Fun And Games · Pains in my Fifth Point of Contact

BEFORE GOOGLE

Gather ’round, my children, and listen to a tale of long ago, and far away! In those far away, long ago times, there was electricity, yes, and telephones as well (although they were anchored to the walls of our homes, by “wires”). Why, indeed, we even had the Goddam Noisy Box, which you young ‘uns call “TV”.

Once upon a time, I was volunteering at a free clinic, serving as a nurse therein. The volunteer physician would interview, and examine the patient, and then provide orders for the treatment indicated. In those days, should one have symptoms of gonorrhea, the therapy was two injections of procaine penicillin g.

This turned out to be around 3 cc each, of a very, very viscous fluid, made particularly slow flowing because it was kept in the refrigerator.

At this point, I had been an RN for several years, working full time in ER. I had administered many, many, many injections intramuscularly as well as intravenously. I was familiar with injections, as well as strategies to mitigate patient discomfort while they were administered.

So, one gentleman was diagnosed with gonorrhea, and I received an order to administer two injections of 2.4 million units, each, of procaine penicillin g. I secured the medication, verified it’s outdate as well as the order, and made sure that the other medications the patient took, as well as his allergies, did not contraindicate this treatment.

I entered the room, and checked that the patient had been told of our plan of care. His reply? “Doc, doc, just shoot it on in!”

I informed him that he did NOT want me to “just shoot it on in”, and he would very much not enjoy the result of my doing so.

He reiterated his demand. I told him,” Sir? You are going to get two of these shots. You do not want me to simply ‘shoot it on in” because you will find it to be way, way more uncomfortable than it needs to be.”

Unmoved, he repeated his demand.

“Sir, how about I do as you insist, for the first injection. Then we can talk, and see if you would like to try it my way for your second shot, okay?”

He stated that he would not change his mind. I injected the first syringe of medication, rapidly, as he had insisted. It took some effort, because the penicillin was very thick, and did not want to flow through the needle at all rapidly.

My patient was very, very impressed by his first injection. Not at all favorably.

He stood up, once I had removed the needle, and commenced to hopping around and swearing. “Goddam! That really, really hurt! Shit, shit, shit! Doc, let me cool myself for a while!”

I corrected him. “Sir, I am an RN, not a physician. Once you calm yourself, you have another injection coming. Why don’t you allow me to administer it in the way that I know I ought to, and you can tell me how it is compared to the first one?”

He soon calmed himself, and I administered the second injection, steadily and slowly. The advantage of doing so correctly, oddly enough, is that the deliberate pace of administration allows the medication to spread out, rather than remaining a single, irritating ball of foreign material in the muscle, eliciting a cramp and muscle spasm. A cramp about which my patient had testified loudly.

Once I was done with the second injection, he stood, adjusted his clothing, and rubbed the second injection site. “Ya know, doc, that second one was not anywhere near as painful as the first one!”

Gooll-llee, Sergeant Carter! Just as if I had gone to school for this stuff, or something!

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.”

Fun And Games · guns · Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact

Retail Pharmacy, So To Speak

A long, long time ago, in an ER very far away, I was a night shift ER nurse.

Surprise!

So, TINS, TIWFDASL, well, uh, not so much. I and the other nurses were capitalizing upon a slow moment and gabbing away at the nursing station, when one of our security officers ran in (literally!) and announced that “We got a shooting in the driveway!”

Having heard no loud noises, I was puzzled, but, these officers were not prone to overstatement, so I asked a couple of the other nurses to grab a cart, I grabbed some gloves, and off we went to the ambulance entrance.

Now, by way of background, this was in the early days of the crack cocaine epidemic (although, how one contracted “crack cocaine” from another person without active, willful action on one’s own part is unclear to me). A couple of blocks away was what might be considered to be an open air drug market. Folks (commonly suburbanites) would drive up, engage a soul in conversation and arrange a transaction, another confederate would be summoned and the exchange would take place, money from the buyer, drugs from the vendor.

We were told that in this particular transaction, the named patient, seated in the back seat of this two door vehicle, appeared to believe that he was the designated quality control inspector. Indeed, the tale appeared to paint this fellow as believing that he ought to remonstrate with the vendor regarding the unsatisfactory nature of the product that had been delivered.

As the History Of Present Illness unraveled, the vendor did not seem to have fully committed to a “Zero Product Defect”, nor a “Every Customer Fully Satisfied, Every-time” merchandising philosophy, as, when the shootee indicated that he, the shootee, intended to enforce his product quality complaint by with holding payment, he, the vendor, is reported to have produced a handgun, and shot the shootee.

Bad times ensued. The driver, unsurprisingly, panicked, and sped away. A few blocks later, he, the driver, noticed our bright “Emergency” sign, and pulled in, bellowing an incomprehensible narrative.

So, security cleared the car of the terrorized goslings, and I (and security, and my nursing partners) tried to extricate Mr. Beenshot’s inert form out of the rear seat of a coupe, indeed, a compact coupe.

It only closely resembled a cluster fuck. For a while.

We maneuvered Mr. Beenshot into our code room, and commenced to resuscitating. Before things had progressed very far, our doc had determined that this guy had a “STAT!” transfer in his very near future, and so the nursing supervisor, who had come at a run upon our paging a Code Blue overhead, peeled off to arrange with our transfer ambulance service that they produce a crew and truck RFQ (Right F*%king Quick), and then phoned TBTCIDC to provide them a heads up.

We eventually got him stabilized (kind of, sort of), and the physician had a detailed chat with TBTCIDC senior physician. Off Mr. Beenshot went, and we sought out the entourage, intending to elicit more history, more circumstances leading up to the shooting, more pretty nearly anything, so we could provide that information to TBTCIDC, as well as, well, notify next of kin.

Alas, the posse had unassed our waiting room sometime while we were distracted, trying to save the life of their friend, I mean, co conspirator.

Fun And Games Off Duty · Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact

Tai Chi: You’re Doing It Wrong!

I recently purchased a new pickup truck. I had been pining for this truck for several years. It took me several years to drop the hammer, because I wanted to thin the herd of my indebtedness, as well as build up my “rainy day” fund again.

Having finally made my purchase, I had several accessories that I desired, and was not about to finance over 6 years. I wanted a “headache rack”, planning to mount antennae for my amateur radio (“HAM radio”), a CB, and other radios that TDW-Mark II and I employ when traveling, or weather spotting, and thereby avoid drilling holes in my shiny, new, truck. (I DID mention, I have a new truck, right?)

So, TINS, there we were, turning off Main Drag in Nearby Bigger City, preparatory to pulling into the lot of The Truck Accessory Place, when we (TDW and I) noticed a disheveled looking adult male approx age of mid twenties, standing in the second driveway of The Truck Accessory Place (hereinafter referred to as TTAP), swinging his arms, and having an animated conversation with person or persons unseen by us.

Nice.

We pulled up to TTAP, entered same (locking my truck in the process), and hailed the counterman. “So, has homeboy here been boxing with dragons very long?”

I received a puzzled look in response. “Huh?”

“See the guy out there, boxing with person or persons unseen by you and me? How long have the dragons in his mind been attacking him?”

He walked around the counter, gazed out of the window, and opined, “He doesn’t look like his mind is quite right.”

I concurred. TDW-Mark II stood nearby, hand concealed in her purse. Her purse wherein she had her sidearm. She stood so as to not obstruct my strong side draw, should that become A Thing.

Mr. Counter returned to his side of the counter, and dialed police dispatch. He described his observations, and asked for an officer to respond. I watched as the boxer bobbed, weaved, punched at unseen adversaries, moving himself toward the neighboring business.

Soon, he crossed the street (startling several drivers on that street, in the process!), and wandered off into the thicket there, not to be seen again.

It has been told that Colonel Jeff Cooper, of Gunsite and Modern Technique of The Pistol fame, was once asked, “Colonel Cooper, if you knew that you were going to a gunfight, what gun would you prefer?”

He is quoted as saying, “If I knew that I was going to a gunfight, I’d stay home!”

I like avoidance. I’m tickled that Mr Dragon Boxing, did not present a lethal force threat.

Pains in my Fifth Point of Contact

Doctor Google.

Those of you who have read more than a couple of my musings, might not be surprised to hear that I genuinely attempt to do the best for my patients that I can. It seems to me that I ought to allow you, the patient, to benefit from my two years of ADN RN school (community college), another two years of RN-to-BSN school (Bachelor in Nursing), 30 + years of experience as an RN, layered upon 1 year of Basic EMT school, another year of Advanced EMT school (ie, “Paramedic” school). All this leavened by 3 years of Physician Assistant schooling, culminating in 15 + years of clinical experience since obtaining my PA license.

Not to mention something on the order of 2,000 hours of continuing medical education, over those 15 years of clinical midlevel practice.

So, therefore, please contemplate the possibility that, when I appear reluctant to prescribe The! Z! Pak! for your stuffy nose, postnasal drip, and cough, it may not be solely motivated by the fact that I am an asshole. Indeed, it just might be because, after all the aforementioned clinical experience and schooling, I might doubt that antibiotics will successfully address your discomfort, and the alternative, over the counter course of medications that I try to suggest (in between your interrupting me every several words) will, in my judgment, actually make you feel less ill.

Jess’ sayin.

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!”

Duty · Fun With Suits!

SURPRISE!

One day, not so very long ago, I arrived at work, and went to log into the electronic medical record (EMR). Generally, there is no drama. I power up the computer, click through the labyrinth of password prompts, web pages, and suchlike preparatory to actually accessing the charts of the patients that I would see that day.

On this day, I could not access the EMR. Since I am somewhat geezerly, computers are NOT in my wheelhouse. I assumed that I had mis keyed my password, and checked it, and re entered it. No joy. I re checked it, and re-re entered it. Again no joy. The computer steadfastly ignored me.

I finally determined that I was not going to be able to cajole the computer into opening up and allowing me entry into the charts. Therefore, I called tech support. Of course, I was electronically placed into the queue, and serenaded by somebody’s version of soothing music.

Since I try to arrive early, so as to allow me to still be on time should traffic be screwed up in my commute, I placed my call around 10 minutes prior to my start time.

Something like 40 minutes later, I spoke to a human being, who took my information, placed me on hold (again!), and soon returned. She informed me, “Oh! You cannot log in, because we changed your login name!”

Now, let us consider this. If you or I were to, oh, let’s say, figure that for some reason we needed to change somebody’s log in name, you, or I, for that matter, might wonder if it would be a good idea to, oh, gosh, lemme see….. TELL A SUMBITCH WE HAD CHANGED HIS FREAKING LOG IN!

Maybe, even, before his next duty shift, perhaps?

I shared this with the young lady. “Wouldn’t that have been useful information to share with me?”

She had no reply.

I thanked her for her time. I turned to the floor staff, and announced that I was, at last, logged in. I observed to my colleagues, “If only, if only, I had provided my personal e-mail, so somebody could change my log in, and, gosh, let me know!”

Pre Planning Your Scene

Reading Recommendation

https://eatonrapidsjoe.blogspot.com/2020/10/home-field-advantage-egress.html?showComment=1602787988156#c8439774302017330220

I don’t think that this guy needs *my* paltry recommendation, but, he has successfully drawn me in, and engaged me. His series-s are very, very thought provoking, in a Aesop’s “Tomorrow” sort of way. Lots of food for thought both at a “micro-economics” as well as at a “macro-economics” level.

Is your larder prepared for the presentation of spice? Metaphorically speaking, of course.

Duty · Fun With Suits! · Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact

Improvise, Adapt, and Overcome!

TINS, TIWFDASL at Medic 13, and we caught a run. Initial dispatch information suggested that this was a heart attack.

We arrived on the East Side of Da City, at the stated address, and discovered out patient was awaiting us, upstairs. The folks who were encouraging us to step right up and set to business, were pretty excited. As we arrived and entered the bedroom wherein our patient awaited us, well, we could see why.

Our initial patient survey was, to be charitable, not encouraging. The bedroom was nearly entirely filled by a double bed, and that bed was nearly entirely filled by an unbreathing human being. Unable to detect a carotid (big ass neck artery) pulse, we concluded that this soul was in cardiac arrest. Doug and I knew that there was NO WAY we were going to move this person, let alone move them down the stairs, into our ambulance, continue a resuscitation en route, and offload same at DBTCIDC.

While I started CPR, as best as I could on the bed, Doug called dispatch on the handi talkie, and brought them up to speed. “Dispatch, we need an engine company, or two, for manpower. We have a active cardiac arrest, on a patient estimated weight of 800-1000 pounds. That is a stat call.”

Dispatch acknowledged our call, and responded, “We will send you help”.

Doug and I both set to resuscitating this soul, until our help, a second MEDIC UNIT, arrived. This crew, Mariel and Don, while welcome, came nowhere near the lifting power we anticipated in ten firefighters. Doug relieved me, and I shared this insight with dispatch. “Dispatch, we need at least one full engine company, perhaps two, and we need them several minutes ago! This is a working cardiac arrest, and there is no way we can move, let alone lift, this 800-1000 pound patient!”

Dispatch informed us that that would be a chief level decision, and I was happy to buy into their decision making process. “Very good dispatch. We need our superintendent on this scene, stat. This is a patient safety issue, and our patient is in full cardiac arrest.”

The field supervisor, a captain in our division, jumped in. “Dispatch, this is shift captain (insert name here). I am on the way to Medic 13’s scene code one. They need an engine company. Please dispatch one immediately.”

Soon, a DCPD scout car arrived, disgorging two of the single tiniest female officers I had ever seen.

Right behind them came our captain. He (the captain) edged his way through the crowd of civilians (who were, helpfully enough, insisting that we simply “snatch him on up, and carry him on down to the hospital!” (while NOT climbing the stairs to lend a hand!)

Our captain surveyed the four rescuer CPR taking place, and retired to his vehicle to have a chat with dispatch.

Mariel had removed our cot from our ambulance, securing it in their rig, wisely determining that our patient, upon the floor, would fill the entire module. As she returned up the stairs, bringing every backboard strap that she could find, the first engine company arrived.

The officer of that company trotted up the stairs, took one look, and about-faced, running down the stairs. Shortly, he returned with 5 firefighters, and a salvage cover. Everybody heaved, and the cover was stuffed ½ way beneath our patient. Everybody “Ho!’-d, and it was pulled out from beneath him. Now we had a carrying apparatus, and the firefighters set themselves at each corner, Doug in one middle, me in another, Don at the head, and Mariel at the feet, and we slowly maneuvered our patient down the stairs, and into our ambulance. Mariel and I climbed in the back, Don took off to meet us at the ER, and Doug set out.

I had the walkie talkie in my pocket, and I could hear his conversation with dispatch while Mariel and I CPR’d our little hearts out. Doug suggested that another engine company ought to meet us there, and that the ER ought to be notified of our patient’s girth. Initially, they seemed unenthusiastic, until our captain suggested that either they dispatch an engine company to the ER, or the Chief of the Firefighting Division, since he, the fire chief, would be the one explaining everything to the news media.

Engine 5 met us at the ER. TBTCIDC had lashed two cots together outrigger style, and everybody moved our patient onto the cot. Once he was in the ER, our part of the show was over.

We effusively thanked our captain, as well as the fire crew.

Duty · Fun And Games · Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact

Random Thoughts, Part V

Another day, fighting disease, and saving lives. Another opportunity to consider the fact that everybody brings sunshine into my life. Sometimes, that is when an individual enters my life…….

A long, long time ago, not so very far away, Doug and I had a run on a soul very much like our “O’BEAST!” friend. That reminded me that some folks have so much misery and unhappiness in their lives, that they have enough to share with everyone around them. Or, so they appear to think!

Regarding that: any particular miserable soul provides me the opportunity to be unhappy for a half hour, maybe an hour. On the other hand, they are wallowing in their sourness, unpleasantness, hour after hour, day and night, 24/7/365. Who is worse off?

Among THAT population, are folks who appear to lack an education in The Classics. This is manifested by their diction, their articulation, as well as their vocabulary. From time to time, “Back In The Day”, we in the ED would have one (or more) of these souls gracing us for an extended time, while their livers metabolized them towards freedom. (It takes a while to detox from a high level drunk!) Such a philosopher would feel compelled to share with us all his ruminations about Maternal-child relationships, and conjecture about our particular manifestation of those relationships. (generally running along Oedipal sorts of speculations) Along with thoughts about hygiene and the value to be found in regularity, and legitimacy of parentage (or something like that).

One physician characterized one individual’s declamations as reflecting a certain “Poverty of conversational themes”.