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

“The Nerve Pill”

So, TINS©, TIWFDASL© in Da City one Dark and Stormy Night. My partner was driving and, therefore, I was blessed with the opportunity to interact with the diseased and injured of Da City, at length. My Very! Favorite! Thing! Ever!

This one gentleman was seated upon the squad bench, and I had reached the part of my interview wherein I inquired after medications presently among those employed by the named patient, namely, da dude in da ambulance.

“So, Sir, do you take any medications?”

He gazed thoughtfully into the distance, or such distance as the module of an ambulance provided, and responded, “Uh, no, not really.”

Internally, the Voices Inside My Head raged over this reply. “ ‘Not Really’? Whaduhfug! How can a question, with an anticipated answer of ‘Yes’, or ‘No’, be so freaking complicated? Dude! This is a ‘Yes’ answer, because you do, indeed, take freaking medications daily, or the answer is ‘No’, because you do not! Even a simpleton such as I can sort this one out!”

What got past my Thought/Speech Filter, was the following: “Uh, does your doctor expect that you are taking medications?”

The response was, “Uh, I guess so, I suppose that he does.”

“What sort of medication might it be, that your doctor thinks that you are taking, but you are NOT taking?”

“Oh, that ‘nerve pill’”

“The ‘nerve pill’? Why did you stop taking your ‘nerve pill’?”

He looked at me, dead in the eye, and, with a straight face, told me, “Because the voices in my head told me that I did not need them any more!”

Let me tell you, the rest of THAT trip to the hospital was not relaxing!

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

Another Triage Tale

Another ER night shift, another exciting opportunity to triage.

So, TINS, TIWFDASL, and another lucky soul ambled in to have his disease fought and his life saved from the scourge, the morbid threat, the life changing consequences of having contracted….THE SNIFFLES!

I sought to elicit his chief complaint, history of present illness, review of systems, daily medications, and medication allergies. His answer to the last, stopped me in my tracks.

“I’m allergic to everything.”

I did another literal, physical double take. “Pardon?”

“I’m allergic to everything!”

“Uh, sir? Are you telling me that you have never, ever, in your entire life, taken a medication that failed to make you ill? Every single time? Without exception?”

“Yep.”

“Every time? Not once did a medication fail to make you ill? Every single one you have ever taken?”

“Yep.”

“I’ll make sure the doctor knows that.”

Pains in my Fifth Point of Contact

Nursing Story The Second

Again, TINS, TIWFDASL in some other ER, in some other little town. The night of THIS story, I had a patient assignment, and one of my patients was the subject of a an order that he receive an IV (infusion of sterile fluid) and a blood draw. Typically, these are performed simultaneously, as very few folks really enjoy a second needle stick in order to obtain the blood that you did not obtain the first time you subjected them to a needle stick, to start the IV. I thought, Easy-Peasy, no problem, I can do this, just like the thousand and twelve other times I had done this very thing.

I gathered the supplies I would require, and approached the patient, launching in to my stock spiel. “Hello, sir, I’m Reltney McFee, one of the nurses, and I here to start an IV and draw some blood. Please, say your name.”

He said his name, the name I was expecting, and asked, “What’s an IV?”

I explained, “Well, sir, I stick a small needle into your vein right here on your forearm, and slide it out, leaving a small plastic tube in the vein. I connect this here tubing to the hub of that plastic tube, and administer sterile fluid to help you feel better. You should feel the benefits in under a half an hour.”

“Will it hurt?”

My internal dialogue, effective squelched by my functioning thought/speech filter, ran along the lines of either “I’m fixing to stick you with this here pointy thing, and you wonder if it’ll hurt? Naw, hell naw, I won’t feel a thing!”, or “Yep. Hurt like a motherfucker. I don’t think you will completely pass out, but, just in case, I’ll get some towels when your bowels and bladder release from the pain, OK?”. Due to that filtering, I said, “Sort of, for a minute.”

He then asked me, “Doc, hurry up!”

I corrected him. Not every male with a stethoscope is a physician. “Sir, I’m a nurse, not a doctor. I’ll be as gentle as I can be.”

He was not listening, it appeared. “Oh, doc, doc, doc! Hurry up!”

I set my stuff down, and faced him. “Ok, here is how this works. I can, if you wish, do this really fast. Or, as an alternative, I can do this once, correctly. Which of these sounds better to you?”

“Uhhh, once sounds better!”

“Very good choice. Now, maybe you would allow me to do this, just like I’ve done it several thousand times before, OK?”

“Uh, OK.” And he stuck out his arm.

So, I applied the venous tourniquet, prepped the site, set up my blood draw tubes, readied my adapter, tore my tape and prepared my site dressing, one puncture, blood flash, and steadied the hub as I withdrew the needle. Attach adapter, obtain blood, remove adapter, attach tubing, secure tubing connection, tape hub, apply site dressing, create and tape down “tug loop” in IV tubing, set IV drip rate, and collect my trash and blood and off I go. Send blood, chart IV start, done.

Like I said, Easy-Peasy!

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

Sometimes, You Just Gotta Talk So That They Can Understand You!

After I left Da City, I worked as a ED nurse. Eventually, I took a job up north, at Erewhon Memorial Hospital. (“Both Nowhere, and Backwards!”) In due course at work I met The Woman Who Would Become The Plaintiff, after she had been She Who Must Be Obeyed. (another story, for another time).

This woman, let us call her Annie (because “The Woman Who Would Become The Plaintiff” is simply too complex to type repeatedly!), and I began to see each other, dating and, eventually, moving in together. Annie had two children already, Brenda (age 3) and her older brother Adam (age 7). Unsurprisingly, they accompanied her.

Well. Love bloomed, and Annie and I got married. I worked, she went to school, the kids attended school, and all seemed well.

One night Annie and I were asleep. I awakened to hear wheezing from down the hall, in the direction of Brenda’s room. Being the inquisitive sort, I followed the sounds, arriving in Brenda’s room, where she was sitting upright in bed, wheezing and terrified. Annie had awakened when I left the bed, and soon joined us. I listened to Brenda’s lungs with my stethoscope, hearing wheezes. I noted her rate of respirations (42 breaths per minute. Yes, 30 some years later, I remember it), and her pulse rate (162. Yep, I remember.) I got dressed, and Annie stayed home to watch over Adam. Off we went to the ED where I was employed as an Emergency Department RN.

Once we entered the door, well, I was not alone in my assessment that This Was Not Good. Brenda was whisked into a bed, gowned, x rayed, breathing treatment-ed, had blood drawn, and an IV started, and generally auscultated/poked/prodded/imaged very thoroughly.

A couple of hours later, Brenda’s breathing MUCH improved, we were discharged with antibiotics and an inhaler, and instructions to return IMMEDIATELY if her breathing worsened. It did not.

So, several weeks later I received a letter from Erewhon Memorial Hospital, informing me that our insurance company had determined that this was not an emergency, and that therefore the insurance company would not be paying anything on the emergency department visit we recently had.

I called Erewhon’s billing department, and asked them what was up? They informed me that I had to speak to the insurance company, in order to determine what they were thinking.

I did so. It develops that our insurance company hires people who are, in short, stupid. I (finally) spoke to a representative who told me that the claim was not going to be paid, “because that visit was not an emergency.”

I asked her on what basis she had made that determination.

“It simply was not an emergency”.

I observed that, where I came from, answering a question seeking an explanation, was not adequately answered by repeating the previous, unsatisfactory, answer. Then, I asked her, “Ma’am? In which corner of the resuscitation room were you standing? I work there, I know everybody-EVERYBODY!- who works there, and I do not recall you standing there, taking notes on the non emergency nature of my child’s acute respiratory distress.”

“Oh, I wasn’t there!”

“Then, how did you determine that my child, in respiratory distress, was not emergent? The leading etiology of cardiac arrest in the pediatric population is respiratory distress, and my child was in respiratory distress, wheezing, tachypneic, tachycardic. Being just older than a toddler, she does not have much in the way of respiratory reserves, and that which she did have, was being expended rapidly. Please, explain that to me, and show your work!”

After a spell of stuttering, she told me that the charting did not support the insurance company’s criteria for an emergency, and I would have to have further conversations with the hospital.

I did so. I walked my happy ass into the billing department, and asked about my daughter’s bill.

The charming soul I spoke with told me that “It wasn’t an emergency, the insurance company would not pay for it, so the entire bill was my responsibility!”

I told her, “Uh, no. My child was an emergency. She was in respiratory distress, wheezing at a rate of 40 times a minute, and tachycardic at a rate of 160 a minute. The leading etiology of cardiac arrest in the pediatric population is respiratory distress, and my child was in respiratory distress, wheezing, tachypneic, tachycardic. Being just older than a toddler, she does not have much in the way of respiratory reserves, and that which she did have, was being expended rapidly. So, I will pay the co-pay, and the deductible, for which I am liable, but you can collect the rest of the bill from the insurance company, which owes you that money, not me.”

She puffed up. “Well, if you do not pay that bill, we will have to send you to collections!”

She saw all of my teeth, in the grin that was my response. “Ma’am, if you do that, you will libel me, and slander me, and impugn my character and reputation. You will get the opportunity to explain yourself, under oath, at trial, when I sue for damages occasioned by the torts I just enumerated that you will have performed.”

She puffed up, more. “You can’t sue me!”

I chuckled. “Ma’am, I can sue you for damages because you are ugly, and your ugliness causes me harm. Count on it. If you send me to collections, I will sue you, personally, and do everything I can to impoverish you. After I am done with you, I will sue your supervisor, personally, for failing to supervise you, and allowing you to perpetrate these offenses. Once I am done with her, I’ll sue HER supervisor, personally, and so on up the chain of command, until I’ve sued every son of a bitch here, and then I’ll go after the hospital as a corporation, and individual members of the board of directors, for breaching their duty to ensure that the hospital is not run in a fraudulent manner, which your plan is. Fraudulent, that is.”

She huffed, and puffed for a while, and then deliver what she evidently thought was her clincher. “You cannot sue me! You simply cannot!”

More wolf grin on my part. “Oh, really? Is that what your attorney told you?”

“I do not have an attorney!”

I smiled, a smile that in no way reached my eyes. “Really? You know, I will fix that. I’m pretty sure that, once you get served by my attorney, you will find an attorney of your own, right damned quick!”

She gaped at me for a moment. “You know, you are an asshole!”

“Yep! Sure am! For most folks I try very hard to conceal the fact that I am an asshole. For you, and everybody working at this shithole hospital, well, I will make an exception! I’ll be in touch! Have a nice day!”

So time passed, Annie and our children moved a couple of times (she is part Gypsy).

A couple of years later, around the middle of December, I received an Explanation of Benefits from the insurance company. I found this odd, since I hadn’t been insured by this company for a couple of years. It appeared that they had paid a claim for emergency services at Erewhon Memorial Hospital, the very claim that I had shown my ass to the billing department about.

It was as if it was our own little Christmas Miracle!

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!”

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.