Duty · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

Health Care Stagecraft

So, I see children from time to time. Commonly, they are dubious about the entire “Going to the doctor” thing (yeah, I DO realize that I am not a physician, I am a midlevel. May I observe you explain that distinction, to an anxious child?) With that as a starting point, you can imagine that my approaching said anxious child with a stethoscope, and then with an otoscope (“the ear looking thingy”) might not end well. Yeah, me too.

One of the lessons I learned on Da Street (besides knock from the side of the door, and always have a second way out of any room I enter, and always have a knife, and…well, the important lesson is…..) is misdirection. On the street this manifested itself as changing the topic of conversation, as, on a hostile scene, announcing, “WE have to go and get the stretcher!”, and then both of us doing so, and motoring merrily away from the threatened free fire zone. Returning, if at all, with police.

In a more sedate clinical setting, this manifests itself with my (now) stock spiel for kids.

“This here (hold stethoscope up) is my body tickling thingy. Now, this is really, really tickley, but I only have one, right? That’s not enough to share. So, if you laugh, everybody will know how much fun it is, and they will be sad. ‘Boo-Hoo! (insert child’s name here) got tickled, and I didn’t! That is so unfair! I am so sad!’ Now, we don’t want them to be sad, do we?” (generally, toddler-sober negative head wag) “So, try very hard not to laugh, so that they are not sad! Okay?”

(generally, “ok”)

Once heart and lungs are auscultated, I continue with my misdirection. “You did so very, very well in not laughing, now we move up to the ear tickley thingey! Same rules, try not to laugh so that they do not know how much fun it is, and they are not sad that I cannot share, okay?”

Generally, again, “Okay.” While the child is trying to identify what the heck is so darned tickley about otoscopy, I finish.

One bonus point, is, even if the child screams and kicks and writhes, I can congratulate them. “Wow! You did so very well! I don’t think that they even suspect how much fun that was! You can stop pretending, now! You have successfully finished! Well done!”

Sometimes it is healthcare stagecraft, that lets you complete your job.

Duty · guns · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Self Defense Cost Benefit Analysis

TINS, TIWFDASL, I had caught the detail, and the happy go lucky soul with whom I was working that particular night on Da City’s EMS, decided it was time to ask me about my ballistic vest. Now, it was not any sort of secret among members of the department that I wore a kevlar vest. After all, in Those Days, Da City was known as “The Murder City”, and not without some justification. We chatted about the threat profile we confronted (although, the chat went along the lines of “What? Do you expect to be shot?” My response was “Nope. I wear this for those scenes on which I do NOT anticipate being shot. On those on which I anticipate being shot, I will simply refuse the run until the police have secured the scene!”)

This guy, no doubt thinking himself clever, pronounced, “Well, if the scene goes to shit, I’ll run out, and you follow me! That way, your vest will protect both of us!”

My rejoinder was, “In that case, you had best be certain that you do not slow down, lest you have my bootprints all up your back, as I run you over!”

Later, my partner and I discussed the vest and EMS. He asked, non-snarkily, how I had come to the conclusion that the vest was the way to go.

I noted that the vest cost me about as much as a Colt Government Model in .45 acp.

It was not a felony to wear the vest concealed, in contrast to the Colt.

It was not a black letter violation of department regulations, in contrast to the Colt (or any other firearm).

The vest would not inadvertently discharge, in contrast to the Colt, where that was a potential problem.

The vest was not going to drop out of my pocket, on the floor of the ED, in front of Ghawd and Everybody, in contrast to a handgun which another of our peers had won the opportunity to explain.

I would not in any circumstance hesitate to use the vest, in contrast to the Colt.

Finally, I was interested in meeting the soul who could relieve me of the vest, and hurt me with it, again, in contrast to the Colt.

So, I wore a vest. Others, or so I was told, elected to wear a firearm.

Pre Planning Your Scene

Reading Recommendation

https://eatonrapidsjoe.blogspot.com/2020/10/home-field-advantage-egress.html?showComment=1602787988156#c8439774302017330220

I don’t think that this guy needs *my* paltry recommendation, but, he has successfully drawn me in, and engaged me. His series-s are very, very thought provoking, in a Aesop’s “Tomorrow” sort of way. Lots of food for thought both at a “micro-economics” as well as at a “macro-economics” level.

Is your larder prepared for the presentation of spice? Metaphorically speaking, of course.

Fun And Games · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Random Thoughts, Part IV

You may have heard of the ChicomFlu. It has been all over the news, and, evidently it is all Mr. Trump’s fault. Interestingly, the same folks voicing concerns about Mr. Trump being a fascist dictator, who is planning on a putsch in order to become President For Life, also are criticizing him for failing to seize control of the economy, and not dictating the minutiae of our lives in order to Halt! This! Scourge!. Apparently, that entire Federalism thing, and Tenth Amendment thing, bypassed these commentators in Government class.

Or else, our government schools failed them. Again.

So, in clinical medicine, in 2020, we now have drive in care. Care, that is, of a sort. So, folks drive up (remember that point), announce themselves (no clown’s mouth, thankfully!), and our registrar trots out and registers them. Our MA does preliminary interview, and obtains most of the vital signs (except BP). I then suit up in an impermeable gown, goggles, N-95 mask, with another lesser mask over top of it to prolong it’s service life, and gloves, and stroll out. I interview them through the vehicle window, examine ears, throat, auscultate heart sounds and breath sounds (and, by the way, I can tell you things about your engine and transmission). With this information, I form a diagnosis, formulate a plan of care, and instruct the patient in that plan.

I nearly always ask if my patient smokes. If the answer is affirmative, my response if “Stop doing that!” Occasionally, when the answer is “No”, I have indisputable olfactory evidence that this is an untruth. If I can smell your marijuana fumes through two masks, you are doing it wrong.

*History Lessons*

If you live in Bagwanistan, or Cuomo Valley
 New York, or, really anywhere, KNOW 
YOUR DAMNED MEDS!

It's commonly considered to be A GOOD
 THING if I avoid prescribing a medication
 that, in concert with whatever crap you
 take daily, will turn you into a flaming 
zombie, or cause your ears to drop off. So
 write that shit down someplace where 
you can find it. This appears to be a novel 
insight to a significant fraction of the
 population.
 

And, while you're at it, ask your pharmacist 
what you're allergic to, and WRITE THAT 
DOWN, as well. 

And, for those of you who are thinking
 that “All that is in my record!”, uh, well,
 if your records are in, say FREAKING
 FLORIDA, it might be a bit difficult for
 me to access. Particularly on 
weekends, or after 1800 hours their time.
 By the way, this also applies to folks
 whose records are in Milwaukee, and are
 visiting Flambeau Hospital, since that is
 the nearest healthcare to Copper State
 Park in BFE, Wisconsin.  Big City Hospital
 in Milwaukee may not see us as an 
entertainment subsidiary of their 
megalithic hospital system, and your info
may well be securely hidden away, 
from us. 

Jes' sayin. 
Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Clem, Cletus, and Why Heavy Equipment Operators Require Functional Partners, Too

Many, many years after I had left the employ of Da City, I came to live in Small Rural Town. Our little slice of Heaven featured, among other things, a municipal water system. The town had been built out shortly after the Second World War, and the infrastructure was contemporaneous with that construction.

Apparently, the engineering lesson of corrosion occurring at the junction of dissimilar metals, had not percolated to the individuals who built the house in which we lived. This epiphany developed after I noticed one Friday morning that there was water pooling in our front yard, between the door and the street.

Side note. NEVER! call the water department with that sort of observation on a Friday. They will shut off the water. It turns out, the service line from your home to the main is YOUR problem. You will NOT get that problem resolved late on a Friday. Or on a Saturday. Or on a Sunday. Not having running water makes for a long weekend of work.

Monday, I was again working, but TDW-Mark I had successfully contacted the Knob City Excavating Company to respond and repair our service line.

This involved excavating my front yard, and, having accessed the service line, replacing it.

It appears that professional excavating practice involves having one individual operating a back hoe, with another standing by, inspecting the back hoe’s progress, apparently in an attempt to avoid engaging the service line with the back hoe’s bucket, reefing thereon, and using that service line as a leader to abruptly extricate all the plumbing from your home.

So, about that. Clem was the back hoe operator, and Cletus, evidently, was tasked with leaning upon his shovel so that neither he, nor the shovel, fell over. In that, he appeared to be successful. Clem DID notice the entanglement of his back hoe bucket with my plumbing, but only after he had begun to extract my plumbing from my house. Fortunately he had only JUST begun to do so, before he determined that Things Were Not Right, and stopped. That was about the point at which I returned home from a day of fighting disease and saving lives.

Things were at a standstill as I entered the house. TDW-Mark I was standing there, gazing into the hole adjacent to our foundation, looking decidedly unamused. Clem was there as well, while Cletus was a’holding that shovel, determined that it was NOT going to fall!

TDW pointed into the depths of the hole, calling my attention to the copper stretched out from the foundation to it’s junction with the iron pipe that, evidently, had been our service line. Another vehicle pulled up, disgorging a worthy who was, is seemed, Bob The Knob, owner and operator of Knob City Excavating. TDW beckoned me inside, where she showed me where the service shut off on our domestic water feed, formerly near our ceiling, was now located at the floor. I suggested to Bob The Knob that he might want to get somebody with plumbing expertise in to review the situation, and effect such repairs as seemed needful. On his dime. And, RFN. (Right Fucking Now)

He did not appear to think that this was particularly unreasonable, particularly if he were to consider the alternative, which would involve court, attorneys, attorney fees on both sides, and much bad Ju-Ju.

The next day, I returned home from work, and TDW-Mark I informed me that Some Dude had arrived, crawled around in our attic, and had pronounced everything shoreward of our shut off to be intact. This worthy had then replaced our shut off, and the associated piping, and Knob City Excavating had replaced our service line with copper, had installed a bimetallic junction (TDW-Mark I had asked/insisted) at the main, backfilled everything once the city building inspector had signed off, and we Now! Had! Water! (cue the rejoicing)

It turns out that Bob The Knob was satisfied with my check in the original, estimated, amount as payment in full. We did not have any leaks subsequent to this adventure, and we all lived happily, ever after.

Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

“Social distancing”, before it was KEWL!

So, TINS ©, TIWFDASL ©, working midnights in a little ED in a little hospital, Up North. One fine day, I awakened at the crack of noon, only to find that TDW-Mark I had my afternoon planned out for me. Our little town had a poverty of grocery options, so every so often, TDW-Mark I would venture over to the next county (or two), shopping in the Mega Mart found there.

This was a sort of yin/yang experience. Yin: inconvenient drive, dragging young children along, considerable time devoted to the expedition. Yang: better selection, better prices, and Family! Bonding! Time!.

So, off we went. TDW had a list, of course, and she was mission focused. That left me to corral the kids, and prevent them from adding unauthorized items to the cart. (“No, Adam! You cannot get marshmallow cocoa sugar treats for breakfast! No, I do not care what all the other kids eat, you are not all those other kids, and your parents are ogres, who insist that you eat something in the same phylum as wholesome, when you eat!”)

As I hovered, redirecting my children, I noticed that this particular store seemed infested with bovine obliviots. I reached this conclusion after several near collisions wherein Obliviot A would nearly run one or the other child over, and then look at me irately when I intervened, and noted that striking my child with a cart would result in severe injury. To the obliviot.

Whatever. I figured it ranked up there with a “beware of dog” sign. Likely, my jury would think that I had an obligation to warn the lowing masses that there was a ravening dad about, and they might want to take suitable precautions. Before I did.

So, after several near misses, I decided that I had had enough. Most of the traffic went this way up this aisle, and that way down that aisle, a fact that I capitalized upon. I settled myself, straddle gaited, in the very middle of the aisle, upstream from my wife and children. Yes, I effectively blocked the entire aisle. That, was, in fact, my “plan a”. My intent was that, succeeding in “plan a”, I would not have to implement “plan b”, which would be accompanied by shrieking and blood, both emanating from the inattentive obliviot who succeeded in striking, and hurting, one of my children.

So, there I stood, colossus like, and, of course, one of the bovine meandered down the aisle. Finding me in her way, she spoke. (surprise!) “You are blocking the aisle!”

I smiled, a smile that in no way reached my eyes. Indeed, most of my teeth showed. “That is correct.”

She advanced, as if to strike me with the cart. I smiled wider. “You have to move! I cannot get past you!”

“Yep! That’s sort of my plan!”

She was not taking in the entire picture. “But, you have to move!”

More teeth on my part. “Well, ma’am, why don’t you just move me? If, that is, you think you will survive that encounter, uninjured?”

Unwilling to take that bet, she continued her protests. I glanced over my shoulder, noted that my charges were rounding the corner, and clearing this aisle. I waved, cheerily, and made my way to the next aisle, which I then blocked.

Soon, TDW-Mark I asked me what I was doing. I replied, “Have you noticed the folks who nearly struck the kids with their carts?”

“Yes! That is so rude!”

I agreed. “Yep. Do you know what is successful in preventing that?”

“No, what?”

“My convincing them that, yes, I am crazy enough to put a beat down on them, should they successfully strike my children! It turns out, if I look crazy enough, they shop in some other corner of the store, and my children are not gonna get struck by an idiot with a shopping cart!”

Fun And Games · Pre Planning Your Scene

Blizzard in Da South.

I did not always work for Da City. Nay, I eventually moved Up North, married, and found myself living in Cincinnati. To my disappointment, once our little family was settled in Cincinnati, I learned that they had, somehow, resolved the Nursing Shortage, raging everywhere else in our fair land.

Shit.

I contacted a travel nursing agency, and sought employment. They accommodated me, finding a placement in another, Southern city. Something like 120 miles distant from our home.

Realizing that “beggars cannot be choosers”, I gave thanks for this job, and settled in for some commuting. Conveniently, the hospital needed a unit nurse, and I had, indeed, worked as a unit nurse. In addition, adding to the convenience, TDW-Mark I worked Monday to Friday 0900 to 1700, and the hospital needed somebody to work weekends. Score!

Therefore, I motored my way to work, and worked my 12 hour night shift. They had a need on 3-11 (or, more precisely, 1500 to 0300) the following day, and I volunteered to work it, if I could avoid working until 0700.

They were agreeable, and, indeed, I could work 1100 to 2300, and go home Sunday night, around 8 hours early. Worked for me!

One weekend, I headed for home immediately ahead of a storm that swept in from the west, chasing me back to Cincinnati. I got home as the flurries materialized. I am from Northern Un-Named Midwestern State, so snow, meh? Nothing I haven’t seen before.

We awakened the following morning, and found ourselves in a low budget winter wonderland. Maybe an inch of accumulation, dusting in the trees. This being not-the-snowy-north, well, let’s just say that the snow management infrastructure was, well, lacking. They closed everything, and the evening news talking heads breathlessly filled us all in on the Horrible! Disaster! That the snow had occasioned. (yawn!)

Being an Amateur Radio Operator (“a HAM”), I listened in to the wide area repeater, taking note of the communications supporting shelters for those who could not stay home (for reasons that I did not understand), as well as other disaster relief communications.

The week passed, and my next fun filled weekend fighting disease and saving lives (betcha were wondering if I was gonna work that one in there, weren’t you?) arrived. I loaded up the truck, packed my meals, kissed the wife and kiddies goodbye, and set off into the wintry wastes.

I took just a little longer than I was accustomed to, since there were stranded tractor trailers scattered here and there on the interstate. Evidently, the snow to my west, and therefore closer to my workplace, had been more serious and more serious than atmy home. Things were not particularly better as I approached Southern City. Monitoring the local repeaters, I heard, four full days later, communications supporting shelters, (still!), as well as other, related, communications.

That malign prognostic indicator was only supported as I exited the expressway, and bunny hopped my full sized truck across nearly frame deep ruts in the frozen snow layered over the roadway.

I had lived in Da City for years on end, and had been impressed with the inattention paid to snow removal. Gotta tell you, Southern City passed them on the fly! On the other hand, the little “no snow removal infrastructure” thing might have played a role.

Pains in my Fifth Point of Contact · Pre Planning Your Scene · Protect and Serve

WuFlu, Kung Flu, Chinese Flu, or Coronavirus: It IS a big deal, but not for the reasons you likely have been told!

The number of projected deaths, when all is done, is not THE PROBLEM. At north of a million people (that’s one million, or more fathers, mothers, brothers, sisters, sons, daughters, grandfathers and grandmothers. And aunts, uncles and husbands and wives.), that is certainly bad enough. Particularly if someone you love is enumerated in that group. Life changing. Reality altering. Leaves a hole in your heart, your life, that you cannot imagine, unless you have lived through it.

BUT! THAT is not THE PROBLEM. THE PROBLEM, is the follow on effects, as a tsunami of ill inundates our already (on a good day) marginal health “system”, that it is in no way prepared for.

“Just in time” inventory systems will not bite us in the ass. Nope, not at all. Rather, the shortfalls and absent supplies will make us yearn for simply being bitten in the ass. Indeed, the “bite us in the ass” problem will more closely resemble the “bite in the ass” one might receive from a hungry great white shark, or, maybe, a ravenous tiger.

Ragarding the magnitude of THE PROBLEM, you need honest numbers, and then you NEED TO UNDERSTAND THOSE NUMBERS! See Lawdog’s blog, here , for an explanation of testing error (false positives/negatives, and the implications thereof).

See Aesop’s articles, here, for his description of the second order effects, and how it will make a clusterf…er, HUG! look like a picnic with your Bible study group. I do not know about timing, but, based on 30 + years as an ER nurse, and a dozen as a PA, and several as a medic, well, his assessment of effects is certainly defensible. I pray he is wrong, but I do NOT believe that he is wrong. (While you are there, read his other posts, about the follow on effects, about how this has been mishandled since, oh, 20 or more years ago, and about missed opportunities).

(and, READ HIS COUNSEL [in other posts] ABOUT PREPAREDNESS, BOTH LOGISTIC AND TRAINING! AND TAKE IT TO HEART!)

Good fortune to you all, and WASH YOUR DAMNED HANDS! NOW, DO IT AGAIN! AND AGAIN!

Fun And Games Off Duty · Pre Planning Your Scene

Back From Vacation. I Have Stories!

I just got back from vacation (well, by the time you folk(s) see this, I will have been back for a couple of weeks, but, anyhow…) So, here are two anecdotes, serving as a sort of “Cruise: after action report”

The elevator counseled “Patience!”

TDW-Mark II and I were on a cruise, earlier this year. I had worked considerable extra shifts, in order to avoid financing this adventure. So, TINS©, there we were, soaking up sunshine and living the life, and we were attempting to take the elevator from whatever deck that we were on (say, deck 3) to Deck 14 (which would be “The Serenity Deck”, relatively quiet as well as sunny).

There were numerous other people who had a similar idea (which, on a cruise ship with something like 2,000 + passengers, is likely to be unsurprising). So, when I pressed the button to summon the elevator, there appeared, after some time, to be no response. I again depressed the elevator call button, and was surprised to hear a typical robot like female voice emanating from the elevator, counseling “Patience!”

TDW was very, very amused.

Departure elevator lobby Hide and Seek

TDW-Mark II is, well, petite. At the end of the cruise previously mentioned, we arose early, got out crap together, and joined the lowing herd stampeding towards the gangway. As we were on a middle sort of deck, well, all the folks who had arisen around the same time as we had, and were on upper decks, well, the elevators were full up by the time that they arrived at our floors. (I, of course, lacked the insight that, should we enter the elevator ON THE WAY UP, well, we would ALREADY be on that elevator, once the upper floor folks tried to join us. Alas, THAT insight, however useful it might have been at the time of departure, did not occur to me until, well, just now. Good timing.)

In any event, soon there would arrive an elevator with space for one of us, but not both. After several such events, I directed TDW-Mark II to enter the next elevator, and I would join her downstairs once I myself became the room-for-one-more elevator passenger.

Great plan. Well, except for one issue. Recall that my wife is petite. Consider one readily foreseeable result of lots of people deciding that RIGHT NOW would be a good time to depart, luggage in tow. Yep, I arrived on the departure deck, waited for the crowd to move so far as to allow me to exit, and did not see my wife. She called to me, and I heard her, but could not place her in the lowing crowd.

I decided that this problem resembled the childhood swimming pool game of “Marco Polo”, wherein contestants were forbidden the use of their eyes, and had to find, and tag, other players. “It” would elicit calls from the other players, by calling out “Marco!”, requiring the others to respond “Polo!”.

I implemented my solution. “Marco!”, I called out.

“Polo!” responded TDW-Mark II. I placed her across the lobby, but still could not see her.

“Marco!”

“Polo!”. Ah, there she was, hand a-waving. We “swam” through the crowd, meeting just a little ways “downstream”, and therefrom making our way past checkout, and on to Customs. The rest of our trip home was uneventful, except for the guy who, in the left hand lane of the expressway, decided that he had to exit RIGHT FUCKING NOW!, and swerved, abruptly, across three lanes of traffic and onto the off ramp. Fortunately, it appeared that the other drivers had experienced this sort of shenanigans before, as they braked, and nearly seamlessly allowed Mr. Late Decider off the expressway, and out of our lives.

But, except for that, it was all good.

Fun And Games · Pains in my Fifth Point of Contact · Pre Planning Your Scene · School Fun And Games

Paramedic School Stories, Part Two:

Which brings us to STORY NUMBER TWO: (remember the grading scheme outlined last week) In the fullness of time, the second semester ended. I calculated the point total for each student, compared said total to the pre established thresholds for each grade, and, based upon this calculation, assigned grades.

I posted these grades, after turning them in to the program director, who was my immediate superior.

Shortly thereafter, I received a phone call from one student, let us call her Little Mary Sunshine. She was upset at her grade.

“Mr. McFee, you gave me an A minus, and I think that I deserved an A”

“Oh?”

“Yes. I think that you should have given me an A.”

“I agree with you.”

“Oh? You are going to give me an A?”

“Nope. I agree that you think that you should be given an A. On the other hand, you earned an A minus.”

“But, I checked my scores! I only missed an A by a single point!”

I checked my grade book. Yep, needed 920 points, earned 919 points.

“I agree with your calculations. You missed it by a single point.”

“I think that you should simply give me that point!”

“How interesting. I however, do not.”

“But…but…it’s not FAIR!”

“In what way?”

“I think you should just give me that point, and then I’d have an A!”

“If I were to give you that point, you would, indeed have an A. On the other hand, you, indeed, EARNED an A minus.”

“But..but..It’s Not Fair!”

“May I ask you a few questions?”

“Uh, OK.”

“You were present in class the first day of class, correct?

“Uh-huh.”

“As well, for the midterm, and the final that first semester, correct?”

“Uh-huh.”

“Likewise, the first class of the second semester, and the mid term of that second semester, correct?”

“Uh, yeah.”

“Did you hear me talk about extra credit, on each of those 5 occasions?”

“I suppose so.”

“And, did you speak to me one solitary time about any sort of extra credit of any sort?”

“But…but…I never imagined that I’d need any extra credit!”

“Yet, here we are. Had you turned one solitary extra drug card, and the only things on that drug card that were correct were your name, the brand name of the drug, and the generic name, you would have earned that extra point. You did not do so. If you do not care about your grade that much, why should I care any more than you demonstrably do?”

Sometime later I received a call from the director of the program, who asked me about Little Mary Sunshine’s concern. I related the conversation, as related above, and summed up: “Bob, it’s your program. You run it, you are responsible for it. If YOU want to give her that A, go ahead. Simply understand that I will not be signing any other grade form for her. You want to do it, be my guest.”

I heard nothing further on that topic.