Fun With Suits! · Sometimes You Get to Think That You Have Accomplished Something!

Teamwork!

This one time, after departing Da City’s employ, I worked for a hospital in Da City. After several adventures as a staff nurse, I was promoted to supervisor.

The way things worked, was the staff nurses attempted to untangle the problems that developed,and then punted the resistant ones to me. So, one evening I received a phone call from one of the floor nurses, relating that Mr. Man was due some coumadin (a blood thinner, used post blood clot, among other indications), and she had none in her medication drawer to administer to him.

Thinking, “This is why I get the big buck!”, I asked her, “Have you looked on the counter, and checked the medication record?”

Yes to both, no accounting for the coumadin either place.

“Did you call pharmacy, and request that they run some up to you?”

Again, yes, she had. Her explanation of why Our Friends In Pharmacy had not delivered the medication, was intriguing. “They said that it had been in the drawer when they swapped them out this morning, and they were not going to send any more up, until tomorrow.”

Puzzled, I asked, “Did they explain how your patient was going to get his medication in that circumstance?”

“Nope, simply said that they would not deliver any more.”

“Let me look around. I’ll be right up!”

I arrived on the floor, and, sure enough, no lonely coumadin on the counter in the med room, nor on the counter in the nursing station.

I called Our Friends in Pharmacy, and asked the pharmacist about the missing coumadin.

“It was there this morning, I’m not gonna send any more. Everybody knows that the nurses take meds from the drawer, I’m tired of it!”

It had been a kind of grueling night for me, and I was not in the mood. “So, let me see if I’m hearing you correctly: you are telling me that you have personal knowledge of nurses diverting medication from patients for personal use, did I hear that right?”

His reply? “Yeah, everybody knows it. It goes on all the time!”

I set my trap. “So, what have you done about this information?”

“Nothing. Everybody knows about it, nobody’s gonna do anything!”

“So, you are telling me that you have personal knowledge of medication diversions, and you have done nothing about this knowledge, did I get that right?”

“Yeah, nobody’s gonna do anything about it, so, yeah, right.”

“What do you suppose the Board of Pharmacy would think of this revelation? Tell you what, why don’t I write them a letter, documenting this conversation, and you can find out, in person, what they think of a pharmacist who has personal knowledge of medication diversion, and takes no action to end it. That ought to be very educational, don’t you think? In fact, if you are here, with the needed coumadin, before I finish that letter, perhaps I will not have to send it at all! Maybe, I could write a letter telling the hospital administrator how wonderful it is to work with pharmacists who are so very, very collegial. Bye-bye, now!”

I asked the nurse, standing next to me, if I could borrow her pen and have a sheet of paper. “What for?”

“Got a letter to write!”

“What sort of letter?”

I told her, “That depends on whether or not we see your favorite pharmacist up here with your coumadin in the next few minutes, or not!”

I heard the pounding of footsteps on the stairs, and heard his wheezing before he even reached the stairway door.

I love it when we all work together to help our patients!

Advertisements
Fun And Games Off Duty · guns · Having A Good Partner Is Very Important! · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

I Hate Late Night Phone Calls

Many years ago, I was working midnights in a small ER in northern Michigan. One night, around 0300, the phone rang. I answered it to find my wife on the other end. Her opening conversational gambit certainly caught my attention.

“Honey, it’s me. Don’t panic.”

Sounded like good advice to me. “OK, I’m not panicking. What might make me consider panicking?”

“Well, when you hear on the scanner that the sheriff is sending a car out here, I thought you’d get worried.”

Hmmm, the hospital still has coffee. Why would the sheriff send a car out to my home, populated by my wife and (presumably) sleeping children? I asked, “Why is the sheriff on the way out there?”

She responded, as if telling me about the dog getting into the trash, “There is a guy on the porch.”

Remember the guy-on-the-porch story I told y’all recently? Yeah, I certainly did. I was beginning to very much NOT like the direction this conversation was taking, so I asked her, “What gun do you have?”

“I don’t.”

This required remedy. “I’ll wait while you fix that.”

My normally clear thinking bride seemed somewhat slow this morning. “Huh?”

“Go get a gun, right now. I’ll wait.”

“What? Why would I get a gun?”

“Because I think it would be a good thing if you had something more compelling than your girlish good looks and winning personality should Mr. Porch decide that now was the time to enter, and lay hands on you and the children. Go. Now.”

Evidently Mr. Porch had decided that he did not, really, need to enter THIS house on THIS night, because this porch guy had elected to wander off before the sheriff’s deputy arrived, and before The Darling Wife felt the need for a little show-and-tell. No loud noises, nobody got hurt, Score! Score, and SCORE!

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

Haldol “Seizure”

 

While I was in my two year RN program, I was working for Da City, on EMS. Once the program director had made sufficiently clear to me that, no, I could not skip lectures, and, since it was, ya know, spelled out explicitly in the program rules that I had to show my fuzzy butt up for all classes and suchlike, well, I showed my fuzzy butt up as directed.

Of course, this meant that I was acutely-on-chronically sleep deprived. I figure that, by the time I graduated, I was on the order of 2,000 hours short on sleep, maybe more. So, entertaining things happened.

Fer instance, TINS©, one day I had arranged for one of the day shift guys to arrive at around 0530, instead of 0700, because I had clinical at 0700. Imagine my disappointment when my friend did not arrive at 0530. or 0600. I called him, he apologized effusively, and rolled in around 0630. I, of course, unassed the fire house, and beat feet towards clinical.

I probably was going around 55 when I passed the patrol car in the 35 mile an hour zone that was East Vernor. He hit the lights, and initiated a traffic stop. I, no surprise, stopped.

At this time, this was the Seventh Precinct. I had caught a run with one of these crews, probably a couple of weeks prior to this close encounter with law enforcement, for a “seizure”. My partner, we’ll call him Johnny, was medic-ing that particular night. As we pulled up, one officer was excitedly directing us to “Hurry Up! She’s seizing!”

Once we made our way into the residence, there was, indeed, a woman on the floor who appeared very much like someone in the middle of a grand mal seizure. Johnny went to work, getting vitals, and I headed off to see if there were any medication on the counter, or other indications of what might be going on.

To my surprise, as I passed her head, her eyes tracked my movements. Startled, I knelt down, and asked her, “Ma’am? What’s going on?”

She spoke (surprising, as this does not happen in an individual having a seizure), saying, “I’m having a seizure!”

Since this was my semester in psych, I had been studying (again, surprising) anti psychotic medications and their adverse reactions. Therefore, I asked her, “Are you taking medicines for your nerves?”

Yep.”

Any new ones?”

Yeah, on my counter over there.” (still tonic-ing and clonic- away). I retrieved a nearly full bottle of haloperidol, and asked her, “Is this the new medicine?”

Yeah, that’s the new stuff.”

I looked at Johnny, and we nodded. “Ma’am, we’ll get you to TBTCIDC, and they will fix you right up! Some cogentin, and you ought to be as good as new!”

The cops looked puzzled. I explained. “Sometimes this sort of medicine causes this sort of reaction. There’s a shot to reverse it, and the doc will either change her dose, or her medicine.”

For the rest of that schedule, the officers in that precinct thought I could walk on water. This was A Good Thing, as I put on my 4 way flashers, put the car in park, and exited the car, hoping to make a rapid explanation, and skedaddle so I would not be too, too late for clinical.

Once I was clear of the car, still in my EMS uniform, the officer driving the car stood up, waved me off, and said, “Oh, it’s YOU. Go on, just slow it down, willya?”

Yessir, Officer! Will do! Tenkyouberramuch!”

Sometimes You Get to Think That You Have Accomplished Something! · Uncategorized

DELAYED GRATIFICATION

 

I entered the PA world somewhat late in life. I had spent nearly 30 years toiling as a RN, in ER, as nursing supervisor and in ICU, when I decided that a change was in order.

For most of my nursing practice, I had counseled my patients that stopping smoking was in their best interests. Those that seemed receptive, got the entire “treatment”, recounting how my (now) ex wife, mother of my children, and an RN herself, smoked. I observed that, aside from marrying me (and subsequently divorcing me), she was pretty smart. In addition, she displayed a backbone formulated not from calcium salts, but rather from ordnance steel. As Mom, I am entirely in favor. (As the Plaintiff, I’m not such a fan) In either case, even in light of her own ICU experience, she persists in smoking. I shared that this illustrated that the difficulty of ceasing smoking was often understated. Worthwhile, but underestimated.

I regaled patients with this tale time after time, as each seemed receptive. I never received any feedback for these efforts. Yet, following the role of nurse as teacher, and later of Physician Assistant as teacher, as well as clinician, I persisted.

My first PA job out of school capitalized upon my years as paramedic, ER RN as well as ICU RN, and placed me in a rural hospital ER. I continued to insert smoking cessation teaching into my discharge instructions, even if I did not see it elicit any change in behavior. My nursing colleagues even observed that my time was not effectively employed, because, in their appraisal, folks would not stop smoking due to my efforts. I persisted.

One attraction of a rural community is that everybody is, indeed, your neighbor. You get the opportunity to practice community medicine, even as an ER clinician. The child whose sprain you treated last weekend, likely will be playing on the local school team alongside your own child the next. You are not anonymous, and neither are your patients.

That was brought home to me one evening, as I took my family out for dinner in our small town. It was some surprise to me, in spite of the foregoing, that our waitress approached us with the greeting, “I bet you don’t remember me, do you?” I admitted the truth, and asked how she was.

“My ankle is all better,” she prompted, and continued. “I bet you don’t remember telling me I had to quit smoking, do you?”

Again, the truth was told. She again prompted me, “You told about how smart your wife is, and how she is a nurse, but still smokes.” (THAT earned me a glare from the Loyal Opposition!) I allowed that I frequently offered such counsel, while attempting to non-verbally make nice with the mother of my children.

“Well”, she continued, “I really thought about what you told me, about emphysema, and leather skin, and throat cancers and all that stuff I was risking. I decided that I did not want to drag an oxygen tank around like my mother did. I quit smoking last week, and it is all because of you taking the time to tell me how bad it was for me!”

I responded with something encouraging, and in recognition of her own investment of energy, decisiveness, and determination, and she thanked me again and walked away to serve other customers.

I think about that woman from time to time. I realized that people will stop smoking, when they are ready to do so, for the reasons that matter to them. The only thing I can do is encourage the decision, and attempt to nudge it along.

Occasionally, I can nudge a decision. Then I must wait for the patient to make that decision, on their timetable, and for reasons that matter to them.