Fun With Suits! · Pains in my Fifth Point of Contact · School Fun And Games · Sometimes You Get to Think That You Have Accomplished Something!

Again, with not fitting the mold!

Remember my fun filled interview for Nursing school? So, nearly 30 years later I applied for PA school. Among the requirements was 500 hours of patient contact experience. So, I had worked as an RN for (shockingly enough) 30 years at that point, and had accrued, with overtime, something on the order of 63,000 hours of patient care.

So, I went to interview for the incoming class, and they asked me if I had 500 hours of patient care experience. I had included my resume detailing my schooling and work experience as part of my application, so I assumed that my work history was not a surprise.

I asked, “Do you mean, in the past 3 months? or overall?”

“How about, overall?”

“Well, something like 60,000 plus hours, I guess.”

The reply? “Well, alright then! Let’s move along!”

I succeeded, and so got to deal with the financial aid office.

I filled out the form, complete with the birthdate revealing that I had been born some 50 + years previously. I ignored the part where they sought my parent’s tax forms.

When I turned in my application, the gosling behind the counter reviewed my papers,  and looked my elderly ass right in the eye, saying, “You don’t have your father’s tax form in here!”

She sure was quick! “No, ma’am, I do not.”

She was, albeit, persistent. “You have to include your father’s tax forms.”

“Ma’am, I am not going to submit my father’s tax forms. For one thing, he has not filed in 13 years. ”

“He hasn’t filed in 13 years? He has to!”

“Ma’am, perhaps you could call him up, and let him know that. But, it’s going to be kind of a long distance call. And, when you reach him, please tell him that I love him, and miss him every day.”

Perhaps, she was not so quick. “Huh?”

“Ma’am, my father died over a dozen years ago. You will not be receiving his tax forms.”

Undeterred, she demanded, “Well, we will need your mother’s tax forms!”

I was over this. “Ma’am, you are not going to receive my mother’s tax forms, either. She is pushing 80 years old, I have lived on my own for 30 years, and the only tax forms you will receive are those belonging to my wife and me. Perhaps I should talk to your supervisor?”

After several minutes, an adult appeared. I reviewed my position. “Ma’am, this young lady insists on my providing my parents’ tax forms. That is not going to happen. I have supported my own family for nearly a dozen years. I am not about to provide my parents’ forms, nor have they supported me for longer than this nice young lady has been alive.”

The adult looked at me for a moment. “And, you are Mr. McFee, correct? And, you are the student? Not one of your children?”

“Ma’am, if you look at the applicant’s birthday on the application, you will see that it matches my apparent age.”

This soul indeed perused the applicant’s birthday, and regarded me. “Uh, sir? I think we have everything we need here. You will not be asked again to provide your mother’s tax forms. Thank you, and have a nice day!”

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Fun With Suits! · Pains in my Fifth Point of Contact

“But, what do I do?”

So, TINS, TIWFDASL as a nursing supervisor at The Little Un-Named Hospital In Da City (TLUNHIDC). One night, I received a call from our ICU. The nurse on the other endtold me that she had an order to transfer a patient, from our hospital to The House Of God. She asked me what I wanted her to do.

(Again), I thought, “This! This is why I get the Big Bucks!”. I told her, “In that case, I think you ought to transfer your patient to The House Of God!”

She responded, “But, I don’t know if they have a receiving physician at The House Of God.”

My rejoinder, “Well, then, call the House Of God, talk to the nurse in their ICU, and verify that there is a receiving physician.”

(Henceforth, I’ll dispense with the “He said, She said” business. From now on, any dialog beginning with “But…”, is her. Any other dialog, is me.)

“But, what if their physician hasn’t received report from our physician?”

“Note that fact in your nursing notes of that conversation, call our doctor, and invite him/her to call House Of God’s receiving physician, and remedy that oversight.”

“But, I don’t know if report has been called!”

“You might elect to look in the chart, for a note documenting that report has been called. Or, when you talk to their ICU, ASK!”

“But, what if report has not been called?”

“Well, while you have them on the phone, give them report. And chart that fact.”

“But, I don’t know what ambulance service to call, to transport that patient!”

“Ask the switchboard who is next on the rotation, and call that service.”

“But, I don’t know if the family has been notified.”

“So, the required phone number is in the chart, correct? Once all the other pieces are in place, phone the contact person, bring them up to speed, and document same in your notes.”

“But, what do I do about his property?”

“I suppose that bagging it up, and sending it with him, might be reasonable.”

“But, what about the chart? How am I going to send the chart with him?”

“Most nurses photocopy it, and send the photocopy with the patient. I recommend you do likewise.”

“But, how am I going to get it photocopied?”

“Most charge nurses, have the ward clerk servicing their floor do the photocopying.”

“But, we cannot spare her for that long!”

“You have an eight bed unit, have three vacant beds, haven’t had an admission in 6 hours. If you cannot spare her, right now would be a good time to fill your supervisor in on what catastrophe is unfolding in your unit!”

(her: “stutter…stutter…er…um…uh…”)

(Me) “I’m waiting?”

(Her) “But…But…What do you want me to do?”

“Get a pen and paper.”

(her) “What?”

“Get a pen and paper.”

(her) “Why do you want me to get a pen and paper?”

“Simply do it. Now.”

(her) “I have a pen and paper.”

“Good. Write this down. Call The House Of God, verify that our doctor has reported to their doctor.

If not, call our doctor, and invite him to do so. You give report, and chart same. Call the ambulance service that the switchboard tells you is next up on the call list. Call his family, bag his property. Have your clerk copy the chart, and send that copy with him. Have you written all that down?”

(Her) “Uh, yeah.”

“Do you understand all that?”

(Her) “Uh, yeah.”

“Ok, now Do IT!”

End of call.

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

Oh, Tempores! Oh, mores!

When I walked into the exam room, the olfactory evidence of marijuana hit me as if I had walked into a wall. If the lights had been flashing, and there had been earsplittingly loud rock music, I would have thought I had been transported back in time to the Grande Ballroom.

It’s often entertaining to interview stoners. Typically they have difficulty maintaining a linear train of thought. I encounter associations that I, sober, have difficulty following. So, I asked this soul how I could help them.

They told me that they used eyedrops (No, they did not know what eyedrops. Nor did they have said drops at hand. Of course not. Why would I care what medications they took?) They told me that they had a bacterial infection, due to these eyedrops. How, might you wonder, could they have a bacterial infection due to their eyedrops? Congratulations, you, too, can have a career in clinical medicine.

Now, for the loose associations. My new friend related that they had several transplants, of a sort that they could not identify. (Most of us might think that knowing WHAT SORT OF FREAKING TRANSPLANT we had received, might be nice to know. Just in case, ya know, we had to see some sort of clinical professional. Ever. ) Their exact words? “You know, a transplant of that stuff!”

Kinda unhelpful. Plan “B”: elicit indications of said “bacterial infection”. I expected something along the lines of discharge, or fever, or productive cough. Again, with the loose associations.

“I just know I’m sick!”

And, my friend, what sort of experiences led you to conclude that you are sick?

“I’m just sick!”

They told me in PA school, that, if you listen to the patient, their story will tell you what is wrong. I suppose that my instructors had never met my stoned new friend.

So, I examined ears, looked in this soul’s throat, felt for swollen glands, listened to lungs and heart, palpated abdomen, and found a completely normal exam, if you discount the marijuana fumes emanating from their every pore, and bloodshot eyes. Oh,yes: and, if you exchanged not a word with them.

So, trusting that the med list my MA had elicited from my mentally wandering friend was accurate (if you ignored the absence of any mention of, uh, EYE DROPS thereon….), I described my stock spiel of symptomatic relief medications available over the counter, and handed them a typed list thereof.

They nodded, agreeably, and shuffled to the door, off to wander the local environs.

Yep, I am DEE-LIGHTED! that marijuana legalization passed in our last election! How can that go other than well?

On the up side, it will provide a blatant and olfactory Jackwagon Flag. Once you encounter some happy-go-lucky soul out in public, wafting reefer fumes hither and yon, well, you may avoid wondering if they are a fool or not. Just sniff.

Fun With Suits! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Yet ANOTHER Tale of Public School Wonderfulness!

When She Who Must Be Obeyed, and I, and our family had moved to another school district, we, surprisingly enough, registered our children in that new school district. We were provided a sheaf of paperwork to be completed, and, in leafing through my homework assignment, noticed a physical form for each child.

I examined it, and noted that, at the bottom, it required the signature of a “Licensed Health Professional”.

I pointed this out to SWMBO, and she asked me what I intended to do with this insight.

“Well, I’ll perform physicals on our children, document them, and sign the forms. Save us the hassle of a doctor office visit!”

She protested that I was an RN, and that they meant for a doctor to sign the form. I invited her to point out where, on the form, it so stated.

She turned it this way and that, and, finally, was compelled to admit that it did not so state explicitly, “but that is what they meant!”

“Perhaps, that is what they should have said!”, and I went off to retrieve my stethoscope and children.

I performed all the diagnostic maneuvers required, documented my findings, and, at the bottom, where it called for the “signature of a healthcare professional”, I signed it Reltney McFee RN, BSN.

Several days later I took the kids to school for registration and walked into the office. The woman there told me she needed some documentation of address so I gave her a utility bill. She needed some ID for me, and I provided my driver’s license. She needed a phone number, and I provided it. Next she asked for the School physical forms. She examined them, and asked, “Who is this?”, indicating the signature.

“That’s me!” I said. She asked me if I was a physician, and I replied, “No I’m not. I’m an RN.”

“You cannot sign this form!”, she informed me. I leaned over the counter, pointed at my signature, and observed, “Yet, it certainly appears that I have signed it!”

“But, you have to be a doctor to sign this form!”

“No”, I corrected her, “it requires the signature of a licensed health professional. I am a registered Nurse, and am therefore a licensed health professional. Hell, I’m even licensed by the Bureau of Health Professions!”

Unswayed by my logic, she informed me, “Nurses aren’t health professionals!”

I picked up a phone book. “Oddly enough, the Board of Nursing seems to think that nurses are health professionals. It’s a local call: why don’t you call the Board of Nursing in the state capitol, and straighten them out? I’m sure they’d enjoy having you correct their little misunderstanding!”

And then I smiled.

She stuttered a little bit, looked flustered for a little bit, went into the back office and then came back out and said “We’ll take it this time.”

I smiled and said thank you and went on my merry way. Next year the kids came home from school and had these physical forms that need to be filled out. I looked at them: there at the bottom of them it said “signature of Nurse Practitioner, MD, DO, or Physician Assistant”, none of which I was.

My nursing school instructors would have been so proud of me! I was an agent for change, and the school system had changed their forms at my instigation!

Fun And Games Off Duty · Fun With Suits! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Fun and Games In The Public Schools!

So, my daughter, Brenda, had injured her knee in gym class at middle school.  
We lived about a mile from the school, and, once she had told the teacher about
her knee injury, did that teacher, or any other official of the  school, call her 
mother, the nurse?  To quote Eddie Murphy, in his persona of The Ganga 
Teacher, "No, no, noooo, no!"

Did they phone her father, the nurse?  Again, "No, no, noooo, no!"

Did they have a teacher drive her home, so that she would not have to walk 
home on her injured knee?  As you might have anticipated at this point in my 
rant, "No, no, noooo, no!"

Did they put her on a bus, again, to prevent her walking home on her 
demonstrably injured knee?  If you have read this far, sing along with me:
 "No, no, noooo, no!"

Instead, of course, they sent her home, walking, on her injured knee, around 
a mile from school to her home. 

As you may have guessed at this point, I was not favorably impressed. Nay, 
I was pissed. 

I wrapped her knee, applied ice, elevated it, after identifying no marked 
instability.  It did hurt her with walking (which, of course, the idiots at the school 
had required her to do to get home, since they had NOT called her father, or 
her mother.  But, perhaps, I had already told you that little detail) 

I dosed her with ibuprofen, and put her to bed. I wrote her a no physical 
education note, and retained a copy for myself. I signed it, 
"Reltney McFee, RN, BSN".

In the morning she appeared  improved enough to return to school. Therefore, 
in consultation with She Who Must Be Obeyed, we decided to send her to 
school. We drove her. Ourselves. To make sure that she did not have to walk. 

So, that afternoon  I was surprised to receive a phone call from the phys ed 
teacher.  This worthy told me that he required a note FROM A DOCTOR, in 
order to keep her out of class. I pointed out that he had, in his hand, a suitable 
note, that I had written, directing him to keep my child out of gym class until 
further notice. 

He replied that, absent a note from a physician, he would require my child to 
participate in gym class. 

I gave this a second's thought, and brought him up to speed. "So, let me see if I 
am understanding you.  You have a note, in hard copy, in your physical 
possession, written by me, her father and a Registered Nurse, directing you 
to keep my child out of gym class due to an injury she suffered on school 
property, and notifying you that, should she participate in gym class she may 
sustain additional injury.  You, in your medical judgment, have determined that 
you know more of this sort of thing than I, and will contravene my explicit 
instruction, in my capacity as her father and a registered nurse of 20 years 
experience.  Cool story.  I'm certain that the jury at your lawsuit will be very 
impressed.  Perhaps impressed to the tune of several hundred thousand 
dollars."

He sputtered, "You cannot sue me!"

"Really? Is that what your attorney told you?"

"I do not have a lawyer."

"Well, what do you know?  I DO have a lawyer, and you can, too!  Once my 
lawyer serves you with the papers he will prepare to hold you personally 
responsible for my daughters crippling injury, suffered through your willful 
and wanton negligence, ignoring the specific instruction that I, her father and 
a registered nurse, have provided you. In writing. Right about that point, 
I wager you will find yourself a lawyer!"

He sputtered a while longer, and noted that he would, sooner or later, require 
a note from a physician. I told him that I would obtain one, at my earliest 
convenience. And, I'd provide him a copy. 

The call terminated. 

Once I had my daughter in my vehicle, outside the school, I asked her how 
gym class had gone.  

"Fine, Dad.  They sent me to study hall, and for some reason, the teacher 
seemed pissed about something."

I smiled, and replied, "Well, it might have been something about sending 
you, and our attorney's kid, and his attorney's kid, as well, to a very nice 
college!"

She looked puzzled at that, but, what the hell, I wasn't going to be able to 
put things over on her for very much longer, and I ought to savor the few 
remaining opportunities. 
Fun And Games Off Duty · Life in Da City! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

The “Heimlich remover” in Song and Legend

 

So, TINS©, TIW(after)FDASL©, having been asleep for a couple of hours after another fun filled, exciting night of EMS in Da City. I was just about hitting my sleep stride, sleeping my ass off, when a commotion on my front porch awakened me.

I had bought a two flat in Da City, and lived in the downstairs apartment, renting out the upstairs to a fellow we can think of as The Clod. The Clod had roommates, who seemed unsavory. This appraisal developed as I noted one of these folks to have what we used to call, on the street, “lobster claws”. This alludes to the fact that IVDAs (pronounced as it is spelled, “iv-dahs”), or folks who spend their recreational time injecting street drugs intravenously, develop sclerosed veins, from the damage those veins sustain from the chemical irritation of the drugs, crappy needle technique, and repeated infections of the veins due to nonsterile injectate. It tuns out that the lymphatic circulation simply is not up to the task of returning all the fluid delivered by the uninjured arterial circulation, and so fluid collects in the downstream portions of the limbs, and the hands swell. When this process has advanced sufficiently, the hand(s) resemble the claws of a lobster, hence the appellation.

Now, some folks have stated their appraisal that my years on Da Streets have left their mark upon me. Indeed, my very own cherubic, innocent daughter, aged 20 something and mother of the sweetest, most wonderful children in North America, reports that I am “the most cynical human being that I have ever known.” (I can only hope so!) So, I had taken note of the fact that unusual sounds, seldom presaged Good Things in Da City. Therefore, awake, I put on some pants and a shirt, tucked a revolver into my pants, and laid my shotgun against the wall next to the door. Then, I peeked out the window to see what was transpiring.

My peek revealed an excited disturbance, featuring several folks unknown to me, and The Clod. I slowly opened my door, hand near revolver, and asked The Clod, “What’s happening?”

All a-twitter, he announced that “Luigi (not his real name) has swallowed a sandwich! Do you know the Heimlich Remover?”

Sheesh! The Heimlich Maneuver had been taught in every CPR class I have ever taken, since Desoto himself was in short pants and wondering why the pretty lights sparkled on top of the emergency truck. I moved closer, and noted that Luigi was coughing pretty vigorously, but, since he WAS coughing, it seemed pretty clear to me that he WAS moving air. This was not something I felt particularly enthusiastic about remedying, so I kept an eye on him, and asked, “has anybody called 911?”

I was dazzled from the glare of the metaphorical light bulbs illuminating over every head on that porch, all at once. The Clod noted that this was “A great idea!”, and bounded upstairs to make the call, leaving Luigi, and me, and Ghawd alone knows who else these bastards were, on the porch. Shortly after The Clod’s run up the stairs, Luigi stopped coughing, which I thought was Not Good. I asked Luigi if he could talk, to which he shook his head negatively. Not noticing any air moving in spite of his energetic attempts to do so, I elected to perform the Heimlich Maneuver.

He was sort of crouched over, which worked well for me. I reached around him, clasping my one fist in my other hand, and, planting the thumb of that fist into his stomach (just below the xyphoid, just above the umbilicus), I briskly lifted him off his knees, and settled him back down. I repeated this gesture several times until he coughed again, and produced a glob of half chewed sandwich about the size of my fist.

At this, he began to gasp and wheeze. The crowd started to thin out, as the sirens approached. Soon, it was The Clod, Luigi, and me left on the porch.

The responding EMS crew was a couple of guys I knew, and the one chatted with me while his partner checked Luigi, and obtained his signature refusing transport.

How long have you been working here?” I was asked.

What do you mean?” was my response.

Well, we all figured that this was some kind of adult foster care, because every time we drive past, there’s always a bunch of these guys hanging out. We figured that the residents had to get out of the house during the day.”

FML. Just what I wanted to hear.

 

Fun With Suits! · Pains in my Fifth Point of Contact

Erehwon ER Day Shift Call Off

So, a long, long time ago, in a county far, far away, I was the overnight ER nurse in Erehwon Memorial Hospital (“Both nowhere, AND backwards!”). I’d clock in at 1900, and until 0200, there’d be two of us working the 6 bed cubbyhole that passed for the Emergency Room out here in the suburbs of nowhere. Once 0200 came along, it was me and the Physician Assistant, all to our lonesome.

So, TINS ©, there I was, Fighting Disease and Saving Lives ©, and, long about 0500, I received a phone call from our director of nursing, Beelzebub. She reported that (a) the day shift nurse had called off, and (b) I was going to have to work over.

Now, at this time, we had four children at home, two of whom were toddlers. In addition, Erewhon Memorial Hospital had awful insurance, and expensive into the bargain. Therefore, since my wife made more money than I, and had cheaper and superior insurance, she carried us all as covered family members. That made HER the primary breadwinner, in my book. Our routine was I’d boogie home, and she’d meet me at the door, and traipse off to her Monday through Friday, 9-to-5 office job. I would then watch our children, until she came home, and nap away for a couple of hours until I got to do it all again. Working 12 hours meant a couple of things. First, it made for long, long duty days with that sort of plan. Second, working every other weekend, well, on work weekends I got to sleep the day away. Third, there were 2 days every week where I had to enter the parental “Iron Man” contest, and the rest of the time I was not more challenged than was my baseline.

So, departing from work late was not going to work for me, inasmuch as that would either make my wife late for work (a non starter), or leave the toddlers alone at home while the older kids went to school (another non starter). Alternatively, I could boogie on home, and be the Dad. That was my Plan “A”, and I was reluctant to deviate from it.

Surprisingly, when I presented my reluctance to Beelzebub, she was unimpressed. “You will simply have to work late, until I can find someone to cover for you.”

As was I. “Uh, no. Your problem is NOT covering for ME. I am here, and will be here until the end of my shift at 0730. Your problem is covering for the employee who called off. I am unable to do so.”

“Well, you simply cannot leave. I do not have anybody to cover.”

She did not appear to be listening. “Well, I likely can stay until 0800, but not one minute later. I will not have my wife be late for her job, simply due to your inability to perform yours. Similarly, my children will have a parent at hand this morning, and that parent will be me. I can inconvenience myself a bit on your behalf, but I did not call in, I am not responsible to write, enforce, or amend the sick or tardy policy, and I will not accept that responsibility.”

Still with the not listening. “You can not leave. I will prevent you from leaving!”

That was interesting. “Uh-huh. How, exactly, do you plan to stop me? Simply so you know, I’m an ex-Da City street medic, and I have been threatened by honest-to-God, no shit felons. It will be interesting to see what you bring to the conversation, that they did not. And, if you’re later than 0730, you will miss your chance.”

She was not giving up. “You cannot leave the narcotics unsecured.”

I had thought this through, just a bit. “I understand that. My plan is to secure the narcotics, and count off with whatever nurse you send to relieve me. If you have not done so by 0730, well, then I will secure the narcotics keys someplace I personally know to be safe, and bring them back with me when I return to work next week.”

“If you take them home, then I’ll send the sheriff out to retrieve them.”

This, as well, had been part of my ruminations. “That works for me. Once that deputy has provided me with documentation that he or she is a legitimate recipient, I will provide them to that officer, and require a written receipt.”

She delivered what she evidently thought was her trump card. “If you walk out that door, I’ll bring you up with the Board of Nursing on charges of patient abandonment.”

Me, I had a figurative Ace of Trumps. “That ought to be interesting. Just so you are aware, in that event I’ll bring charges against you, before the Board of Nursing, regarding your neglect of duty. You know folks will call off: you provide sick time. Yet, evidently, your ‘plan’ is to have somebody work as long as 36 hours, because you do not have any sort of real plan. I’m confident that I can argue that any reasonable and prudent administrator, of your background and training would know, or ought to know, that somebody might call off. With that knowledge, comes an affirmative duty to have a real plan to address the dislocations that this sick call will predictably produce. A plan that, evidently, you do not have.”

She did not seem to have a counter. “You cannot bring me before the Board of Nursing!”

I was unconcerned. “I’ll be certain to mention that. In my written complaint. To the Board of Nursing.”

The call terminated at about that point. I called home, and brought my wife up to speed on the entertaining soap opera that was my workplace. She was concerned about the youngest kids, and we game-planned a couple of alternative measures to manage things. We ended the call with a plan of action.

So, long about 0735, one Mark 1, Mod Ø Very Pissed Off Floor Nurse arrived to “take report”. Inasmuch as there was no soul there at all, not on the payroll, that part was quick. Narc count went smoothly, and I danced my happy ass out of the door. I met my wife on the road, part way to her job in the next town, we handed off the kids, and she continued to her job, and we went home.

The Moral Of The Story: Nurses are very, very good at passive aggressive behavior. I had been a nurse at that point for nigh onto 20 years. I would put my passive aggressive against anybody’s.

And, planning for things that are readily foreseeable, might be A Good Thing.

Tee-hee.