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“These are a few of my favorite things!”

Exhibit 1: Cleti seeking work noted excusing them for their call off yesterday. When I did NOT see them, And there is no record of any visit anywhere. And, of course, no symptoms today. (Hangover, anybody?)

Exhibit 2: Jane Doe arrives, reports (complaint). My MA elicits a chief complaint, obtains vital signs, verifies medications, allergies, medical history. Generally, as the MAs with whom I work are smart and on the game, they try to identify what, if anything, Jane Doe has attempted to manage her symptoms with, as well as how long this has afflicted Jane.

Since not uncommonly the interrogatory the MA initiates will get those ol’ neurons a’firing, and other, potentially relevant, information will bubble to the forefront of Jane’s consciousness, I will myself reiterate the allergy-medication-history-symptoms-duration-efforts to remedy these symptoms line of inquiry.

So, when you have twice assured health care professionals that you have NOT employed anything to address your sniffles, for the love of Crom, do NOT interject into my instructions, right after I instruct you to employ any of a dozen over-the-counter nasal steroid sprays, that “I have already tried Flonase!” (or whatever).

It wastes my (indeed, as well as your) time, provides you with the appearance of stupidity, and raises my blood pressure.

Item 3: (Heads Up! This is NOT a ‘sick person’ story!) If any of you have shopped for a vehicle recently, you may have noticed that nearly every vehicle in America that has four wheels and an engine, has a back up camera. My new truck, indeed, does have one.

So, TINS©, there I was at the gas station, looking for a vacant pump. This one fellow pulled away, and I noticed, as I approached the spot that he had vacated, that the woman parked at the next pump behind him had, well, let us say that she had decided to determine how far she could stretch the dispensing hose forward, and still reach her gas inlet.

I pulled in, and backed my full sized truck up, attempting to avoid replicating her hose stretching experiment. Of course, that required that I approach her front bumper closely, a fact that I observed in my (Surprise!) back up camera display. I halted, something like 6-12 inches from her bumper. I exited, and approached the pump to begin my transaction, and she looked me over, and observed, “You got kind of close to my bumper, ya know!”

I smiled, indeed, with a smile that likely even reached my eyes. “Yep. That’s why I have a back up camera, to make sure that I did not get too, too close!”

She looked surprised at that. “You have a back up camera?”

Again, as I started to pump my own gas, “Yep, sure do!”

Uneventfully, she drove away.

(TDW-Mark II observed two things: First, “When she spoke up, I pulled down my visor mirror, so I could keep an armed eye on things”. Secondly, as she and I discussed it later, she observed, “You were nicer than I would have been. I might have observed, ‘Ya know, sweetie, it’s kind of sad that the Rover brought you back here!'”)

Item 4: I have whimsical voices in my head. In this, The Age Of Da Rona, folks seeking entry to our clinic are interviewed. Those who answer affirmatively to any of several inquiries get “drive through” health care. The registrar noted the vehicle, as well as the complaint.

That leads to several whimsical moments. For instance, there is the “GMC sinus” entry. That would be an altogether new variety of sinus affliction.

Then there is the notation of the “Tan Dodge Congestion”. (Hmm. THAT’S a new model name for me!)

Or the “Silver Ram”, leading to the chorus in my head serenading me with

“City sidewalks,

Busy sidewalks,

Dressed in Holiday style,

In the air there’s a feeling of Christmas.

Children laughing, people passing
Meeting smile after smile
And on every street corner you’ll hear
Silver RAM
Silver RAM, It’s Christmas time in the city….”

Finally, Item 5: a comment in response to post at Gun Free Zone blog (https://gunfreezone.net/journalists-are-dumbasses-who-think-that-tv-shows-are-reality/)

Christopher Schwehr

APRIL 23, 2021 AT 2:04 PM

It’s known as FOCUS: Fuck Off ‘Cuz U Stupid.

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Memorial Day

May you all have a contemplative Memorial Day, full of gratitude for those who gave their last breath, to protect, preserve, and defend this experiment in self government.

Please consider this, a story of one such sacrifice.

https://www.google.com/url?sa=t&source=web&rct=j&url=https://tulsaworld.com/archive/mission-saving-mariam/article_caeece59-65cc-56a2-8558-867ee99161ce.amp.html&ved=2ahUKEwiVwujTz-3wAhVAKVkFHReVDngQFjAFegQICBAC&usg=AOvVaw1wJBISE5G8uolzvme0pfGP&ampcf=1&cshid=1622247821492

“Saving Miriam”, regarding Corpsman Chris Walsh.

I read it, and my damned allergies overcame me.

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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!”

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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