Uncategorized

Self Own (or) EMR follies

It occurred to me that I have been venting, recently, on a tear about my encounters with third parties that, well, are not dazzling me with their brilliance. Perhaps, in the spirit of full disclosure and honesty, I ought to own up to a couple of episodes that tell one and all why my pencils no longer have erasers. Here’s one recent experience.

When I first encountered electronic medical records (EMR), many, many years ago, one of my precepting physicians walked me through his office’s EMR. In the course of his narrative, he observed that, “One of the follies of the EMR is that it will allow you to thoughtlessly chart very stupid stuff, easily and repeatedly. You have to be careful of that, or you will look like an idiot.”

I was reminded of that physician’s wisdom the other day. I had a gentleman in my clinic, seeking care for a sexually transmitted disease (STD). He reported that he had been notified by his paramour that she, the paramour, had been diagnosed with some STD or another, and therefore he would require treatment before another round of Happy Fun Times could be arranged.

Cool. I performed my exam, obtained the specimens required to verify the particular sort of affliction that had been visited upon him, and ordered the appropriate medications. Then I sat down to chart.

In order to save charting time, I have a pre populated template, citing various common or normal findings. I reviewed my template, preparatory to signing off on this chart and moving along to the next patient, and noted my common finding of “post nasal drip”, “runny nose’, and “sore throat”.

I corrected these entries, thinking at the time, “If you have a runny nose, sore throat, and post nasal drip because of your venereal disease, you are likely way, way too sick to be seen by my midlevel self!”

Uncategorized

Patriots Day

You may recognize it as 9-11. You may remember those who died, victims of heartless….souls.

You may remember those who died, pursuing their duty, and, doing so, gave

their last, full, measure of dedication.

Small town America, remembers.

As my youngest son says, “Respect!”

Uncategorized

Prayers: Answered!

My brother, the “Massachusetts Brother”, with whom The Momette is presently residing, encountered an affirmative ANGEL, professional, engaged, conscious *AND* conscientious, who, per his report, has arranged a Rad Onc appointment, freaking TOMORROW!

That appears to resolve THAT dilemma.

Hearty thanks for any and all prayers, presented on Mom’s behalf.

Uncategorized

AN APPEAL TO HEAVEN

My mother HAD an appointment to see a clinician at the office she had gone to for 40 or so years, and that appointment was booked for 1030 this morning 10 September.

Circa 60 minutes prior to that appointment my brother, in Massachusetts with her, received a phone call relating, as he reports it, that the insurance she has from out here, was not accepted, notwithstanding the fact (according to the insurance company out here), that “any office that accepts original Medicare will accept our insurance”.

In addition, they would not, for reasons I do not understand, accept payment by check/cash/other negotiable specie, which my brother explicitly promised.

All of which they had two ….er, weeks… to figure out.

So, my appeal. My mother needs a radiation oncologist in Massachusetts. Typically, she will require a family doctor to refer her to one. Based upon present evidence, she does not have one. To our surprise.

Do any of you know of a radiation oncologist in Massachusetts, or can one of you finagle a referral to one?

Please?

Contact me at “reltney_mcfeeatyahoo.com”

Uncategorized

Tangents.

A long, long time ago, in a Blue Hive not so very far from here, I was Fighting Disease, and Saving Lives. In addition, I was pursuing my BSN, as in my imaginings, that which I desired to do required a graduate degree, and THAT required that I earn a baccalaureate degree.

As it developed, this week’s version of BSN program entry prerequisites included physics, and so I registered for, and took, a physics class. Of course, I worked 1900 to 0700, and, equally of course, class was from 1900 to 2000. So, I played “Let’s Make A Deal!” with one of the guys from day shift. In exchange for Day Dude staying over to 2030 hours, I would stick around until 0830 the following morning, allowing Day Dude to sleep in a bit. Sleeping was an activity generally highly thought of in my circles.

I am a bit of a science dilettante, and enjoyed the academic aspects of the course. This one time, I had a question regarding the material. Once class had taken a break, I approached the instructor. Since I had to immediately scurry off to the firehouse post class (see above), I was in uniform. In those days, EMS uniform was tan shirts (think sheriff office), and forest green pants. On each shoulder was a large (think, Seventh Cavalry sized) patch proclaiming the bearer to be a part of “Da City Fire Department, EMS Division”, rockered around a large, forest green, “Star of Life” which occupied the very center of the patch. Not particularly subtle, amirite?

So, I approached the instructor. As my turn to have his attention arrived, I started to speak my question, only to be interrupted by him. “Are you some sort of forest ranger? “

Wow, talk about flight of ideas! I ignored him, and asked my question. He asked his, again. I answered him. “Nope, I’m EMS, See?”, and turned so the large patch was almost in his face. “Now, about the class….”

Fun And Games · Pains in my Fifth Point of Contact · Uncategorized

Random Thoughts III

Story “A”

You may recall my delight at marijuana legalization, correct? Because, “medical marijuana” wasn’t ENOUGH of a cluster f*&k, right? Of course, there is my recurrent delight at the discretion, great judgment, and common courtesy displayed by the genuii who stroll (nay, stumble) about, reefer fumes pouring from every fold of their clothing, if not every pore, in a nigh overpowering display of Poor Life Choices On Parade.

So, TINS©, TIWFDASL© when this braniac arrived, spawn in tow. My poor clerk registered the Named Patient (actually, plural, as in both kids), and then let me know that the chart was ready for me to lay some healing upon them. As if.

So, my first clue that Things Were Not Right, was when the nominally 3 year old child, named Adam, was sitting upright reading some (non picture) book. My second clue was that the nominally 12 year old child, was around 36 inches tall, and appeared to be around 40 pounds. And, did NOT appear critically malnourished.

I asked the reading child, “Please, tell me how old you are?”

The reply was “I’m 12!”

“How old is your brother?”

“Oh, he’s 3!”

I excused myself, and asked my clerk, “Did you know that Adam is 12, and Brady is 3?”

She looked at me, and informed me, “I asked the mother, and asked her twice, which child was which, and who had what birthday. It did not look right to me, but she repeated herself, same birthday both times, for each child. That is what I put down.”

“Well, it is wrong. Please, fix it, and double check it, all over again. Please try to sort out what else she fucked up in registering the kids, please.”

Once the clerk asked the 12 year old for his school id, the mystery was resolved.

My new Life Rule! If you are so stoned that you cannot remember your own gorramned childrens’ birthdays, and you successfully mix the TWO of them up, either stay the Fenomenon home, or WRITE IT DOWN!

Story “B”

Have you heard about Homeopathic Medicine?

What Is Homeopathy?

“Homeopathy, also known as homeopathic medicine, is a medical system that was developed in Germany more than 200 years ago. It’s based on two unconventional theories:

*“Like cures like”—the notion that a disease can be cured by a substance that produces similar symptoms in healthy people
*“Law of minimum dose”—the notion that the lower the dose of the medication, the greater its effectiveness. Many homeopathic products are so diluted that no molecules of the original substance remain.

(from: https://nccih.nih.gov/health/homeopathy )

Let’s keep “The Law Of Minimum Dose” in mind for a moment. So, I work in an urgent care clinic in The Un-Named Flyover State. It’s….quirky. Yeah, let’s go with that. So, our cleaners are some folks who are NOT from some national housekeeping chain. I do not know where the owners hired these folks from, but, well, they are, in keeping with the theme of the organization, quirky themselves.

Over the past several weeks, I have been noticing that the hand soap dispensed from pump bottles, has been appearing clearer, and clearer. Similarly, it has seemed less viscous, and less viscous, from week to week.

In keeping with these observations, it has started to require more and more pumps to elicit enough soap to, ya know, WASH MY HANDS!

One of the MA s clued me in to what is happening.

“The cleaners never pour more soap into the dispensers, they just add water. It’s free, unlike the soap that costs.”

I wondered, out loud, “What happens when it is simply only water in the “soap” dispenser?”

She told me, “I dunno, maybe, finally, they’ll buy more soap?”

I corrected her. “NOPE! We will be told, that this is the latest public health innovation! Homeopathic soap!”

Story C

A long time ago, in a county far, far away, I was working as an ER nurse. I overheard one of the clerks engaged in a telephone call.

Now in this agency, at that time, Administration did not want us providing “medical advice” over the phone. I was on board. My stock spiel, when I was trapped into answering some such call, was along the lines of “If you think you have an emergency, you ought to come to the emergency department. If you do not think that you have an emergency, perhaps your problem could wait until (the morning)(Monday), at which time you could arrange for your family doctor to address it. If you do not think that your problem can wait until (the morning)(Monday), well, at this time of night, your only option is to come in to emergency.”

I, myself, often would be the recipient of some query at that point, along the lines of “Well, how do I know if it is an emergency/can wait until Monday?”

My answer would be “You are there, you have sense (Yeah, I was lying through my teeth!), and only you can make that determination. I am not there, and I cannot see what you can see, since you are on the scene, and I am not.”

So, I heard the clerk speaking to some Brain Truster. Attempting to explain, repeatedly, how and why she could not tell him whether his laceration needed stitching. Mr. Telephone was persistent, and I could tell, from my clerk’s responses to him, that he was saying stuff like “Well it’s (insert length here) long, and about (insert depth here) deep, and it’s (insert some indicator of severity, like bleeding or suchlike here), so why can’t you tell me if it needs to be stitched?”

She finally had had her fill of his idiocy. “Sir, what color blouse am I wearing?”

“How the hell would I know what color blouse you are wearing?”

“So, how am I supposed to have any opinion worth anything about your cut?”

Life in Da City! · Uncategorized

In Review….

I’m an old stretcher ape. Started in EMS a long, long time ago, working in, and for Da Big City. Worked my way through nursing school, and eventually went to grad school, in my capacity of Official Old Fart. I’m chock full of stories, all of which begin with the obligatory disclaimer, followed by the Mark One, Mod Ø preamble: “This is no shit! There I was, fighting disease and saving lives….”

Abbreviations, Acronyms, and Terms Of Art: I tried to assemble all the esoterica in one place, for ready reference/translation to the non-medical readers. Somebody suggested that the link/page of this stuff was inaccessible for one reason or another. Here’s another go at it!

I’ll try to collect all the unusual, non-standard-English phrases and suchlike here, for easy translation.

  • BVM: bag-valve-mask. A device for introducing room air into the lungs of a     nonbreathing person, by compressing a bag, pushing the air from that bag through a one way valve into the mouth (and therefore airway) of said person via a mask. Releasing the bag allows it to self inflate, and the patient to exhale, so you can repeat the whole process again. And again. And again…
  • Carotid pulse/Artery. Large bore neck artery, main pathway for blood to travel to the brain from the heart. One on each side of the (kinda) front of the neck. High pressure. Lotsa blood flow.
  • CLOVER: (from The Urban Dictionary): Clovers believe that they are always doing the right thing, and therefore everyone should wait on them, or are basically oblivious to others’ needs.  Clovers generally believe that if someone does something that irritates them in some way that a law should be made to correct the problem – “There ought to be a law”. A Clover will always side with the police or the government no matter what egregious evil they have committed.
  • “da corridor”: the district immediately south of Da University, a sort of wrong-side-of-the-tracks “entertainment” district. An environment rich in overdoses,alcoholism, prostitution and assorted pathology. Commonly, in the spring you would notice new, young, generally female faces among the inhabitants. Towards autumn, most of those faces were absent (Ghawd, I hope that they went home!), and the ones remaining were in no way as fresh, bright eyed, or as healthy looking as they had been around 5 months previously.
  • DBCPD (Da Big City police Department)
  • HEARN: Hospital Emergency Alert Radio Network, a  VHF. radio channel employed for (surprisingly enough) alerting the hospital of pending arrival, particularly of a priority patient. 
  • Kel-Lite: heavy duty, police-style flashlights, useful for illumination, or as a bludgeon
  • RFN: Right Fucking Now
  • SBTHIDC/SBTCIDC: Second Best Trauma Hospital/Center In Da City.
  • “Stat”, “Stat-like”, or “right Stat like”, all equate to “IMMEDIATELY!”
  • TBTCIDC: The Best Trauma Center In Da City
  • TINS: This is no Shit
  • TIWFDASL: There I was, fighting disease and saving lives….
  • TLHTTIC: The Little Hospital That Thought It Could
  • “To”: (pronounced “toe”, like the digit) short for “ghetto”, as in “Life is tough in the ‘to”
  • “Wheedle-Deedle”. The sounds made by an electronic siren. See Also, “Most weird Noises From An Electronic Siren

Uncategorized

Duty in Everyday Life: A Thanksgiving Contemplation

 

Happy Thanksgiving. We live in a time of unparalleled prosperity, of unequaled safety, of plenty and a degree of freedom from honest WANT, such that the kings of centuries past could not enjoy the leisure, the security, that we, every one of us, today enjoy.

This is a gift from many sources, not the least, The Almighty. Secondarily, from our ancestors. I hope and pray that each of us continues to receive these blessings, and that we are grateful, and give thanks, for these boons that are our everyday lot.

This is a repost. From time to time I am allowed to reflect upon all the ways in which I have been blessed. This tale is among my deliberations.

I have spent a lot of time talking, directly or indirectly, about duty. I am by no means any sort of authority on the subject. I have, however, spent some time contemplating what it means to recognize DUTY, to attempt to measure up to one’s duty, to accomplish Duty, and consider what my Duty might be in this or that circumstance.

Let me tell you about a man, who went above and beyond. This is not tale of derring do, of valiant action in combat, or hazardous duty, rather it is the story of a MAN who stood up in circumstances where I could not, and went way, way out of his way to do a good deed for a stranger.

A couple of years ago, in The Maternal State, they had a sizable blizzard. Now, being in or near the northern tier of states, this should be no big deal: winter, Up North, snow, so whucking fhat, amirite?

Yeah, that is generally my go-to response. Well, lemme tell you, this was somewhat more snow, and more wind, and more nastiness than is the baseline for this part of The Maternal State. Power lines iced up, and, swaying in the wind, well, they snapped, in multiple locations. Oops, power outage.

So, my mother is in her 90’s. At this time, pretty independent, but, still, 90 plus, and on the order of 800 miles from her nearest family.

My brother had anticipated the weather, and done some internet reconnaissance. He had identified a hotel in the next town, and, calling the reservation number (remember THAT thought!), had been told that the hotel in question did have an auxiliary generator, and would be in service. He therefore had made a reservation for our mother, securing, he thought, a heated safe place for her.

He filled me in on his plan, but had no idea of how to get her from her, now unheated, house to the hotel. As you might have considered, there was NO FREAKING WAY we wanted Mom driving in this mess. I called the taxicab companies local to my mother, only to find that none of them were answering their dispatch telephones. Shit.

I phoned the local police department, and spoke with the sergeant on duty. He pointed out that while he, and the officers on duty, were certainly willing to make sure my mother made it to the hotel, well, they were kind of busy (read, “extremely”) doing, ya know, POLICE stuff occasioned by the storm, the basic level of idiocy amongst the population in general and The Maternal State in particular, and the way poor weather exacerbates the foregoing. He did not see this happening in any clinically significant time frame. Shit. Again.

I let my finger do the walking among the internet search results for “transportation services” in The Maternal State, and the Maternal County. I recalled my brother, The World Traveler (not the hotel finder) had spoken of hiring a car service to travel from The Maternal Manse to the airport, or vice versa. I called several car services, and, finally, reached one who answered his phone.

We had a lovely conversation about the weather, and how and why it seemed unlikely that I would find a taxi company who would answer their phone. He, himself, answered his own phone, only because he took this opportunity to come into the office to complete some sort of paperwork.

I told him my tale of woe, featuring my elderly mother, distant children, and so forth. He asked me for her address, and where the arrangements had been made for her accommodation. He told me that he’d swing by, check up on my mother, and give me a call with his appraisal of things. I thanked him, effusively, and awaited his call.

Something around an hour later, I received a phone call. Mom was fine. My new friend, calling me on his personal cell phone, provided me the opportunity to speak with my mother. She asked me who this guy was, and I recounted the story of my brother’s hotel efforts, and how this fellow answered his phone, which, by itself, set him apart from everybody else in her corner of the state. I told her that he could/would transport her to the hotel for heated accommodations. She thought that was a great idea, and handed to phone back to the Car Guy. Shortly, I received a call from him reporting that he had Mom, and her little dog, were on the way to The Hotel. Again, with effusive thanks, I awaited the next situation report.

I received it, and it was infuriating. It appears that the national reservation folks for The Cretin Hotel Chain (by the way, I apologize to cretins, everywhere, for maligning their good name!), (a) did not know a goddamned thing about the power status, or lack thereof, in the subject property, (b) could not possibly care less about said power status, unless somehow The Creator elected to Personally and directly intervene, in a biblical display of His power, to motivate these gormless fuckwads to pretend that they might appear to give a shit (not that they might actually do anything effective to support that pretense. Even The Creator Of All has some limitations upon His power!), (c) would happily spin any line of bullshit that might result in their establishing a reservation, and (d) if kharma actually was a thing, would spend eternity sleeping outdoors, on some forsaken ice floe, adrift on a freezing gale swept ocean of sewage, with a solitary hospital “blanket” to protect themselves from a shivering, frozen, blue demise. If Crom was merciful. Which I hoped He would not be.

You might not be surprised, at this point, to learn that the hotel had no power and no heat.

I just might, one day, tell y’all how I REALLY feel. Assholes. (and I mean no slight to assholes).

My new friend, and Mom’s chauffeur, reported his plan to personally reconnoiter other hotels in the vicinity and report back to me. He did so, and he called me: no joy. None had power, so none had heat. Shit. Again. Again.

So, my new friend drove Mom home, and, arriving and ushering her inside, put her on his phone. Mom felt OK, the house was only around 50 something which, while chilly, was only unpleasant, not life threatening. She had canned food, a Sterno stove, the food in the fridge seemed in no danger of thawing (unsurprisingly, right?), and she had several blankets for cozy sleeping.

I thanked my new friend, again, and again, and bade everybody goodbye.

I spoke to Mom later that night, when one of her neighbors, charged cell phone in hand, stopped by with a hot meal (they had a camp-stove, it seems). Mom was doing OK, the neighbor (PBUH!) came on to reassure me that his appraisal was that Mom was managing OK, and he, the neighbor, would check in on her in the morning.

The next morning, the Car Service Guy called me. He had stopped by Mom’s house, and reported that he found her reading, swathed in a blanket, drinking a cup of (Sterno stove) coffee, eating a cold bagel. He put her on the phone, and she concurred in his report. He came back on, reported that the news was predicting power would be restored in a day or two. We chatted a bit, I thanked him, again. Again. Again. And he slogged back home, driving through the ass deep snow.

I received a call the next morning. Mom was chirpily informing me that the power was on, she had had a lovely, lengthy, hot shower, was cooking a casserole to have, hot, for dinner, and presently was enjoying a hot cup of coffee, and hot muffin. Her second of the day.

So, all is well that ends well, right?

Let me tell you MY take away. God has blessed us with angels. Some we cannot see as they are spirits. Others walk among us.

One exemplar is this guy, warm and dry in his office, piddling around, grateful that he did not have to be out in the butt ugly weather afflicting his hometown. He received a phone call from Sumdood, who he had never met, from Ghawd Only knows where, spinning this tale of his mama who allegedly lived nearby, had no power, and needed somebody, NOT the caller, to chauffeur her tail to refuge. Oh, and her little dog, too!

So, did he tell me to FOAD? Did he tell me it would be a profound pain in his ass? Did he tell me it was not his job? No, no, and no. He gathered the information that would be required to conduct an in person reconnaissance of her circumstances, and promised to report back to me. He did so.

He helped Mom gather her belongings for her voyage, and drove her, her luggage, and her dog, to the local property of The Cretin Hotel Chain. Finding that my brother had been bullshitted by the dickless, hapless, shitheads at the Cretin Hotel Chain’s national reservation operation, he called me with this insight, and attempted to find alternate accommodations for my mother. Failing in this quest, he drove her home (through the awful roads associated with an awful storm in winter in the northern tier of states, mind you!), schlepped her stuff inside, attempted to assure her safety, and comfort, and called me. Again. On his personal cell phone.

Then, the next day, with the same (or worse) shitty roads, he got out of his nice warm bed, and drove to my mother’s house, again, to check on her safety. And called me with a progress report. She was chilly, but fine.

Thus far, only mentioned in passing, are the Blessed Souls that are her neighbors. She’s not their mother. They did not grow up in her neighborhood. Simply, they are NEIGHBORS, in the finest traditions of small town America. God Bless Them. They visited, in turns, several times each day the power was out, bringing hot food, visiting, offering to charge her phone (and, just so you know, it works way, way better with a charge on the battery!), and generally being guardian angels for her.

She could not have lived there alone, for as long as she in fact did, without their oversight and backup.

TL/DR summary? Somebody is setting me a good example. I resolve to try to imitate it.

Protect and Serve · Uncategorized

Patient Care Is Everywhere!

I had the opportunity, a couple of years ago, to speak with an police officer who 
personified the “Protect and Serve” mindset. An elderly, very confused 
gentleman, with a baseline mentation deficit, was brought in to the hospital 
at the instigation of the officer. 

Having been dispatched for a "welfare check", he found this soul confused, 
and in the officer's estimation, "looked sick." We evaluated the patient, and 
tried to (start to) fix his medical issues.  While waiting for the lab results, the 
officer and I chatted. The officer related to me that he was an officer, 
“not for the attorney with a 150,000 dollar car and a nice house: he doesn’t 
need me. That guy, over there: he depends on me to do the right thing. 
He is why I took that oath.” 

Once we had finished caring for the gentleman, and were ready to discharge 
him, another officer from this same (yeah, rural) department came and took 
him home, seeing him safely into his apartment.

Another occasion, same rural police department, same officer. This time he  
accompanied an EMS transport. This soul was in custody, so the officer parked 
himself outside the room, to keep an eye on his charge. During their stay, in 
the room across the hallway, was a child, who was very dubious about the 
entire "going to the hospital" thing. This officer was approached by the fearful 
child, who momentarily had his fears overcome with curiosity about a 
live-and-in-person police officer. This officer was very engaged with the child, 
producing wide eyed interest as the boy lectured the officer on the ins and outs 
of frogs, and minutiae of their lives in the wild. He (the officer) offered a few frog 
insights of his own, and the two of them had an animated conversation there in 
my ED hallway. 

The rest of my encounter with the boy was made considerably smoother, when 
the officer asked the boy, "Are you behaving for my friend Reltney?  Yeah, he 
may be a doctor (well, a PA at this point, but, ya know...), but he's pretty nice.  
Give him a chance, wontcha?"

My point? There has been come conversation of “Officer as social worker” 
becoming part of the police toolbox. This theme is not new, although it used 
to be called "walking the beat, and knowing your beat". Some officers, who 
are each a credit to their profession, have been employing that tool for a 
long time. And, in some regards, to steal a phrase from the American 
Nurses' Association, "Patient Care is Everywhere!"  Some of the practitioners 
are not formally licensed in health professions. And, some of us simply see 
it as being a good neighbor.