nursing house supervisor. Start of shift stuff had been done, I had made some rounds, and arranged for staff to get off the unit to eat. I was piddling around with some paperwork of some sort, and heard an overhead page of “Code Red: 1 East!”

At that time, in this facility, 1 East was our psych unit. I phoned the switchboard, and she told me that there had been a pull station activated on the unit, and I needed to go verify it before she could call the fire department.

Uh, excuse me? WTAF??!! I directed her to call 911 right freaking now, and communicate the alarm at once. “But, our policy is to wait until the supervisor verifies the fire!”

I told her that, employing the telepathy that had stood me in such good stead in years on the Fire Department’s EMS division, I had just this second confirmed the alarm, and she needed to stop dicking around, and call the fucking firefighters.

I hung up, and took off at a trot for the nursing unit, and unlocked the door.

Immediately, I was happy that the alarm had NOT been delayed. The unit was quite smoky, and the smoke was starting to bank down to about shoulder height. I found the charge nurse, and asked her for report. She reported that every patient had been accounted for, and every one was presently in the day room, with two sets of smoke doors between them and the fire room. One of the patients had, somehow, ignited his mattress, and then things got exciting.

The security supervisor and I did another sweep of each room, double checking that nobody was on a floor, or draped over some furniture. Happily, nobody but the two of us was there. Oh, yes: the two of us and the first due engine company.

The firefighters trundled the smoking mattress out of the unit and into our alley, whereupon they performed a sort of urban baptism ceremony, pouring The Healing Waters Of Engine 56 upon the Sinning Mattress.

The next morning I had a stern chat with my boss, and the phrases “NFPA standards” and “fire code for health care facilities” were flung about. Along with the observation that the reported SOP was ABSOLUTELY inconsistent with the prevailing standard of care.