Duty · Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact · Protect and Serve · Sometimes You Get to Think That You Have Accomplished Something!

Sometimes, The Pucker Could Squeeze Diamonds

So, TINS, TIWFDASL at an urgent care out in Flyover Country. It was a typical afternoon, featuring a parade of sniffles, coughs, and poison ivy. Our clinic was on the south side of the road, east of Middling Sized City, and the Big Time Big Deal Hospital And Trauma Center. In other words, to get the the BTBDHATC, one would exit our driveway, and turn west (that is, LEFT!)

Abruptly, the registrar summoned me. My MA and I walked over, to behold a limp toddler. Very Not Good!

The MA escorted the male carrying the child to an exam room, and began to collect vitals. I examined the child, discovering a heartbeat (Crom be Praised!) and spontaneous respirations. The registrar collected demographic information, and I asked the adult what had happened, prior to arrival.

“Well, he started shaking, and then he stopped. He just wouldn’t wake up, so I brought him here.”

Well, the “wouldn’t wake up” part was still descriptive of the child, and I noted that I would have to call an ambulance immediately, because this could have several causes, none of them good. Indeed, “floppy child” is right up there in my Triage Catalogue Of Very Bad Things.

The adult male paused at this. “I don’t want to send him by ambulance. I’ll take him myself!”

I was surprised. I noted, “So, you *DO* realize that several of the things that caused this, could reappear, and he could stop breathing or his heart could stop. EMS is trained and equipped to deal with those things, should they occur. You, while driving, are not, right?”

He persisted. “I’ll drive him myself”.

We directed him to go there immediately, with no delay nor detour. We explicitly directed him to exit our driveway, TURN FREAKING LEFT (that is, west), and not stop until at the ED.

He stated that he understood, and would do so.

He scooped the child up, and exited the building. I sat down to chart, as well as call BTBDHATC, in order to provide them with forewarning of the sick, sick, sick child coming their way. That is, until my registrar called me, excitedly, to report that this sunovabitch had turned EAST! (exactly away from the hospital) upon exiting our driveway.

WTAF!

I had the clerk print a face sheet, and called emergency dispatch. I related the above information to dispatch, along with my concern that a critically ill child was *NOT* being taken to the ED. I provided the street address we had received, as well as the contact information.

I next called the child protective services emergency number, to report the above. I was assigned a report number, which I charted, and my own name and contact information was taken.

Several hours later I received a telephone call, from a gentleman asserting he was from CPS. I asked him to confirm the report number, the child’s date of birth, name and address of our record. He did confirm all these details.

He queried me about the particulars of the child’s presentation. I supplied the requested information. I asked how the child was. The worker paused, and said, “Well, I am not allowed to provide information regarding an ongoing investigation, particularly one where the child in question has been hospitalized. I’m sorry. “

My response? “Yeah, it’s too bad you couldn’t tell me if the child had been hospitalized or anything. I understand. Thank you.”

Fun And Games · Life in Da City!

RANDOM THOUGHTS, INSTALLMENT NUMBER VIII

@The other day, my MA gave me the typical “thumbnail” report of my next patient. “(sick person of some sort”), (vitals), ….And, you know, he’s older.”

This particular soul was born TEN YEARS after I was!

@ROBOCALLS: I receive telephone calls, from time to time, from unknown numbers. Almost every one is from some computer dialed bullshit. My practice is to say “Hello”, and then begin to count ten seconds. If there is no human being on the line by then, according to my (it’s a robo call: I’m not particularly patient) timer, I hang up.

If there is some human on the line by then, they have, maybe, ten or fifteen seconds to convince me that I have any interest whatsoever in speaking to them.

And, if it’s one of those “we need to speak to you about your computer repair the other day” idiots, it depends: if I’m feeling froggy, I may stay on the line simply to trifle with them and waste their time. If I’m feeling curmudgeonly (which, to be honest, is most of the time), I hang up. In mid word.

OVERHEARD THE OTHER DAY:

Joe-Bob arrives, asking if he could get the work note written for Cletus. The clerk inquired after Cletus’ last name. Joe-Bob did not know Cletus’ last name.

She asked if Joe-Bob knew Cletus’ date of birth? “Nope.”

Cletus’ phone number?

“Nope.”

Cletus’ SSN?

(surprisingly/sarc) “Nope!”

Did Joe-Bob know the date of the visit which elicited Cletus’ work note?

(say it with me, now…) “Nope.”

She wrote down *OUR* phone number, and suggested that, once Joe-Bob rejoined Cletus, perhaps he, Joe-Bob, could invite him, Cletus, to telephone us, and at that point arrangements could be made.

@ Life Lesson: A lesson learned from hard experience: No matter how frequently you look at your watch, in the middle of an awful shift, it is still 3 o’clock!

Life in Da City! · Pains in my Fifth Point of Contact

The Sunshine Rule, Revisited

As you may recall, my go-to principle is that everybody brings sunshine into my life. Sometimes, that is when a soul arrives……

So, TINS©, TIWFDASL© one sunny Saturday morning, and my very first child of Ghawd rolled his eyes when I asked, “do you have any allergies to medication?”, which is part of my Mark I-Mod Ø interview question set.

My inattentive friend responded, “Of course I have allergies! My nose has been stuffy and runny for a week!”

I tried it, once more. “Do you have any MEDICATION allergies?”

“I dunno”

(sigh) “Are you taking any prescription medication?”

“Yeah….”

“Can you tell me what medication you are taking?”

“Nope. Cannot remember.” (eye roll)

I concluded that further interview would waste my time and annoy this gentleman, further. And so, a surly exam followed.

COMMENTARY: Simply so you know, IDGAF what you are allergic to, nor do I care what medication you are/are not taking, despite your physician’s goading, instruction, entreaties, or hectoring.

I *DO* care, very much, that I do *NOT* prescribe prescribe a medication that will cause your immune system to turn you into a fireball. Similarly, I really, really do *NOT* want to prescribe a medication that, in concert with whatever the (expletive) you are, indeed, taking, will perhaps form a binary explosive in your bloodstream. Because you could not/would not tell me whatever else you are, indeed, taking.

So, to me, this sort of thing is kind of important. Please, try to keep up.

Fun With Suits! · Pains in my Fifth Point of Contact

My resume is on Indeed. Read it!

The other day, I received an emailed solicitation to work as a locums. I *have* worked as a locums, and it worked out OK for me at that time. By way of scene setting, I have worked ED and urgent care as a PA, NOT as a neonatal provider of any stripe.

(paraphrased) “Hello from Erewhon Locums Company! With our national reputation for placing the right provider, in the right position, we are looking for a provider to fill the opportunity described below!

Job Highlights: 

  • Location: (some other state)
  • Specialty: Locum Nurse Practitioner
  • 7/18/2021 – Ongoing
  • Will Wait for (some other state) License / BC
  • Schedule includes day and night hours. Usual shifts 8am-5 pm, 5pm-8am or 24 hours- a combination could be required based on needs of service. Weekends and holidays required as needed. No call required.
  • Procedures Required: Intubation, umbilical lines, PICC placement, lumbar puncture, reservoir taps, thoracentesis, exchange transfusion
  • EMR System: (Infernal EMR)

Why Erewhon Locums?

  • $1,000 referral bonus opportunity
  • Personal travel and housing concierge 
  • Dedicated support specialist for payroll 
  • Experienced credentialing team 

My e mailed reply:

Well, yes, it is a great match, aside from the fact that I’m a PA, not an NP, that I am no sort of neonatal practitioner, none of the procedures listed is in my skillset, and that I will not work in (other state) for any amount of money that you are likely to pay me. 

But, other than that, yeah. Great fit. 

Duty · Life in Da City! · Pains in my Fifth Point of Contact · Protect and Serve

Two More Tales

Once upon a time, Da City was “The Arsenal of Democracy”, heavily industrialized, and a place where a reasonably hard working high school graduate could graduate, and, within a year, have a solidly middle class lifestyle working in a factory. One auto company had established an industrial complex just outside Da City, and on an island in this complex, had established forges, stamping plants, and coking ovens. Even across the river, the smell had to be experienced to be believed.

I worked with one guy, back on EMS, who had worked, pre-fire department, for one of the private ambulance services. They had caught a run for some emergency or another on this island, and, this being the days of 24 hour shifts, my friend fell asleep, letting his partner, who was driving, take care of things.

He related, “I was awakened when the ambulance stopped. I looked out, at the gas flaring off, and the chemical smell of sulfur heavy in the air. The area aroiund us looked like a hellish war torn moonscape, and I thought, “Oh my f@@king Ghawd! He’s wrecked the ambulance, I’ve died, and this is Hell!”

Another story, from a slightly later time, had me working with Doug and Rob, at a house in the far western area of Da City. We were dispatched to an assault, and met the cops on the scene. Upon entering the house, a gentleman (looking to be something like 6 feet and some change tall, probably running probably 220 pounds) reported that the woman of the house, who, herself, looked to be like 5 feet 2 inches, maybe 120 pounds, had assaulted him, striking him with her fists. He reported that he needed to be “checked out” due to his (non evident) injuries. She interjected that she had not assaulted him, he had, rather, assaulted her (and inflicting no perceptible injury in that process). He responded, loudly, and it was on. The Great West Side Debating Society Quarterly Meeting began.

While “the adults” were yelling etc, I noticed, in corner of the next room a perhaps 5-7 yo little girl, crouched in corner, mouth open, fists clenched as in a silent scream. While cops refereed “the adults”, I crouched down in front of child, attempting to verbally soothe her. One female officer noticed, and came over. I introduced the officer to the child, “This is my friend, Officer Evans. She would like to talk to you for a while. Is that OK? She, and the rest of her friends will keep you safe.”

We disengaged, everybody signed no transport forms, we went in service. As Rob finished the trip sheets, he paused, and commented, “You know, I think we may have just witnessed a watershed moment in that little girl’s life.”

Bastard. I fear that he was right.

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

“Show Me Some Teeth!”

One afternoon, I came in to my shift as a nursing supervisor, and the director of nursing had, it appears, JUST finished receiving a phone call asserting that somehow, the hospital staff had lost some patient’s dentures. Of course, I was the High Value Target in that particular free fire zone, and I caught the assignment. “McFee! You find out what happened to this patient’s dentures! Do not rest until you find them!”

I promised my best efforts, and was reprimanded. “I do not want your best efforts! I want you to show me some teeth!”

Uh, Ok. Yes ma’am!

I inspected the patient room, freshly cleaned by housekeeping. No dentures. I went to billing, the keeper of the valuables, and searched for property that had remained unclaimed. No dentures.

I interviewed our laundry folks, and inquired regarding foreign objects in the washer or drier. No dentures.

I inspected the patient intake form, cataloging the patient’s property at arrival. Of course, there was indeed a notation that the patient had brought her dentures with her to the hospital.

I took a break, and visited the security supervisor. We chatted for a bit, until he asked why I had not been wandering around, and had not been in evidence that shift.

I told him the Story Of The Missing Teeth, and my efforts to transition that tale into a dental retelling of The Prodigal Dentures: “Rejoice! My teeth, that have been lost, have been found! Kill the fatted calf, prepare the feast!”

Along with my, thus far, horrible fail in accomplishing it.

He sat back, and a thoughtful look crossed his face. “So, Reltney, do you need to find THE teeth, or just any teeth?”

I observed that the patient in question might feel a little, well, odd, wearing somebody else’s teeth.

My friend the security supervisor opened his safe, and extracted some ancient dentures. He then clarified things for me. “See these green teeth, here? Now suppose they were inadvertently dropped outside the door here, in the driveway, and some inattentive security officer, like, say, me, were to accidentally run them over, like, six or eight times? I doubt that anybody would put the shards into their mouth, you could show your boss teeth, albeit broken teeth, and so she would be happy, the complaining patient would get new dentures, so they would be happy, and your boss would stop breathing down your neck, and so you would be happy. How many opportunities do you think you will get to make that many people happy, all at once?”

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

Phone calls that make you go”WTAF??!!”

So, TINS, TIWFDASL as a nursing supervisor in a small hospital in Da City. I had checked our afternoon staffing, and accounted for all the staff. I had wandered around, meeting and greeting my staff, and made arrangements such that everybody could eat. I checked in with security, and, as usual, there was nothing happening.

I was back in the nursing office, completing some paperwork or other, and received a call from the switchboard. The operator informed me that Channel 69 news was calling, asking about some patient who had fallen out of a window at our facility. I told the operator to send the call to me, and stat call the security supervisor to meet me in my office, RFN.

The call was odd. (Now THAT is a surprise, idn’t it?) The caller identified herself as a reporter for one of the local stations, and that they had received a report that a patient had fallen from a window, and landed on a roof of part of our building. I responded that this was inaccurate. I knew this to be inaccurate because, in the event that such a thing had occurred, the staff would call me immediately, no such call had been placed, therefore no such thing had happened.

We concluded our conversation, and I turned to my friend the security supervisor. I asked him to immediately inspect our roofs, either in person or with one of his officers doing so in person, and ascertain the absence of anybody (or, any body) on any of our roofs. He hopped right to it.

Next I called each of my charge nurses, and ordered them to immediately, with no delay, personally lay their eyes on each and every one of their patients. They were ordered to immediately call the switchboard to report that they had indeed personally laid eyes on every one of their patients, or stat page me overhead in the event that any patient was not physically on their unit.

One charge nurse protested that she was too busy to perform this task. I noted that this was what we termed “a work order” in our employee handbook, and her options were to get to it, right now, or prepare their soliloquy for 0900 the following morning, wherein they would have the opportunity to convince the director of nursing that they should, indeed, continue their employment at our hospital. Because ANY other response other than “Let me go, so I can get to this”, would result in their being clocked out and escorted from the building, right about now.

Surprisingly, that elicited compliance.

The security supervisor paged me, requesting that I meet him in the cafeteria, that being about the center of the hospital. I arrived and he briefed me: his officers had inspected the roofs, and noticed nothing awry. A couple of his officers had shanghaied the maintenance man, and secured a ladder. They were going to climb up and re-inspect the accessible roofs, to verify what their preliminary survey had suggested. And, nobody/no body had been found.

I physically went to each nursing unit, spoke with each charge nurse, and had them show me their census, along with a report of their actions to inspect each patient. No missing persons. Hallelujah!

I phoned my immediate supervisor, and gave her the short form report. Of course, the long report, in five part harmony, with full orchestration, with circles and arrows and illustrations to fully communicate the entirety of the affair, was waiting on her desk for the morning.

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”.

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

The Fellow Who Would Not Go

A long, long time ago, in a Blue Hive not so very far from here (In truth, not nearly distant enough!), I was a nursing supervisor. This one time, TINS©, TIWFDASL©, and I received a phone call from one of my nursing floor charge nurses.

It developed that one of our physicians had written discharge orders for this one gentleman, let us refer to him as “Mr. Man”. Mr. Man was apparently of the opinion that our physician was mistaken, and that he, Mr. Man, was not sufficiently recovered to return to his home. I responded, spoke to the nurse, and then spoke to Mr. Man. He pretty much recreated the report that I had heard from the nurse, culminating in his ultimatum: “I’m not going anywhere, and you cannot make me!”

I phoned the physician and relayed my conversation. This doctor asked me a few questions, corroborating his assessment of the patient’s clinical circumstance. Having done so, he reiterated his plan of care: “Mr. Man does not meet the criteria from the insurance company, who is paying for his hospital stay, and they are not going to continue paying for his stay. He is discharged, I have written prescriptions, and arranged a post discharge office visit. If he has issues, we can discuss them at that visit.”

I relayed this to Mr. Man, and he again indicated his determination to remain. I returned to the nursing station, and invited my friend the security supervisor to show his smiling face, so that we could confer. My friend the security supervisor had no new input, although he sent a couple of officers to stand by the floor, in case Mr. Man decided that some interpretative dance, so to speak, would make his case more effectively.

Shortly, the med nurse was passing by, surprisingly enough, passing her afternoon meds. I stopped her. “Do you have any meds for Mr. Man?” She consulted he med book. “Yep, he has (whatever) due at 2 o’clock!”

“Hand it to me. I’ll take this one over from you.” I placed the meds securely in the med room, and returned to my chat with security. Sure enough, as I had expected, Mr. Man put on his call light, shortly after he noticed the med nurse pass by without stopping. I answered his light (security dawdled just down the hallway).

“Yes, Mr. Man, what can I do for you?”

“I am supposed to get (whatever) around this time. I just saw the nurse pass me by.”

“Why, yes you did, sir. You see, since the doctor has discharged you, you are no longer a patient here, you are now a visitor. It is not our practice to administer medications to visitors, and so the med nurse did not have any medications for you.”

“How am I supposed to get my meds?”

“Discharged patients usually obtain their medications from a pharmacy.”

“I bet you think you’re smart! You cannot make me leave! I’m staying right here!”

“Yes, sir, I understand what you are saying. Is there anything else?”

“No. Go away!”

With a smile, I departed. A couple of hours later, supper time arrived. I removed Mr. Man’s tray, and sent it back to dietary, with the admonition that he had received orders for discharge, a therefore would not require meal service. Indeed, shortly he noticed the aides passing supper trays, and, again, he engaged the call light. Again, I responded.

“Mr. Man, what can I do for you?”

“You could serve me my supper tray!”

“Oh, sir, I’m sorry! We do not feed visitors. You have been discharged, and therefore are present here as a visitor.”

“How am I supposed to get something to eat?”

“A lot of people find that a grocery store is helpful in this regard. Other folks find restaurants to be more to their liking.”

Again, I was dismissed.

In our facility at that time, visiting ended at 2000 hours. Our switchboard operator announced this fact, and bade all visitors a good evening. I popped my head into Mr. Man’s room, and reinforced this message. Security, this time in the person of the security supervisor, accompanied me.

“Sir, you will have to leave soon.”

“I dare you to throw me out!”

Security responded. “Sir, our usual practice is to ask folks to leave. Those who do not depart, are trespassing, and we ask Da City Police Department to handle that. I imagine the responding officers will ID such a person, run a LEIN check, and either walk that person out, or, if somebody were to have outstanding warrants, arrest that person, and lodge them in jail”

Mr. Man again indicated that our audience with him had come to a conclusion.

Outside the room, we heard one sided conversations as of telephone calls, and, from what we could discern, seeking transportation. Again, shortly, we were summoned by the call light. Mr. Security and I responded, and I (again) asked, “Mr. Man, what can I do for you?”

“I don’t have my prescriptions, and my ride will be here in a couple of minutes.”

“Yes, sir, I’ll get right on that!”

I secured his prescriptions and discharge instructions, and Mr. Security and I returned to the room, where I delivered the instructions and prescription, and then the security supervisor and I wheeled Mr. Man to the door, where he sprang from the wheelchair, entered a vehicle, and exited our lives. Whew!

Fun And Games · guns · Life in Da City!

“Doc, am I gonna die?”

 

So, TINS©, TIWFDASL©, and we caught a run for a shooting. Being full of excitement, because, gosh, THIS was an opportunity to, ya know, SAVE A LIFE!, we coded our happy way to the scene, there to meet the police. They pointed out the named patient, who, to our surprise, was NOT hovering at death’s door. Rather, he had sustained a small caliber gsw to his lower leg, had intact pulses downstream of his injury, and no evident bony injury. We walked him to the rig, buckled everybody in, and set out for TSBTCIDC.

We had dressed and bandaged his wound, and I was busily documenting same, along with the vitals we had obtained, when he asked me a question.

“Doc, am I gonna die?”

I looked at him, and shook my head no.

“Doc, really, am I gonna die?”

Sighing, I tucked my pen away, and addressed him. “No, you are not gonna die from this wound. You may not even be admitted to the hospital overnight.”

Hearing no further inquiry, I turned, again, to my charting. But, it was not to be.

“Doc, really, I can handle it. Am I gonna die?”

Some people, and one track minds. “Sir, you are not gonna die today, and not from that wound. Really, I’ve seen hundreds of shootings, and your injury is in no way life threatening. Okay?”

He nodded, as if in understanding. I (attempted to) return to my charting.

Shortly, he spake again. “Doc, really, I can handle it. Tell it to me straight, Doc. Am I gonna die?”

I was about over the “Doc” idiocy. “Sir, I’m not a physician, I’m a medic. And, do you really think you can handle the truth?”

“Yeah, I can handle it! Give it to me straight?”

“You sure you can handle the hard, icy, no bullshit truth? Because, if you are really, really sure, I’ll tell it to you straight! No punches pulled, no bullshit, no evasions. Is that really what you are looking for?”

“Yeah, Doc! Tell me the real deal!”

(Ah, well, it appeared that ‘listening to and following directions” was not at the very forefront of my friend’s skill set.) I rubbed my forehead, as if confronting some weighty ethical dilemma. I looked skyward, as if seeking Divine Guidance. I gazed at him, and delivered my response.

“Ok, if you’re sure you can handle it, here’s the real deal! You are not going to die! Do you know why, you are not going to die?”

“No, Doc, why?”

“Because you are not going to live that long!”

The rest of the trip was in blessed silence, as he endeavored to make sense of my revelation.