Fun And Games Off Duty · guns · 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!

SNIPPETS V

STORY THE FIRST

So, TINS, TIWFDASL, just a couple of weeks ago, and, as I entered the room, I was greeted by the younger of the two women seated in the exam room. “There he is! You saved my mother’s life!”

While that certainly was a welcome greeting, I admitted that I was confused. The younger woman, evidently the daughter, filled in the missing pieces. Several weeks previously, she (the narrator) had accompanied her mother (the other soul in the room while we conversed) to a visit to our clinic. She (the mother) had been having a cough of some sort, and I had felt that something in the experience did not sound right. After some assessment in clinic, I had sent the mother to ED, and those worthies had identified a 100% occlusion of one of mom’s coronary arteries (the arteries feeding the heart). Mother had received a stent, and been sent home, and was still among us. Indeed, she was here, today, due to another cough.

Thankfully, today’s cough appeared uncomplicated, and I recommended my usual measures to ameliorate the post nasal drip that seemed to be the source of the cough.

Sometimes I get to think that I really do, from time to time, positively impact people’s lives. That’s nice to think.

STORY, THE SECOND.

Just the other day, I was shopping. Such is the life of a life saving, disease fighting, internet blogging champion (of sorts). As it develops, I am middling tall: 5-7 or so. It turns out that the pasta I was hunting for was on the top shelf, and several other people had purchased some, before me. THAT meant that I could just barely not reach the boxes. I had just realized that I, a tool using animal, could open my knife and extend my reach, tipping over the needed number of boxes, and add same to my cart. That is, I had just realized it, when a gentleman, taller than I, reached up, grabbed a box, and handed it to me, asking me if I needed more.

I requested two more, and thanked him, moving forward with my shopping.

A few aisles over I observed a woman attempting to retrieve an item from a shelf beyond her reach. Before I could respond, another (taller) gentleman stepped up, retrieved the sought item, and handed it to her.

Everyday, plain folks, acts of civility and kindness.

STORY, THE THIRD

We visited my wife’s sister, and her husband, recently. They live in rural Kentucky, and it is rather a change from their previous neighborhood in Metropolis. Indeed, it is a considerable change from my table-flat neighborhood of Un-Named Flyover State.

We arrived, following the directions provided, and noted that the terrain was, well, “hilly” does not really do it justice. As a consequence of that terrain, roadways tend to meander, circling around this hill, or weaving their way up to, over, and down that ridge.

We had spent something like 45 minutes meandering , as the road took us up in elevation, when I noted a sign ahead, announcing “Curves Ahead!”.

I turned to TDW-Mark II, and exclaimed, “Wait, what? THAT was the STRAIGHT part?”

STORY, THE FOURTH: OOPS!

So, TINS, TIWFDASL, and, well, things had come to a slow down. I was working with a physician, on this day at this clinic, and she had never handled an adrenalin autoinjector. We had one handy, and I handed it to her so she could examine it.

I was not quite quick enough, to admonish her to not remove the guard, nor to handle the trigger, on the one end of the device. Therefore, she did, successfully, remove the cap, and then trigger it, sending the needle into one of her fingers, along with some of the adrenalin therein.

The Good News was that, since she was youthful, she promptly withdrew her hand, and therefore only received a fractional dose. The bad news is that adrenalin is a very, very powerful vasoconstrictor, and therefore her affected finger became very, very white, and also burned. Oh, yes, it burned. I cast about, wondering if we had any phentolamine. (an alpha blocker: used to reverse the effects of, among others, adrenalin, when injected into an end capillary bed, Like you would find in your fingers.) Since ours was not an ICU, nor an ED, we did not have phentolamine, nor anything that would serve.

The good news, such as it was, is that due to her youthful age, good health habits (spelled n-o-t s-m-o-k-i-n-g) and the fractional dose of adrenalin she had received, well, after around 20 minutes, her finger regained it’s color, the burning pain faded, and she returned to normal, simply just a bit more shaky than previously.

Subsequently, I obtained, and CONSPICUOUSLY labeled a trainer, specifically intended to harmlessly teach folks how to handle and operate an adrenalin autoinjector. This one has no needle, and no drug.

STORY, THE FIFTH

So, TINS, TIWFDASL….well, okay. I was NOT FDASL, rather, I was off, and, having accomplished all my chores (or, such fraction of “all my chores” as I was going to accomplish that day), my step son (son of TDW-Mark II) called. I had spoken to him about a range day, and he was off work that day, I was off work that day, and it was off to the range we went.

I took my Garand, my .380 pistol, and my 9 mm pistol. Of course, I grabbed the ammo can labeled 30-06 (for the Garand), .380 (surprisingly enough, for the pistol in caliber .380), and the ammo can labeled “9 mm” for, no doubt surprising, the 9 mm pistol.

Now, recall that I have been an RN for, lo, these many yeas. That I have passed uncounted thousands upon thousands of doses of medications, and double checked myself each time, so as to accomplish the “5 rights” of med pass: right patient, right drug, right dose, right route, and at the proper time. This was effected by reading the order, the med container, comparing each with the other, and then, DOING SO AGAIN.

So, we arrived at the range, uncased the Garand, and set up targets. Several dozen rounds later, we placed the rifle in the case, put the ammunition away, and took out the .380 pistol. Fun times.

When it came time to take out, and shoot, the 9 mm pistol, well, I went to the “9 mm” ammo can, opened it, and beheld something like 200 rounds of RIFLE AMMUNITION.

For those in the studio audience who are unfamiliar with Things Firearm, well, 9 mm is a pistol round, and rifle rounds are (a) the wrong size overall, (b) with the wrong projectile (bullet), propelled by (c) an entirely wrong charge of powder, leading to (d) entirely way, way more pressure once the cartridge is set off, for any common pistol to contain, meaning (e) should, somehow, a rifle cartridge be forced into the pistol that I had before me, anyone firing it, should they survive the resulting explosion, would forever after be known as “Lefty”.

Not mentioning the emotional distress I would experience should this pistol, one of my favorites, be reduced to shrapnel.

Sigh. It appears that I had horribly failed the ammunition labeling process, leading to jovial kidding from my step son. Other than that, a good day at the range.

And, the ammunition got re-(and correctly)-labeled.

Duty · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact · Sometimes You Get to Think That You Have Accomplished Something!

PARENTING STRIPES

Another blog had an entry that reminded me of one of my own parenting moments. As I recollect, Number One Son was misbehaving, and so The Darling Wife-Mark I and I imposed some limits: grounding or some such thing. We observed that a repeat performance would elicit a spanking.

He responded, “Well, I’ll just call the police!”

I smiled. Told him to get his shoes, and get in the car. Now.

We had a leisurely drive to our local small town police department. I asked if I could speak to an officer. The nice desk lady asked, why?

I responded, “This child just informed me that should he require a spanking, and I administer it, he will call the police. I simply do not want to wait. May I speak to an officer, please?”

She bade us sit, and soon an officer arrived. I introduced myself and Number One Son. The officer asked, had I spanked the lad yet?

I replied, no, not yet.

He asked, in what manner would I spank the child?

I responded, with my bare hand, since the point was not pain, nor injury, but, rather, recalibration of his behavior. Once my hand started to hurt, likely my purpose had been accomplished.

So, the officer asked, you intend to spank this child, if other measures do not change his behavior, in order to discipline him?

Yep, was my answer.

“Isn’t that kind of your duty as a parent, to correct misbehaving children? I do not see anything you are describing as actionable by me. You’re simply doing your job as a dad.”

I turned to my son, and asked, “Do you have any other questions for the nice officer?”

Duty · Gratitude · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

Jes’ Folks. Plain, Everyday Folks

Glenn Reynolds, proprietor of Instapundit, wrote an article for USA Today, nearly three years ago. Read it, please. And, reflect on who benefits when we are set at each other’s throats.

https://www.usatoday.com/story/opinion/2019/07/22/fatal-car-accident-reveals-fundamental-american-decency-column/1790753001/

I have had similar experiences, among them one chronicled here. It was as if we had our own “Insert Name Here County First Responders Association” meeting, there on that highway.

Again, this tale recalls a similar event. In this case, folks trudged their happy asses out of their warm, dry, non-windy homes, to help push a nearly (lessee: nought goes into nought… divide by zero…. carry the eight… three guzintas…) 10,000 pound ambulance out of a snow drift, at night, while it was snowing it’s freaking ass off.

So, tell me again who benefits when we are set against each other? If we are demonizing each other, how likely is it that we can ever (a) agree on a list of priority problems, (b) discuss rational maneuvers to address these problems, and (c) agree on any sort of effort to implement these interventions?

Por ejemplo, howzabout covid? Could we have discussed risk vs benefit of lockdowns, of “two years to flatten the curve” (had our governor been honest), or, even, “two weeks to flatten the curve”? Could we have had a real, ya know, two way, conversation about vaccination, efficacy, adverse drug reactions, liberty, personal autonomy (remember “my body, my choice”? Seems so long ago. Good times, eh?), risk vs benefit? Instead, anybody who speaks about any sort of disincentive to accepting vaccination, like, say, severely truncated testing protocols, or, say, known (even if small in magnitude) incidence of cardiac adverse reactions, or any of a dozen (that I can think of off the top of my head) risks genuinely presented by the extant vaccines, gets shouted down, deplatformed, or, worse, fired and hounded. So, I ask, who benefits when that happens?

In stark contrast to the Chattering Class, above cited are first person narratives of genuine Americans who, in a crisis, come together and identify what needs doing, and then, quietly, FREAKING DO IT. These folks identified one of their neighbors, identified that this neighbor was in need, and set to work. No command, no haggling, no bullshit. Simply, “How can I help?”

Tell you what: I resolve to be inspired by good examples. I will try to NOT buy into name calling, and, rather, own disagreements with others, and seek to see those disagreements as honest differences of opinion, where I am able to do so.

I resolve to try to be inspired by volunteer firefighters who interrupt Christmas with their families, in order to respond to a neighbors catastrophe.

If we open our eyes, there are uncounted examples of folks living up to their ideals, even as there are examples everywhere of those who fail. Sometimes fail horribly.

Mr. Reynolds, thank you for reminding me that most of the time, most folks simply try to get through their day, and, maybe, help their neighbor. To paraphrase his thought, I will try to let myself be reminded that, given the opportunity, most folks will reveal their fundamental decency.

Duty · Gratitude · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

Telemedicine: Threat, or Menace?

One fine day, I was at work, FDASL, and received a text from my daughter, let’s call her Brenda. She related that her second child had developed what looked like pink eye, to Brenda’s assessment. She (Brenda) had contacted whoever, and that medical soul had video chatted/e-visited/virtually visited/some other bullshit with my grand daughter, and had prescribed an ophthalmic antibiotic.

Brenda was not altogether certain that this assessment was spot on, and wanted her clinician dad’s take on things.

As you may have surmised, MY take on non patient contact, not in the same room “visits”, is not filled with much enthusiasm. There is something to the gestalt of being in the physical presence of somebody, that provides you with clues that are neither evident, nor are they provided across a video screen of any sort. (Ever smell the fruity breath of diabetic ketoacidosis? Ever smell it over a phone?)

Placing that aside for a moment, I asked for some pix. (I am aware that this amounted to the very same thing I had just, 11 words ago, railed against. Wait for it.) My grandchild’s eye appeared red, and (uncommonly in pink eye), so did the tissue surrounding her eye.

I asked if this grandchild could move her gaze left and right, upwards and downwards, painlessly. Was there any change in her vision?

The response I received was that the vision in her affected eye was “blurry”, as well as “it hurts when she looks up”.

My response text, verbatim, was, “Who is going to see her in person, in the next half hour?”

Brenda took her child to our local urgent care, which clinician, to THIS clinician’s credit, is reported to have entered the room, taken one look at my grand daughter, and turned to her mother, and said “So, I’m not going to charge you for this visit. Do you know the way to Big City Referral Hospital? Good. Do not dawdle. Go directly there, now. Yes, I mean the emergency department. Thank you. Drive safely.”

THOSE folks examined her, CT’d her, and started an IV (a process that Grand Daughter did NOT approve of!), and IV antibiotics, and admitted her for several days. The CT had revealed a peri orbital cellulitis (mild, but, nonetheless…), which responded to the medication.

She is now home, sassy, and none the worse for the experience. Take home points: Brenda demonstrates many, many of the affirmative attributes of The Plaintiff: she is smart, decisive, has a finely calibrated and high functioning “shit don’t sound right” detector, and is a bulldog advocate for her children.

I loathe “telemedicine”.

Sometimes I am both blessed and lucky. This time, to the benefit of my grandchild.

Fun And Games Off Duty · Life in Da City! · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

THE PLAINTIFF AND THE HOUSE.

Long ago, and far, far away, I was sitting in a conference room with my attorney, The Plaintiff, as well as her attorney. We were discussing asset distribution. Her attorney announced that THEIR plan was that we sell the house, split the proceeds, and ride off into the sunset, separately.

Okay, that deserves some context. We had purchased that house something like 8 months prior to this conversation, it was in 2008 (remember those days? Housing values were plummeting like a drunken frat boy off a second floor porch), and we had obtained a “zero down” mortgage. I had kept an eye on housing values, and had noted that this house was worth less than considerably less than owed on the mortgage. We also had, between us, a camper trailer that had been paid off. I suggested, instead, that she take the house (simply so our boys would have their home, in a stable manner), and I would take the camper. I added that she could then, when she deemed it proper, she could sell that house, and keep all the proceeds. Alternately, as I observed, she could consider the market, and realize that the house was worth considerably less that what was owed. In that event, I would accept no responsibility for that shortfall. And, I’d take the camper.

Her attorney was aghast. “You cannot tell me that the house is worth as much as the camper!”

I said, “No, I am not telling you that the camper is worth as much as the house. In my appraisal the camper is worth considerably more than the house, but, it is about what your client wants, after all, isn’t it?”

To make a long story short(er), I kept the house, she got the camper, and no money changed hands in this matter.

Fun And Games Off Duty · Gratitude · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

KITTEN TAILS, PART THREE

Our Cat Farm grew, as Momma Kitty joined us. One autumn day, TDW-Mark II observed Momma Kitty come onto our porch, and eat the dry cat food we had been placing out for her. TDW opened the kitchen door, on this pleasant autumn day, and verbally invited Momma Kitty to enter, and get acquainted.

Much to our surprise, she promenaded into the kitchen. She next sat herself in one of the windows, and we could not convince her to move. TDW then retrieved our travel crate for the one dog, opened it, and Momma Kitty simply walked in, settled down on the dog bed, and looked at us as if to say, “Well? Do you think you are done?”

We secured the door of the crate, and realized that we now needed to find, and retrieve, her latest batch of kittens.

TDW (perhaps, by now, y’all have realized who is the brains of this operation. And, it’s not me, apparently.) had observed the dogs lingering over a particular potion of the porch, as surmised tha the kittens would likely be located underneath.

So, we accessed the underside of the porch, TDW entered, and passed out the two kittens she found therein. The first kitten, now know as Oliver, was a wee bit, and appeared to have a lesion of some sort on the back of his neck. (this later was identified by our vet as an abscess) The second kitten, now know as Trixie (due to the black and white, “cow camo” pattern of her fur, reminiscent of TDW’s pet cow from her childhood), appeared to have some sort of mucoid material from her one eye. We wondered if the litter had been larger initially, and suspected that the stimulus to bring Momma Kitty in might have been some predator (we have raccoons about) might have attempted to clean out the litter, and these two, and Momma, survived.

We cleaned them up, as a start, and arranged for vet assessment. Oliver got an antibiotic, and his abscess resolved. Trixie was another story.

The vet could not visualize her one eye, and voiced concern that this might be a viral conjunctivitis, and have a corneal ulcer associated with it. She wondered if this would, in fact, heal, or if, once healed, she would have no vision in that eye.

So, we became cat nurses. Trixie got her eye ointment twice a day. After several weeks, she improved. And, since curveballs seem to be my lot in life, one of the other cats appeared to develop pink eye as well.

Since conjunctivitis is wildly contagious, unsurprisingly the other cats developed it. To my surpirse, only 7 of our ten cat herd did so: the three oldest appeared to miss that fun. So, we drew a kitty MAR (medication administration record), and began twice a day sick call.

The bad news was that the biggest of the kittens Was Not Having the medication administration. That led to Sumo Cat “Parenting”, which is every bit as much fun as it sounds. Particularly for those of us who bleed freely. And do not have hind claws. Fortunately, TDW, wise in the ways of Catdom, determined that should we profit from the old aphorism “letting the cat out of the bag”, and place Reluctant Cat into a sack made of two retired pillowcases, his paws and claws would be neutralized, I could immobilize his head, and she could administer the eye medicine.

To Reluctant Cat’s credit, he either did not realize that he could readily gnaw the shit out of us, or else elected to let this insight pass by, unacted upon. In either event, he improved.

The good news is that, soon, we would corral Reluctant Cat, and his escape artist sister (previously referred to as the superball, or the furry bottle rocket), and medicate them.

That task accomplished, we would administer treats, in the form of canned cat food, which they seemed to very much enjoy. Then, we would open the bathroom door, to release them and seek the next contestants, only to find that there was a feline line up, and next two would walk in, apparently unworried.

We would shut the door, medicate (and chart) these two, and provide their reward/treat. Opening the door, those two would saunter out, and the next two would meander in. Shut the door, medicate cats, treat/reward cats, chart meds, open door, those two exit, and the next one would enter and be medicated, rewarded/treated, easy-peasy.

As the kittens became integrated into the pride, one adopted our older cat. (I told of Henrietta and Max in a previous note) We were surprised to see that, once Oliver was in the pack, he appeared to adopt Olivia, from the previous litter, as if he was her “pet kitten”.

The cuteness mounts!

Fun And Games · Gratitude · Sometimes You Get to Think That You Have Accomplished Something!

THE SUNSHINE RULE: THE OTHER SIDE

It came to pass, we were open on New Year’s Day, and I was on duty. On that day, our waiting room waits were approaching 3 hours. I am not a fan, notwithstanding the fact that generally I have little control over how many folks disembark from The (metaphorical) Bus, when The Bus stops, and disgorges it’s passengers for our treatment pleasure.

As you may imagine, most of us, myself included, do not find it to be a life enhancing experience when I, or they, get to while away the hours in the waiting room, with a dozen or more unknown, snotty, feverish, sick strangers.

On this particular day, it occurred to me that I was oddly blessed. Nobody felt the need to extend my medical education with the results of their internet search, nobody “knew their body”, and, indeed, nobody KNEW! that The! Z! Pack! would resolve their woes.

In addition, nearly everybody was in good humor. Indeed, several folks made it a point to actually thank me for working that day. Specifically, literally, “Thank you for working today!”. Direct quote. No BS.

I had seen one of these folks a couple of weeks previously, and given them my stock spiel regarding treating their post nasal drip induced cough with fluids/inhale steam/Zyrtec/Flonase/Tylenol/follow with family doctor/return if worse. She told me, to my face, that “I got way better once I followed the advice you gave me. I’m still a little stuffy, and cough now and then, but nothing like when I saw you last time!” (today’s visit was for another malady).

Then there were the folks, a majority of the patients that day, who were possessed of a very robust sense of humor. On days when the wait is lengthy, my introductory spiel goes along the lines of “Hello, I’m Reltney McFee, I’m a nurse practitioner. I’m sorry about the wait, and thank you for you patience. I apologize for the abundant opportunity that you had to demonstrate your patience! What can I do for you today?”

Most folks chuckled, and those that did not chuckle, said something along the lines of “That’s ok. I’m here today because of….”

All that is to provide some particulars regarding the first two clauses of my Sunshine Rule: “Everybody brings sunshine into my life. For some people, that is when they arrive….”

Duty · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

Fighting Disease, And Saving Lives

Gather ’round, boys and girls, and let Uncle Stretcher Ape regale you with another tale of FDASL.

So, the other week, I meandered into work, safely early (or so I thought). I was just about to drop my lunch, backpack, and coat, when the overhead page alerted: “Code Alert to walk in!”

Well, that was odd. I grabbed my stethoscope, and walked out of the office, simply to be certain that I was, indeed, in the walk in. Yep, I certainly was.

One of the MAs, looking excited, directed me to the room adjacent to where I was standing.

I entered to find a flaccid child, eyes literally rolled up into her head, as the MA at the bedside was busily obtaining vital signs. She gave me hurried report: child had arrived looking unsteady, reception had twigged, promptly to my FAVORITE “vital sign”: (“Dude Don’t Look Right”), summoned the MA staff, and, well, then things got exciting.

The child, as soon as she had been laid down, had gone unresponsive, per the report I got. I auscultated, verifying presence of air movement and heart beat. Finding a radial pulse, I went to the registrar, and asked, “Where is my bus?”

She smiled, knowing how I think, and replied, “I’ve called the ambulance already”

“Outstanding!” was my reply, and I returned to the room.

As I turned around, I noticed my physician supervisor, as well as my pediatric supervisor. I gave them a brief synopsis of what I knew, and what my plan was (“get her off to ED, as soon as humanly possible”, if I recall correctly).

Soon, EMS arrived. I gave them report, as best I could, and they packed her up and skedaddled (No, that is not strictly speaking a medical term. But, it worked for me!)

I subsequently spoke with the registrar who had first contacted mom and child. She had determined, indeed, that this child very much did not look right, and had promptly summoned assistance.

The first MA to respond, had promptly identified that this was way, Way, WAY beyond our level of care, and had initiated calling EMS, RFN (Right Freaking Now), as well as the “Code Alert”.

Good call.

So, a couple of days later, my physician supervisor, along with the administrator, passed through for a weekly review of our quality indicators. Winding up their pitch, they asked if we had anything to call to their attention. Yep, I did.

I praised the registrar who correctly, and promptly made the triage call. I praised the MA who had responded, and initiated the “Code Alert”, as well as the EMS call, properly, promptly, and effectively. I wound up by stating that they deserved praise for responding appropriately and calmly in a crisis.

This is to illustrate, again, quiet people who, taking pride in what they do, strive to improve, attend to duty, and take care of business. As Heinlein said, “Take a look around you. There never were enough bosses to check up on all that work. From Independence Hall to the Grand Coulee Dam, these things were built level and square by craftsmen who were honest in their bones.” (https://thisibelieve.org/essay/16630/)

I work with these folks. I rely on their intelligence, their judgment, their engagement with what they do. As Eaton Rapids Joe noted, “You get more of what you recognize”.

Duty · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

If You Take Care Of Your People, Your People Will Take Care Of Business

A long, long time ago, in a city so very far away, I was an afternoon shift nursing house supervisor. In the course of my shifts, I would receive call offs from midnights, and attempt to discern that point at which nights would be short, and I would have to attempt to backfill their staffing.

One such evening, I had determined that nights would, indeed, be short. I started on the unit that was short, and called up. The first nurse I spoke with was the recipient of my stock spiel.

“Ms. Smith, golly, have I got an opportunity for you!”

She was amusedly skeptical. “Oh, you do? What sort of opportunity might that be, Mr. McFee?”

“Ma’am, I have the opportunity for you to make eight hours of time and a half, right this very night! What a deal!”

“What might I have to do, to earn this time and a half?”

“Why, simply keep your same assignment, and ride home in the morning glowing in the satisfaction that comes from a job well done!”

“Suppose I don’t have a ride home in the morning? I carpooled with Ms. Diaz, and she is completely uninterested in OT.”

I had an answer to that problem. “In that case, I’ll trot up there with a cab voucher for you!”

She was surprised. “Can you do that?”

“It certainly appears that I can, as I have the cab voucher right here in front of me!”

“But, I did not bring anything to eat later!”

“No problem. What would you like? We have KFC, pizza, Burger Biggie, and others not so far away.”

“But, I did not bring any money!”

“Who asked you for money? You’re working over, I will be sure that you eat, and have a way home. Any other concerns?”

“But, who is going to pay for the food?”

“Not you. Beyond that, not your problem!”

She sighed. “OK, let me call my husband. I’ll get to keep my assignment tonight?”

“Yep! I will so advise the night supervisor!”

“Thank you, Mr. McFee!”

“Ms. Smith, you are welcome. Thank you for being flexible!”

I caught up with the security supervisor, and asked him if one of his officers could make a chow run. I handed him a $20 dollar bill, asked for my change and the receipt, once Ms. Smith had her food.

The next day, I took my receipt to my boss, explained how I had negotiated coverage for night shift, and presented the receipt. She wrote out a petty cash voucher, and sent me to the cashier to get reimbursed.

Duty · Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact · Protect and Serve · Sometimes You Get to Think That You Have Accomplished Something!

Sometimes, The Pucker Could Squeeze Diamonds

So, TINS, TIWFDASL at an urgent care out in Flyover Country. It was a typical afternoon, featuring a parade of sniffles, coughs, and poison ivy. Our clinic was on the south side of the road, east of Middling Sized City, and the Big Time Big Deal Hospital And Trauma Center. In other words, to get the the BTBDHATC, one would exit our driveway, and turn west (that is, LEFT!)

Abruptly, the registrar summoned me. My MA and I walked over, to behold a limp toddler. Very Not Good!

The MA escorted the male carrying the child to an exam room, and began to collect vitals. I examined the child, discovering a heartbeat (Crom be Praised!) and spontaneous respirations. The registrar collected demographic information, and I asked the adult what had happened, prior to arrival.

“Well, he started shaking, and then he stopped. He just wouldn’t wake up, so I brought him here.”

Well, the “wouldn’t wake up” part was still descriptive of the child, and I noted that I would have to call an ambulance immediately, because this could have several causes, none of them good. Indeed, “floppy child” is right up there in my Triage Catalogue Of Very Bad Things.

The adult male paused at this. “I don’t want to send him by ambulance. I’ll take him myself!”

I was surprised. I noted, “So, you *DO* realize that several of the things that caused this, could reappear, and he could stop breathing or his heart could stop. EMS is trained and equipped to deal with those things, should they occur. You, while driving, are not, right?”

He persisted. “I’ll drive him myself”.

We directed him to go there immediately, with no delay nor detour. We explicitly directed him to exit our driveway, TURN FREAKING LEFT (that is, west), and not stop until at the ED.

He stated that he understood, and would do so.

He scooped the child up, and exited the building. I sat down to chart, as well as call BTBDHATC, in order to provide them with forewarning of the sick, sick, sick child coming their way. That is, until my registrar called me, excitedly, to report that this sunovabitch had turned EAST! (exactly away from the hospital) upon exiting our driveway.

WTAF!

I had the clerk print a face sheet, and called emergency dispatch. I related the above information to dispatch, along with my concern that a critically ill child was *NOT* being taken to the ED. I provided the street address we had received, as well as the contact information.

I next called the child protective services emergency number, to report the above. I was assigned a report number, which I charted, and my own name and contact information was taken.

Several hours later I received a telephone call, from a gentleman asserting he was from CPS. I asked him to confirm the report number, the child’s date of birth, name and address of our record. He did confirm all these details.

He queried me about the particulars of the child’s presentation. I supplied the requested information. I asked how the child was. The worker paused, and said, “Well, I am not allowed to provide information regarding an ongoing investigation, particularly one where the child in question has been hospitalized. I’m sorry. “

My response? “Yeah, it’s too bad you couldn’t tell me if the child had been hospitalized or anything. I understand. Thank you.”