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Practicing Listening Skills

My father took ill, on the order of 30 years ago. He had a heart attack, and, while recovering from that excitement, was found to have cancer. Given that he was at that point in his seventies, well, it was a rough time for him, and my mother.

Now, shortly prior to these discoveries, they had moved from The Unnamed Midwest State, to The East Coast. They had been born, and met, married, and started our family in The Megalopolis. With my one brother and I living in and about Da City, and our other brother living overseas, well, my brother the contractor was not a strong candidate to help mom take care of dad, and I, the nurse, seemed better suited, occupationally, to show up out there.

So, I did so. The mortgage company did not seem likely to grant me a payment holiday. It appeared that the credit union was on this same page. Therefore, I needed to work as a travel nurse should I spend any time on The East Coast. I did so, pulling 12 hour weekend night shifts.

After I was credentialed, I was assigned to work various East Coast emergency departments, my job back at home. So, this one time, I was sent to St. Elsewhere, in some fishing town on the southern coast of The State.

I arrived early, and announced myself, asking for the charge nurse. She greeted me, and asked me if I had any ER experience.

Now, by this point, I had spent around 8 years on Da City’s EMS, and close to 7 years in ER in Da City. My answer was “Yeah, some.”

She looked me up and down, and gave me her New Kid Spiel. “This is a fishing town. We have a bunch of young guys, working hard fishing, and, when they come into port, they play hard. Now, if you get a 20 something guy, tap dancing away, can’t sit still, anxious, sweating, and complaining that he feels like his heart is about to jump out of his chest, he’s not having a heart attack. Likely, it’s cocaine.”

I nodded. “Sounds right.”

She paused. “You know anything about cocaine? Ever seen any cocaine overdoses?”

“I know some, I’ve seen a couple.”

“Where have you worked?”

“Da City, in ER. 8 years on Da City EMS before that.”

“Why am I telling you about cocaine? You were just gonna let me carry on, weren’t you?”

“Yeah. If I listened, likely I’d learn something.”

She rolled her eyes. “Here are your keys, your module is over there, get Lucy to count narcotics with you.”

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Answering Machine Message

 

So, as I may have already made plain, a long, long time ago, and very far away, I was a medic for Da City. At that time, let us be generous, resources were poorly matched to demand. This was evident in every arena, from 30 minute EMS response times, to fire responses by engine companies several first alarm districts away, to police response hours after the call originated. Even the “Public Safety Answering Point” was over taxed, and under resourced.

On one occasion, I had need to call 911, myself. Imagine my surprise when the answer was a recorded message that stated, as nearly as I can recall, “You have reached the 9-1-1 emergency center. Please stay on the line! All of our operators are busy answering other calls. Your call will be answered.” Even more disturbing, this message replayed on a, seemingly, endless loop, auguring ill for the likelihood of a prompt response.

So, fast forward a couple of years. Poor Mallory, in a fit of bad judgment, had moved in with me in my house in Da City. She lived with me for several years, all the more remarkable when you consider how difficult it must have been to live with me (ask The Plaintiff!), layered upon the fact that Mallory was an exceedingly nice woman, from the suburbs of Da City. She appeared to grow accustomed to my habit of arming myself in my own home, for I had seen the results wreaked upon folks who had not done so, and had found it unappealing.

So, this was in the era of rotary dial phones, and tape home answering machines. A rotary dial phone is kind of like a cell phone, except that it did not cost you around $100/month, did not have an answering service built in, had no internet access (“Internet? What is this ‘internet’?”), and had no “apps” with which to clutter it’s screen, In fact, a rotary dial phone had no screen, simply a rotary dial (cleverly named, no?) which, when spun, turned back to the starting position and emitted a series of clicks, that by some Black Art, allowed The Phone Company (for, in these misty past times, there was only one Phone Company) to connect you with other people, with whom you could talk (kind of like texting, with annoying sounds, emotional subtleties and intonation thrown in).

This “answering machine” of which I speak, allowed the user to record a personalized message, enticing the caller to leave a message so you could know to phone them back.

Being a sarcastic sort, I recorded the following message on my personal home telephone answering machine: “You have reached the 9-1-1 emergency center. Please stay on the line! All of our operators are busy, answering other calls. Please leave a message at the tone. Your call will be answered….eventually……we hope.” (BEEP!)

Mallory was disturbed, to understate the thing, when she called me once and encountered my (I thought) clever message. She remonstrated with me, citing copyright violations among other concerns.

I responded, “Mallory, I really, really doubt that Da City wants to take this to court either as a criminal matter or as a lawsuit. Should they do so, be certain that I will do my level best to ensure that every single television station, radio station, and newspaper within hundreds of miles of Da City, knows of the court date, and is enthusiastically invited to show up. How do you suppose Da City will appear, with their transcript read aloud, under oath, in open court, against my parody thereof? That might be very, very entertaining!”

Besides the merriment it caused me, that message also had the not inconsiderable benefit of dissuading telemarketers from bothering me!

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.

Fun And Games Off Duty · Uncategorized

Motorcycle PI on the way to the State Park

One sunny summer day,  The Darling Wife and I were on the way to a state park one of our friends had spoken fondly of. We were motoring along on one of the divided highways, and noticed that traffic had stopped.

Indeed, it had JUST stopped. We halted next to a fellow pulling a large house trailer with his station wagon (yep, true story!). He had managed to stop, likely a near-panic-stop, without leaving his lane, and well short of the supine figure on the pavement maybe 20 meters in front of him. The spilled motorcycle nearby suggested how he came to be there. Suddenly, I was VERRRY impressed with Mr. Station Wagon’s motoring skills.

Once we had stopped, and I had parked the vehicle, I noticed other motorists creeping past us, on the shoulder or between the lanes of parked cars. TDW and I were puzzled by this, thinking that, occasionally, events happened that were more important than somebody getting to their destination without delay, and some poor schmuck supine in the roadway might qualify.

I exited the vehicle, and retrieved my medic bag. I suggested to TDW that she pay attention to traffic, and phone it in to the local sheriff/fire department/EMS/Etcetera, while I sorted out the scene. She interrupted her tirade about “stupid mother flatterers”, or something that sounded kinda like that, to acknowledge my comment, and took up the CB microphone when a trucker asked what was happening.

Once I had walked up on the scene, one individual was kneeling at the supine person’s head, immobilizing him, and announced, “I’m an off duty firefighter!”

I replied, “I’m a physician assistant, an ED nurse, and former paramedic.”, and began to size up the situation.

Another person presented herself, and announced she was an ER nurse. I suggested that vitals would be really nice, and handed her my stethoscope and BP cuff.

Yet another person arrived, asking, “Can I help?” I suggested a pen and paper would be good, to write down the vitals for the responding medics, and this soul took off, returning with a notebook and pen.

Yet ANOTHER person arrived, announced that he was a National Guard medic, and everybody introduced themselves. Again. He was detailed to arrange for scene security, so that no impatient retard could creep/blow through the scene and sweep us all up like last week’s dust. He grabbed a couple of other bystanders, and made it so.

I started a secondary survey, looking for unseen bleeding or fractures. I found none, and about that time the first firefighter/Medical First Responder arrived. The nurse and note taker provided him with vitals, and I provided my summary of the survey.

I gathered my stet and cuff, and retreated to the car, where TDW awaited. She had news for me, relating to the 18 wheeler behind us, that I now noted to be jack-knifed across all lanes of traffic. It seems that he was the trucker asking about what was happening. She told him about the “special” souls intruding into the accident scene with their cars. She quoted him as observing, “So, ya know, I can fix that!”. The next thing she beheld was this truck turning from the extreme right lane of traffic, until his cab was nosed against the median rail, and his trailer was into the right hand shoulder.

Sure slowed down the jackwagons. Nicely done!

Once the medics had packed up Mr. Dumpedhisbike, and moved along, and the fire department had moved the motorcycle, we were free to resume our journey. TDW observed, once we were mobile, “Ya know, I see again why you pack all that stuff into your trunk! Sure comes in handy, from time to time!”

Having A Good Partner Is Very Important! · Life in Da City! · Uncategorized

History Lessons

Long ago, and far away, I was FDASL © in Da City. On EMS, when I was partnered with Doug, things were generally smooth, as he was a great partner, had his head in the game, and we worked well together. In addition, he was a genuinely nice guy.

We took turns medic-ing, and driving. One night, Doug was driving, and I was doing patient care. Well, TINS ©, Doug and I were out on a scene, with a gentleman who was some variety of sick. For some reason, now lost in antiquity, this soul felt compelled to deliver an oration on the subject of The History Of Oppression Of People Of Color (such as himself), By The Blue Eyed Devil (that would be me).

He had pretty much completed the review of Prehistory, The Roman Empire and Oppression, and was beginning the preliminary discussion of Black Folks Being Oppressed In The Middle Ages, when he stopped for a breath. Turning to my partner, himself of The African Persuasion, our patient invited him to participate in my education. “Ain’t that right, Bro?”

Doug looked at this person, as if he had just discovered a new species of insect, and responded. “Sir, ya know, if I were you, I’d speak a little more nicely to my partner, here. Me, I think you’re an asshole, and just as soon as my partner has had enough of your shit, well, we’re out of here.”

My tutor turned to me, goggle eyed. I smiled, and (just as if I really meant it) I said, “Uh, sir? Weren’t you just about to tell us what sort of sick you were, and whether you wanted us to take you to the hospital?”

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Lawdog nails it.

https://thelawdogfiles.blogspot.com/2018/03/meditations-on-death.html

READ THIS.

Mr. Dog understands Duty, and Honorable actions. A week or two ago, I heard a police officer interviewed on the radio, talking about law enforcement response to active shooters.  It went something like this: You hear bad noises.  Go to where the noises are coming from, and make it all stop. Period.

After Sandy Hook, within my family we discussed What Should We DO? I looked at my wife, she looked at me, and we agreed:  armed hall monitors, like in Israel.  I was asked, “How are the schools supposed to afford that?”

We answered, “Well, for 4 days a week, when she and I are not at work, my grandchildrens’ school will not have to worry about that expense. ”

“Do you think you will kill an armed intruder, intent on shooting students?”

My answer, “I sure as hell hope so! In any event, said intruder will have something to worry about, other than which is the next helpless victim.  I am confident I’ll fuck up his attack plan.”

I was told, “You’ll simply get yourself killed.”

My reply:  “That is possible, may be likely.  Can I not measure up to the courage of the teacher who died, sheltering other people’s children, with her own body? If I fix him in place long enough for the responding officers to END HIM, will my death have been in vain?”

Could it be, that my wife and I are the only parents/grandparents/neighbors who would volunteer for such duty?

I cannot believe that.

Mrs. Clinton’s child was protected, in school, by men with guns.

Mr. and Mrs. Obama’s children were protected, in school, by men with guns.

They are not alone.  Politicians’ children are protected by men with guns. (d)s, as well as (r)s.

Are not your children, your grandchildren, as worthy of protection as theirs? As anyone’s?