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

PROFESSIONALISM

While my divorce was unwinding, I was working midnights in the ED of Mid Sized Hospital in the Adjacent Relatively Big City. I had a seven on/seven off schedule, which worked out pretty well for the week on/week off custody schedule for the youngest two kids.

So, TINS©, TIWFDASL© (well, to be precise, I was standing in my kitchen, looking around to see what I had forgotten to pack for the night to come), when my phone rang. My darling daughter was on the line. “Hey, Dad! How would you like to come over and take a look at your grand daughter?”

“I’m always up to visit my grand daughter, as well as her mother! What’s the occasion?”

“Well, Carmen is having some difficulty breathing, and I’d like you to look at her and tell me what to do.”

“Be right over. Unlock your door!”

A couple of minutes later, I was knocking on her door, stethoscope around my neck. Brenda opened the door, and I heard Carmen wheezing from across the room. “Call the ambulance, right now!”

Brenda was unconvinced. “Dad, if we call the ambulance, they will simply take her to Local Small Town Hospital. They will simply wind up transferring her to Next Town Big Hospital. Why don’t we just drive her to Big Hospital, ourselves?”

Good time for me to collect data. “Honey, do either you or baby daddy know CPR?”

“Um, no.”

“Y’all have oxygen in your car?”

“No!”

“You guys have any way to alert Big Hospital ED that you are coming in hot with a critically ill child?”

“You know we don’t!”

“So, let’s call EMS, who do indeed know all those things, and have all those things, so that they can treat Carmen properly, hmm?”

“We’ll just drive her over to Small Town Hospital, ourselves.”

“NOW, sweetheart. Right now!”

“I just have to…”

“No, you don’t. Get your ass on the way, right freaking now, and no more delay. Now!”

As they cleared the door, I phoned Local Hospital ED, where I had been an ED nurse, and provided a heads up. “Hey, my daughter is on the way with my grand daughter, who is in respiratory distress. Under a year of age.”

“When will they be here?”

“Open your door, now!”

I locked up, and made my way to Local ED. Once there, I saw the staff meeting that was a pediatric critical child. The ED physician was in the room, my daughter and baby daddy, two ED nurses, a respiratory therapist, the lab, and a couple of other folks that I could not make out in the crowd. I spoke to my daughter, and told her that I was off to work, and I’d stop by in the morning to see how things were going.

I called my daughter the next morning, on my way out of work, and met her at the Big Hospital Peds ICU. She told me that, unsurprisingly (to me), Local Hospital had tested, x rayed, oxygen-ed, and IV-d Carmen, and then transferred her to Big Hospital, via Peds Mobile ICU ambulance. Carmen was considerably improved over last night. I could not hear any wheezing, and she appeared to breathing easily within her oxygen tent. I said my hello to Carmen, ascertained if my daughter needed anything from me, and said my goodbyes to return home, and to bed.

Carmen was discharged the following day, and Brenda had a ream of instructions, as well as the opportunity to administer breathing treatments, as well as oral medications, to an infant several times daily. As a civilian, not a nurse.

A couple of weeks later, I was again preparing for work, and, again, received a phone call from my daughter, again inviting me to visit Carmen. “Always delighted to visit. What’s the occasion, this time?”

“She’s struggling to breathe, and the breathing treatment did not seem to help today.”

I instructed Brenda to immediately go directly to Local Hospital ED. “But, they will simply send her to Big Hospital again!”

“Yep, that is entirely likely. As is the fact that they will send her in a peds MICU, with a physician, respiratory therapist, and a couple of paramedics. All of which I highly approve of. Now, get going, right now!”

I, again, met Brenda at our local ED, again Carmen was the center of a veritable staff roll call in the treatment room, and, again, that evening she was whisked as described, approvingly, above, back to peds ICU at Big Hospital.

I stopped by the next morning. Brenda greeted me. “Dad, just like you said, they transferred her by ambulance back here. When we arrived, all the ICU nurses remembered Carmen, and were crying as they brought in the vent, the crash cart, and the intubation cart. Mom was here, and, gotta tell you, I was trying as hard as I could to keep it together for Carmen. The nurses’ crying was *NOT* helping! If mom had not been here, I would have lost my mind!”

I replied, “Honey, your mom is a pretty good nurse, and she keeps her head really well in a crisis. I’m really glad that she was here for you!”

And, at that point, I did the smartest thing I had done in a while. Right then, I shut up!

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

“He Didn’t Have To Be”

Well, campers, the sun is shining, it is 40-something outside, and that means that, in The Un-Named Flyover State, it is time to start sunbathing!

Well, almost, but not quite. In any event, it is time to reflect, gratefully, on the looming advent of spring. And, that turns me back to my recent theme, gratitude and thankfulness.

In 2006-2007, The Plaintiff divorced me. It was a dark time. I had taken-for-granted (perhaps, one of our problems, right there?) that she would always be there, and that we would always work through our rough spots. I was, of course, mistaken, and the divorce provided irrefutable evidence of same.

I was immersed in depression, and found myself weeping at traffic lights, for example. (Has anybody else experienced the angst, the melancholy, pouring out of a RED LIGHT?) (uh, no? oh, ok. Maybe it was simply me…..)

It was in the midst of this self pity party, that my step daughter (who I have everywhere else referred to as my daughter, as that is how I view her, notwithstanding the fact that she has none of my chromosomes) made for me, and gave me, a Christmas gift, that I treasure to this very day.

Brad Paisley has a song, on his Who Needs Pictures album, entitled “He Didn’t Have to Be”. The narrative is a step child (in Paisley’s, and his co writer’s case, a son), who gets included early on in his single mother and (to be) step dad’s activities, and how that forms a family. My daughter copied that song, and created a slideshow, set to that song, of photographs of my children, their mother and I, as our own family formed, and grew.

I wept. At the time my daughter created that slideshow, she was, herself, a single mother, working full time, as well as going to school full time. Her child, my oldest grand daughter, had spent more than a little time in pediatric ICU. My daughter had spent who knows how many hours collecting those photos, organizing them, arranging them, including that song, knowing that it would touch my heart, perhaps knowing, even, that I *needed* that memoir.

That was the single nicest, most apt, most engaging Christmas present, that I have ever received. She gave it to me for Christmas 2007, and I played it, again, today.

Over 13 years later, I wept, again. Thank you, honey. You have touched me, again. Still.

For so many reasons, I am grateful for my children.

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

Guardian Angel, Working Overtime

So, TINS©, TIWFDASL©, working a weekend gig in a very, very rural corner of The Un-Named Flyover State. I was a mid-level in, completely out of character for me, a very, very rural hospital’s (VVRH) walk in clinic. I was working with an LPN, a woman of sense, alertness, and industry. Sometimes, Blessings are not obvious.

So, mid morning, she gave me report on Our Next Contestant. Late 20’s fellow, had complained of back pain for a week or two, and he attributed this pain to “I pulled my back, working out doors”. So, this was long about February, and in VVRH’s catchment area, it was mighty freaking cold. Snow, long about hip deep, lined the roadways, and the roads, themselves, had been plowed, and, in keeping with Flyover State Rural Road Commission Operating Procedures, had *NOT* been salted. Since everybody got their water from wells, and most of us thought that salting our water was ill advised, the roads had some sand applied, “upstream” of intersections.

I listened to the vitals, and noted her assessment that “this guy doesn’t look right”. I entered the exam room, introducing myself. He told me that he had started to hurt a couple of weeks prior, the pain in his back, described as “Like something tearing”, had increased with time, despite his employing the ever popular intervention of “ignoring it, hoping it would go away”.

Having concluded on this beautiful sunny 8º F day, that is was *NOT* going to get better, he had WALKED three miles into town, by his estimate, seeking help.

He had muscle spasm in his back, true enough, but something about his story sounded several degrees out plumb. I palpated his belly, and felt something therein pulsing away. He also reported that my pushing on his belly, made his back pain worse. I was not certain what it was, but I was pretty sure that this was way, sway above my pay grade.

I phoned the ED physician, spun my tale of oddness, and he accepted my patient. My nurse wheeled him down the hall to Emergency, and we plodded through the rest of our day.

Nearing the end thereof, the ED physician walked in my door, and told me a story, featuring my long walking friend. He, the physician, had also thought that the examination, along with the back pain, was odd, and so he, the physician, had CT’d my patient. That study revealed a honking big, seriously dilated abdominal aortic aneurysm (a dilation of some part of the aorta, in this case in my patient’s abdomen).

For those in the studio audience who are not medically inclined, the aorta is the single largest, highest pressure, artery in your entire body, running about 2 cm in the area just below your diaphragm, about at the level of your renal (kidney) arteries. Those of us who have studied the US Military’s tactical trauma care course, or have had some sort of “care under fire” training”, will have learned that, should the aorta be penetrated, either by projectile or through a rending of it’s wall, the entire blood volume of an adult male (running around 5 quarts) can empty out in something approaching a minute, plus or minus. One thing that places you at risk of experiencing that, besides the projectile-through-your-aorta thing, is having a large aortic aneurysm abruptly rupture.

Of course, in VVRH, there was no abdomino-thoracic surgery service. My friend the ED doc attempted to arrange a transfer for this fellow, only to be SOL (Surenuff Outa Luck). The roads in our corner of the state were being snowed in, and therefore ground transport to pretty nearly anywhere was not going to happen.

Doc cast his net more widely, and more widely. Adjacent State Big Time Medical Center would accept him, but, alas, we would have to figure out how to beam him up transport him there. Middling Outstate Medical Center could not accept him, since they had no vacant ICU beds, which our new friend would certainly require, assuming he survived (a) the trip, (b) the surgery, and (c) the post op period. Any one of which could end him.

Next Up Upstate Medical Center, alas, similarly had no ICU vacancies, and so, finally the physician negotiated a transfer to Downstate Academic Medical Center, who, miraculously, sent a fixed wing aircraft and critical care transport team to our little single runway county airstrip.

A couple of weeks later, I was working a weekend as was the physician in question. He made a point of strolling over , and relating the above to me, both because it was remarkable that the patient had not only survived the trip, as well as the surgery, and the recovery, into the bargain, but was home, and evidently neurologically intact. The doc knew this, because this fellow had come into ED seeking care for a sprain or some such thing, that he had newly acquired, working outdoors!

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

The “Wrecks” Story (or) How I Met My Vet

A long, long time ago, TDW-Mark I, our children, our dog and I lived basically right down the block from where I type this today. This particular tale is about the dog. The children had been allowed to name him, thinking that we would spell the name the way that they would, as “R-E-X”. However, TDW-Mark I was possessed of a considerable sense of humor (at one time…) (after all, had she not been married to me for nigh onto 20 years?). SHE determined the spelling, “W-R-E-C-K-S”. This was due to the fact that he resided in a household with adolescent males, who were, themselves, high spirited. Therefore the dog was, himself, well, energetic is a kind way of phrasing it.

So, TINS, one morning we awakened, let the dog out on his chain, and settled in for breakfast. After several hours, we noticed that the dog had not barked to be let back in, his usual practice once he had had enough of The Great Outdoors. We looked to see what was up, discovering that the chain had broken, and the dog was not in evidence.

We searched the neighborhood, finding no trace of the dog. We produced “lost dog” flyers, and mounted them at intervals about our corner of our small town. That produced no results.

After a day or two, TDW-Mark I sent me to the local police department, The County Seat Police Department, and I learned that one of their officers had encountered a dog resembling our missing Wrecks, who had been struck by an automobile, and had been transported to a local vet.

I traveled to the vet’s office, and asked after our dog.

This vet confirmed that he did, indeed, have my dog, and that the dog was surprisingly uninjured after his encounter with the car the previous evening. This was determined after x-rays and examination. I asked him how much I owed him for his care. “Nothing. You don’t owe me anything.”

I persisted. “You spent no small amount of your time, and your expertise, on a dog that you had no idea if he would ever be claimed. I get that you do so out of the goodness of your heart, and as a service to the community. On the other hand, I can pay for the care you lavished on my dog. Indeed, if you insist on thinking of it this way, you can imagine that I am paying for the other critter, that goes unclaimed, such that you are not required to pay out of your pocket, for performing a public service, simply because you can do so, and it needs doing.”

I took a deep breath. “It offends me to think that you are going to be leeched off of by some schlub. I am not going to be that schlub. If for no other reason, please take my money because you ought no be penalized simply because you are a nice guy.”

He told me, “Thank you, but, really, you do not owe me anything. Thanks for the thought, but, we are good!”

I smiled and replied, “So, in that case, here is a check for $150. The next time somebody’s dog gets injured, and they cannot pay you for their care, let me help defray the expense you incur.”

And, he has been my family’s vet ever since, going onto 25 years.

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.

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

Serendipity

One evening, I was eagerly anticipating the prospect of departing work on time. We had not turned a metaphorical wheel for something like 45 minutes, and the clock on “the clubhouse wall” promised us only 20 more minutes until we recreated a LeMans start, jetting off into the night.

So, of course, somebody wandered in. She got registered, and my MA roomed her, interviewed her, vitaled her, and got some pee to analyze for indicators of a urinary tract infection, as such were her reported symptoms.

I reviewed the vitals, allergies, meds, and past medical history, as the urinalysis machine deliberated, finally printing out it’s findings. Surprisingly, given Miss Lady’s report of frequent, urgent, uncomfortable urination, there were no white blood cells nor nitrate (indicators of bacterial source of her discomfort). What there was, was an abundance of glucose (sugar). Indeed, the machine indicated something like 1,000 mg of glucose per decaliter (100 ml, or 1/10 of a liter). That’s a lot of glucose. I requested a finger stick blood glucose test.

That read “High”, as in, too much glucose in the drop of blood tested, for the machine to measure it. The machine will register blood sugar levels as high as 600 mg/dl.

I entered the room, introduced myself, and asked, what prompted her visit tonight.

She recounted the urgency, frequency, and discomfort with urination. “I feel like I have a bladder infection!”, she declared.

“Well, ma’am, there are no indications of infection in your urine. There is, however, an abundance of sugar in your urine. This is present, as well, in your blood. Are you a diabetic?”

“No.”

“Well, ma’am, you have more sugar per ml of your blood, than is present in a similar volume of sugary soda pop. You are, indeed, a diabetic. You need to go to emergency right now, so that they can get you started on managing your diabetes. Give me a minute, and I will print out your chart so you can show the folks in ER what I have found.”

Duty · Gratitude · Sometimes You Get to Think That You Have Accomplished Something!

Maternal Update

Several folks commented, asking how my mother was doing, or wishing her, and my family, well.

Thank you, all. TDW-Mark II and I were both touched by your kindness.

Presently, she is chirpily ensconced in The Maternal State, with my brother, The Accountant. We have chatted, several times (Mom and I), and she is happier where she considers herself to be “home”, than back here in The Un-Named Fly-over State.

She has had her first radiation therapy treatment, and I await an update from my brother/mother.

And, once The Brother Who Is An Accountant has had His Way with several of God’s Children, who are NOT exemplars of “The Healing Arts”, well, THAT will be the topic of a blog post of it’s own.

A very DARK post.

In the meantime, I will attempt to figure out how to give major props to physicians, in the no shit highest traditions of Medicine, who have genuinely Taken Care of Business, to my mother’s benefit, and see if I can do so without blowing op sec.

I will simply say, they are cut from the same bolt of cloth, as the car service guy, who with no drama, no fanfare, simply do their christian best to do the right thing. (see my post of 6-28-19)

Sometimes You Get to Think That You Have Accomplished Something!

Life Happens

So, for the past year or so, my internal goal was to post a new tale roughly every week. Last week, Friday, 27 August, I did not. And, paying attention as I do (for am I not a steely eyed, all knowing, situationally aware gem of readiness?) (or, not so much. Go with that one!), I noted this fact yesterday.

First, the bad news. My mother is elderly. Indeed, she is yet stretching the “elderly curve”. Therefore, she is medically fragile, although you wouldn’t know it from a perusal of her medicine cabinet. Hell, by that metric, she’s healthier than I am!

So, early last week, let us say, she had “a medical issue”. With Brother A being an accountant, and Brother B being a factory worker, well, that leaves Brother C (that would be me!) to be the medical intermediary. Most of us might find that to be, well, distracting. Indeed, I did find myself distracted. So, while we await biopsy results, doctor office visits, in this The Age Of WuFlu, and related malarky, I work, do my household chores, and sleep, when not voyaging to Da City to visit The Maternal Unit.

All of this to say to the hundred or so guests who visit this site every week, thank you for your patronage, sorry about the skipped week thing, and I ought to have more “Sea Stories” coming up in a week or so.

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

Happy Anniversary To Me!

It was long ago, and far away, this 27 July 2017, when I first took keyboard in hand to begin to record these semi random blatherings, tales of my mis-spent youth.

Several folks have been kind enough to comment, suggesting that they have been kind enough to actually read my Tales Of The Dark Side. Others have actually **followed** my blog.

Thank you, one and all. While I had originally thought to immortalize these things fro my children, thinking that I had mis-remembered or entirely forgotten several of my own father’s stories, I am pleased that folks have found this blog, and appeared to enjoy the stories enough to read them, and, in some cases, come back for more.

WordPress reports that I have had over 11,000 views, and nearly 3600 visitors in 2020, from ten countries.

Thank you.

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

Splinting a Cat, And the Lesson I Learned….(Not What I Had Expected!)

A long, long time ago, in a Blue Hive not so very far from here, I was a street medic for Da City. (Gasp, NO! Say it isn’t so! I…I..never suspected!) I was working nights, attending nursing school days, and attempting ti triage my weekends between school projects, studying, sleep, and having a social life. Oh, yes. AND working.

So, TINS©, TIWFDASL©, and, having concluded a rollicking night of same, I entered my apartment. The building in which I lived had been built circa 1910, and had seen sporadic maintenance since then. This is particularly relevant given that I observed my cat, imaginatively named Mr. Cat, seated at my front window.

It was summer, and I had left my windows cracked. My cats had taken to lounging in the window, both to take in the scenery as well as to bask in an intermittent breeze. This was OK, until in one particular window, in which Mr. Cat had been loafing, the sash cord, which held the window open, failed, sending the window crashing closed.

Mr. Car’s “catlike reflexes” were sufficient to enable him to avoid being entirely trapped by the weight of the closed window, but he wasn’t quick enough to entirely extricate himself. His one front paw was held as if in a bear trap, and he greeted me with a look as if to say, “I say, old man, could you assist me? I appear to be stuck, and it is becoming tiresome.”

The cat-length semicircle of destruction spoke to his efforts to resolve his problem on his own.

I opened the window, and he promptly removed it, and began to clean his paw, as if dust were the only problem. When I observed that he did not appear to want to walk on it, I corralled him, sat down, and began my secondary survey.

I could not palpate any discontinuity in his bones in the affected paw, but he was very reluctant to have me confirm that appraisal with a repeat examination. His breath sounds were clear, and his heart sounds were rapid, but regular with no murmur. (Of course, how much “rapid” was kitty baseline, versus pain versus irritated cat, was difficult to discern.)

He continued to limp, and so I gathered up materiel, and set to fabricating The McFee Cat Splint. I cut out cardboard from a box, wrapped it about the injured limb, and secured it (or so I had thought) with roller gauze.

He, unimpressed, shook his injured limb until the splint went that-away, and he went this-away, and he limped off. Sigh.

I re-corralled him, and we wrestled him into The McFee Cat Splint Mark II. This version featured several wraps about his torso, so as to slow the shake-this-thing-into-next-week response that he demonstrated once I had released him. Good news? It did not head off into a far corner. Bad news? Well, howzabout YOU attempt to explain the concept of “no weight bearing” to a cat, and let me know how well that works?

Sigh.

So, we collaborated (for certain values of “collaborated”, particularly if those include one handedly immobilizing a non-compliant cat, placing a New! Improved! McFee Cat Splint Mark III upon said cat, and then, again, single handedly, securing same upon the same non-compliant cat) in splinting his foreleg, again. This version extended beyond his paw, so that, crutch like, the weight that he would usually place upon this paw was transferred to his chest wall/”armpit”.

Kinda like rodeo, without the clowns. Unless you included me, that is.

I began to put my crap away for the morning, but he persisted in not bearing weight upon the formerly trapped paw, and I soon determined that it was time for an assessment by someone who knew their way around a cat. Against Mr. Cat’s protestations, off we went to the veterinarian.

I had not, in all the excitement, changed out of my EMS uniform that morning. So, there I was, once I had registered Mr. Cat, and requested a “walk in” visit (“Be patient, no telling when a slot will open up.”), seated in one of the chairs, cat in lap, uniformed, sleepy (although, that was kind of my ground state in those days), next to a grandmotherly Black woman at the vet.

She asked me what had happened to my cat, noticing the splint he still wore, and (score!) pretty much as I had designed it. I told her the tale, truncated a bit for the waiting room retelling, and she made sympathetic noises. We conversed a bit about pets, and how they fare in our absences, and so forth, passing the time.

Her name was called, and she looked at me, and at the vet tech summoning her, and then she performed a no shit act of Christian charity. She said, “His kitty has been injured, please take him before me, I can wait a bit longer”.

If you have read more than a couple of my posts, you likely realize that I am generally a cynical bastard, a curmudgeon. I commonly have low expectations of people, and they commonly fail to meet them. This tale took place something on the order of forty years ago, and, retelling it now, I am tearing up. This woman, who I had never met, showed herself to be more giving, more compassionate, than I was. She showed me that individuals can be beacons of community, of respect, of sympathy, for folks that do not look like them. She took pity on a white guy, and his cat, because she could.

Because she was capable of empathizing with another, not of her “tribe”. And, being capable, did so.

My cat recovered from what the doctor determined to be a sprain, and lived a long and (cat) happy life.

I moved out of Da City, married, got divorced, remarried, watched my children grow, and have families of their own.

And, today, I offered a prayer on behalf of that woman, my neighbor-in-fact, who bathed me in her compassion, and for whom, today, I cried.

Ma’am, thank you for that lesson.