Fun With Suits! · Pains in my Fifth Point of Contact · Sometimes You Get to Think That You Have Accomplished Something!

Hospice Nurse Midnight Shift Call Off

A long, long time ago, in a galaxy not so far from here….

No, wait, that is not quite right. Well, anyway, after I had departed Da City’s EMS, and started working as an RN, my father took ill. Years previously, he and my mother had moved back to The Megalopolis, and resided in The Maternal State, nearly half way across the country from me. My brother the contractor did not seem well suited to the demands of helping care for a sick elderly man, so I volunteered.

As it happened, while I was helping Mom take care of my Dad, I was working 12 hour night shifts in various EDs around The Maternal State, receiving my assignments from this or that temporary staffing agency. The money was OK, and I was able to keep up with my house payment, my car payments, and all that stuff.

Things progressed. My father was dying, and there was no stopping it. I was glad that I could take some of the burden off of my mother, who was nearly overwhelmed in any event by the looming demise of her husband of decades. You do that which you can do, correct? Around this point in the process, my father had been admitted to hospice, and his care needs had escalated to the point where Hospice supplied a nurse to care for my dad around the clock.

So one morning around 0900, I arrived home from work, and went to bed. I was awakened for a phone call around 11 am, to find that the agency was informing me that my shift that night had been canceled. I mumbled affirmation, and stumbled back to bed.

Around 1400, I was again awakened to learn from the Hospice case manager that they were unable to find a nurse to care for my dad overnight that night. “I don’t know what we are going to do!” she apologized.

I wasn’t all that wound up over it. “So, it looks as if you have a nurse, then.”

No, I don’t. I have called, and called, and I cannot find a nurse to care for your father tonight!”

Yeah, you did. Me.”

You cannot care for your father overnight!”

How come? You need a nurse. I’m a nurse. You need somebody who will be reliable. I flatter myself, that I am reliable. You need somebody here. I’m gonna be here, nurse or no nurse. Looks like I know what I’m gonna be doing, instead of watching late night TV!”

Are you going to be able to do this? Can you handle that responsibility?”

Do you have a better idea?”

She admitted that no, she did not.

Well, then, it certainly looks as if I have to do it, and have no alternative to handling it, doesn’t it?”

We agreed, and I returned to bed.

This time, around 1500, I was awakened for another phone call (this appeared to be developing into A Thing!, and I was not liking it!). My agency was calling, and the staffing coordinator perkily informed me that she had found me an assignment for that very night! “Gosh, thanks, but, after you called me to cancel me, I made other plans.”

She was aghast. “What? Are you refusing an assignment?”

Nope. I had an assignment as of 0730 this morning, when I left duty. I was sleeping, in preparation for reporting for that assignment, when you called me, to cancel it. Once you had canceled me, I had no obligations to anyone, and I have made other arrangements since then. Now, you are calling me and asking, at the eleventh hour, may I remind you, if I can take a last minute assignment. No, I cannot. I am busy tonight, with obligations that I cannot ignore. I’m not refusing an assignment, I am simply not able to accommodate your last minute brainstorms.”

We ended the call at that point, and I resigned myself to my (sleep deprived) fate.

Mom and I had supper, I made some calls, and wrote checks for some of my bills. Once 2300 arrived, the afternoon nurse gave me report, and oriented me to the overnight routine.

We changed my father’s bedding, and bathed him. As we turned him to his left, I held him for her part of the cleaning and linen change, and he sighed once, long and loud. I looked into his eyes, and watched them dilate. I felt for a carotid pulse, and found none. “I think he’s gone”, I told the nurse. She and I tidied up the bed, tucked him in, and she went for my mother.

The next couple of hours were not etched in my memory. Eventually, Mom and I were alone in the house. We cried, we hugged, and we went to our beds.

Monday I had an assignment. I showed up, happy, in a sort of left handed way, to be doing SOMETHING that did not involve constant reminders of my dad’s death. The charge nurse for St. Elsewhere greeted me with, “We heard about your dad. We’re sorry to hear it. How are you doing?”

I was surprised. She was a lovely soul, cute, smart, professional, and capable (all things that I admire in a woman). She was friendly, and I was very open to that. However, I hadn’t told anyone about my dad’s demise. I was touched that she would make the effort to offer consolation to me, a relative stranger. I had been hoping that I could immerse myself in ED nursing, and not think about my dad for a while.

I offered my response, thanked her for her concern, and asked what pod was mine for the night.

Fast forward a couple of weeks. I received another call from the agency, and another assignment offer. I had made plans to take my mother out for dinner, and therefore I declined the assignment. (Yeah, THIS one I straight up declined.). The coordinator took me to task. “I’m getting really tired of covering for you all the time!”

What the fuck? My query was edited before being spoken. “Huh?”

I said I’m getting tired of covering for you!”

Uh, what are you talking about? Covering for me? When?”

Remember two weeks ago? That Friday night, when you had made other plans? That’s what I’m talking about!”

I was almost speechless. Fortunately, this was a telephone conversation, not one taken across a desk. That fact alone kept me from big trouble. I put as much ice into my voice as I could, and clarified: “Oh, wait! Do you mean the night my father died? Do you mean to tell me that you are irritated that I could not work on the night my father died, in my arms, and you are really, no shit, taking me to task for not working that night? Did you really, actually, just say that to me, not two weeks after he died? It sure sounds as if you did, and I cannot think, off hand, of any other way to take that. What did your supervisor say when you told her you were inconvenienced by my not working that night? Say, how about I call her, right fucking now, and ask her? Gimme her goddamned phone number, please. I feel the need for a heartfelt chat!”

For some reason, she was, well, “reluctant” probably does not fully capture her lack of enthusiasm for me chatting with the manager of the office on a Saturday night.

I continue to be surprised. By humanity in general. And, in particular, that she was such a jackwagon, and that she did not provide me that number.

Although, not giving me the number might have been a good thing.

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Fun And Games

“WHY DO WE NEED FARMERS? I ONLY EAT FOOD FROM THE SUPERMARKET!”

Perhaps I have mentioned that TDW-Mark II grew up on a farm. As you might expect, she is familiar with chickens, and the process whereby eggs are acquired. She is, in addition, familiar with the process whereby chickens are changed into roast chicken, and even into chicken nuggets.

Similarly cows, and milk, as with cows and beef.

So, she was in school studying to prepare herself to be a social worker. Of course, she was required to take a course on ecology, or some similar stuff, because, after all, what social worker will be able to mend broken psyches, or minister to the fearful and ill, should she/he not have studied ecology, amirite?

Please understand that, while I did, indeed , “trade up” with the transition from Wretched EX (formerly TDW-Mark Ø), my wife (TDW-Mark II) is very much a non traditional student. This works both from the perspective of her age (she is not a gosling), as well as her having had some life experience prior to college. In addition, she has developed opinions based upon that life experience, and they are not particularly consonant with the stereotypical gosling/kid kollege student opinion set.

In her class, she learned all sorts of wonderful things, such as why corn in general, and corn syrup in particular, are death in a carton/on a cob, and ZOMG! WE! ARE! ALL! GOING! TO! DIE!, because of the presence of corn and corn syrup in our diets. Nice.

So, this one time, the class took a field trip (no, I do not, either, understand the point of a college class taking a field trip, unless is it a paleontology or archaeology class visiting some dig somewhere. This was not such a class!) Since this is Land Grant College Country, and the local Enormous State University is a Land Grant College, well, her little ecology class visited the Land Grant College Agricultural School. To be exact, the University Farms.

Being a farm girl, TDW Mark II dressed accordingly. Jeans, boots, denim shirt, hair up in a baseball cap, gloves in her pocket. No surprises there, right?

Her gosling classmates, not so much. Once she got home (TDW, not the gosling/classmate), she was laughing (TDW, not the gosling classmate).

TDW started off her after action report with a dramatic foreshadowing. “Ohmigawd! I just cannot believe some people! This one girl showed up for the farm tour in nice, dressy, high heeled boots, a nice dress, and a nicer blouse. You had to see her picking her way around the cow pen! And, she had lots of fun on the ladders! It seems that miniskirts are not really designed with climbing in mind, although the guys in class did not seem to mind very much!”

I had spent the day washing clothes, washing dishes, cutting the grass, and suchlike so that we could spend a nice weekend doing something that was NOT chores, so I nodded while finishing the last of the dishes.

It seemed that TDW Mark 2’s classmate had some difficulty meandering around the farm. Farms, after all, are industrial environments, when you stop to think about it. Once the procession had returned to the classroom, Ms Fine Clothes dove deeper into the vat of clueless in which she had evidently immersed herself.

The instructor initiated some sort of discussion, perhaps seeking to tie the afternoon’s travels back into the nominal subject of the class (ecology, or environment, or some such thing). This student observed that she or he had not appreciated how much effort went into raising and marketing animals for milk, eggs, and meat. Another noted the vast difference between the olfactory experience of a farm, and the Styrofoam cleanliness of the supermarket.

Ms. Nice Clothes stood and made her point. “Oh! My! Gawd! I could NEVER eat an egg from a chicken! They come out of their butts! I’m so glad that I only ever have eaten eggs from the supermarket!”

And, TDW Mark II wonders why it appears that I have a tic, consisting of shaking my head and muttering “What the actual FUCK?!?”

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

Bad Diction

Back In The Day, as you may have surmised, I worked for Da City as a medic. In those misty days of yore, we were dispatched by voice, our dispatchers contacting us on FM radio channels, on the VHF High Band. (that means that there were these things like cell phones, only way, way larger and heavier, and they weren’t dialed. Instead, like one of the old fashioned telephones, there was only one “line” and that “line” connected us with dispatchers who would tell us about emergencies that they had learned about via their telephones. And, ours had no wires. These “radios”, for that was what we called these things, used radio waves similar to those in your parent’s cars, right around the sorts your parents use to listen to their old, old music.)

Now, the radiotelephone devices we used were, to be charitable, NOT “high fidelity”. Sometimes, it was listening to a conversation in a crowded and noisy room. In addition, not every one of our dispatchers were blessed with voices and diction that reflected well on the musical qualities of the English language. Indeed, some sounded as if they were practicing their Demosthenes Imitations, dispatching around mouths full of river pebbles.

So it came to pass that one dark and stormy night, my partner and I were dispatched to a run someplace in Da City, for a person with, and I swear to Crom that this is what I heard, “rectal breathing”.

Now, there was generally a random correlation between what we were told, and the actual nature of the run. Several occasions featured runs for “sick person”, who, it developed, had noticed that they were suffering from lead poisoning, likely right around the time that the last gunshot finished echoing. Another featured a run on a “shooting”, which, once we were on the scene, featured nobody shot. As soon as it was clear that the jackwagon complaining of “sinus problems” was the source of the call, we departed, telling the nominal patient, “Gotta go, somebody hereabouts got shot, and we gotta go find him!”

So, we chalked it up to extraordinarily bad diction and a low fidelity radio system, when we found our patient complaining of “rectal bleeding”.

Pains in my Fifth Point of Contact

Another Stoner

 

So TINS ©, TIWFDASL © in the clinic, sometime in the past year or two. Remember how happy, Happy, HAPPY! I have been about marijuana legalization? Yeah, about that: so, I was interviewing this happy go lucky soul, who detailed his allergies, his (physician prescribed) medications, and medical history. I asked him if he smoked, a common enough question particularly, among those with breathing difficulties or a history of asthma or COPD.

Well, yeah, but I don’t smoke cigarettes!”

I pointed out that placing burning material into your face, particularly with the intent of inhaling the products of combustion so produced, was not a good health choice.

But, it’s medicine! I have a medical marijuana card!”

I responded that the existence or non existence of his medical marijuana card did not change the fact that inhaling carbon monoxide, tar, complex cyclic hydrocarbons (such as are commonly found in smoke) is not smart, and does deleterious things to your lungs, at the very least.

Getting directly into the spirit of the conversation, and demonstrating a prompt grasp of my observations, he informed me, “But! I have a card! It is medicine!”

Side note: that linear thinking, clear insight, accountability for self, is why I simply LOVE dealing with marijuana users. Or, maybe not.

Sir,” I told him, “every firefighter knows that inhaling products of combustion is very, very bad for you. That is why the city spends several thousand dollars, for each and every firefighter, to equip them with apparatus that prevents them from breathing in that crap. Since that has become the standard, firefighter deaths from heart disease, lung disease, and carbon monoxide poisoning have dropped to the point that they are almost uncommon. Now, you are telling me that the fact that you, yourself, have a medical marijuana card over rules all that accumulated hard earned experience, bought with firefighters’ lives, and that, due to the miracle of this card, it is healthful to inhale smoke from burning things. Cool story. You’re wrong. I do not care about whatever you tell yourself about marijuana and it’s use as a medication. Inhaling smoke from burning stuff is bad for you. If you want to bake brownies, bake cookies, use marijuana snuff, rub it onto your toenails, or brew a nice hot marijuana stew to bathe in, I do not care. You simply need to realize that smoke is bad, breathing smoke is bad, and your lungs do not care what paperwork you do, or do not have, when they turn brown and stop working. Now, do what you want. Good luck.”

So, yeah, that entire teaching moment went about as well as it sounded like it did.

Fun And Games Off Duty · Fun With Suits! · Pains in my Fifth Point of Contact · Sometimes You Get to Think That You Have Accomplished Something!

Sometimes, You Just Gotta Talk So That They Can Understand You!

After I left Da City, I worked as a ED nurse. Eventually, I took a job up north, at Erewhon Memorial Hospital. (“Both Nowhere, and Backwards!”) In due course at work I met The Woman Who Would Become The Plaintiff, after she had been She Who Must Be Obeyed. (another story, for another time).

This woman, let us call her Annie (because “The Woman Who Would Become The Plaintiff” is simply too complex to type repeatedly!), and I began to see each other, dating and, eventually, moving in together. Annie had two children already, Brenda (age 3) and her older brother Adam (age 7). Unsurprisingly, they accompanied her.

Well. Love bloomed, and Annie and I got married. I worked, she went to school, the kids attended school, and all seemed well.

One night Annie and I were asleep. I awakened to hear wheezing from down the hall, in the direction of Brenda’s room. Being the inquisitive sort, I followed the sounds, arriving in Brenda’s room, where she was sitting upright in bed, wheezing and terrified. Annie had awakened when I left the bed, and soon joined us. I listened to Brenda’s lungs with my stethoscope, hearing wheezes. I noted her rate of respirations (42 breaths per minute. Yes, 30 some years later, I remember it), and her pulse rate (162. Yep, I remember.) I got dressed, and Annie stayed home to watch over Adam. Off we went to the ED where I was employed as an Emergency Department RN.

Once we entered the door, well, I was not alone in my assessment that This Was Not Good. Brenda was whisked into a bed, gowned, x rayed, breathing treatment-ed, had blood drawn, and an IV started, and generally auscultated/poked/prodded/imaged very thoroughly.

A couple of hours later, Brenda’s breathing MUCH improved, we were discharged with antibiotics and an inhaler, and instructions to return IMMEDIATELY if her breathing worsened. It did not.

So, several weeks later I received a letter from Erewhon Memorial Hospital, informing me that our insurance company had determined that this was not an emergency, and that therefore the insurance company would not be paying anything on the emergency department visit we recently had.

I called Erewhon’s billing department, and asked them what was up? They informed me that I had to speak to the insurance company, in order to determine what they were thinking.

I did so. It develops that our insurance company hires people who are, in short, stupid. I (finally) spoke to a representative who told me that the claim was not going to be paid, “because that visit was not an emergency.”

I asked her on what basis she had made that determination.

“It simply was not an emergency”.

I observed that, where I came from, answering a question seeking an explanation, was not adequately answered by repeating the previous, unsatisfactory, answer. Then, I asked her, “Ma’am? In which corner of the resuscitation room were you standing? I work there, I know everybody-EVERYBODY!- who works there, and I do not recall you standing there, taking notes on the non emergency nature of my child’s acute respiratory distress.”

“Oh, I wasn’t there!”

“Then, how did you determine that my child, in respiratory distress, was not emergent? The leading etiology of cardiac arrest in the pediatric population is respiratory distress, and my child was in respiratory distress, wheezing, tachypneic, tachycardic. Being just older than a toddler, she does not have much in the way of respiratory reserves, and that which she did have, was being expended rapidly. Please, explain that to me, and show your work!”

After a spell of stuttering, she told me that the charting did not support the insurance company’s criteria for an emergency, and I would have to have further conversations with the hospital.

I did so. I walked my happy ass into the billing department, and asked about my daughter’s bill.

The charming soul I spoke with told me that “It wasn’t an emergency, the insurance company would not pay for it, so the entire bill was my responsibility!”

I told her, “Uh, no. My child was an emergency. She was in respiratory distress, wheezing at a rate of 40 times a minute, and tachycardic at a rate of 160 a minute. The leading etiology of cardiac arrest in the pediatric population is respiratory distress, and my child was in respiratory distress, wheezing, tachypneic, tachycardic. Being just older than a toddler, she does not have much in the way of respiratory reserves, and that which she did have, was being expended rapidly. So, I will pay the co-pay, and the deductible, for which I am liable, but you can collect the rest of the bill from the insurance company, which owes you that money, not me.”

She puffed up. “Well, if you do not pay that bill, we will have to send you to collections!”

She saw all of my teeth, in the grin that was my response. “Ma’am, if you do that, you will libel me, and slander me, and impugn my character and reputation. You will get the opportunity to explain yourself, under oath, at trial, when I sue for damages occasioned by the torts I just enumerated that you will have performed.”

She puffed up, more. “You can’t sue me!”

I chuckled. “Ma’am, I can sue you for damages because you are ugly, and your ugliness causes me harm. Count on it. If you send me to collections, I will sue you, personally, and do everything I can to impoverish you. After I am done with you, I will sue your supervisor, personally, for failing to supervise you, and allowing you to perpetrate these offenses. Once I am done with her, I’ll sue HER supervisor, personally, and so on up the chain of command, until I’ve sued every son of a bitch here, and then I’ll go after the hospital as a corporation, and individual members of the board of directors, for breaching their duty to ensure that the hospital is not run in a fraudulent manner, which your plan is. Fraudulent, that is.”

She huffed, and puffed for a while, and then deliver what she evidently thought was her clincher. “You cannot sue me! You simply cannot!”

More wolf grin on my part. “Oh, really? Is that what your attorney told you?”

“I do not have an attorney!”

I smiled, a smile that in no way reached my eyes. “Really? You know, I will fix that. I’m pretty sure that, once you get served by my attorney, you will find an attorney of your own, right damned quick!”

She gaped at me for a moment. “You know, you are an asshole!”

“Yep! Sure am! For most folks I try very hard to conceal the fact that I am an asshole. For you, and everybody working at this shithole hospital, well, I will make an exception! I’ll be in touch! Have a nice day!”

So time passed, Annie and our children moved a couple of times (she is part Gypsy).

A couple of years later, around the middle of December, I received an Explanation of Benefits from the insurance company. I found this odd, since I hadn’t been insured by this company for a couple of years. It appeared that they had paid a claim for emergency services at Erewhon Memorial Hospital, the very claim that I had shown my ass to the billing department about.

It was as if it was our own little Christmas Miracle!

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

“Just wait a while. He’ll stop doing that!”

So, TINS ©, while I was FDASL© as a medic for Da City, this one crew had gotten a run on a jackwagon who had engaged in a shoot out with the DCPD, and had lost. The story ran that he had shot at officers, secured cover behind a utility pole, and then had exited cover to fire, again, at the officers. It seemed one of the officers had, indeed, paid attention at firearms qualification, because Mr. Gonnashootacop received a bullet in his face, that exited the back of his head and took a substantial portion of his brain along with it. Not an outcome likely to promote his long term high level wellness, in my opinion.

It seemed to appear so as well, to the EMS crew that caught the run, as they determined that he was DRD (“Daid Raht Dere!”, as we say it in Da City), and they went in service and left the cadaver to the care of the investigating officers.

Unfortunately for that crew, Mr. Gonnashootacop had not attended to that memo, for it was told that after EMS had departed, he took another (final) (agonal) breath. The officers, unsurprisingly, freaked the phenomenon out, called for another ambulance, which crew read the writing on the wall (which explained, “This Way To Department Charges And Unemployment!”) and transported Mr. Gonnashootacop to the friendly local ED, where he was pronounced (again), this time by a physician. Finally.

The story continued relating that the first crew was granted 6 weeks of unpaid time off, in order to allow them to fully deliberate upon, and repent from, the error of their ways. The rest of us recalled the aphorism that “there is no teacher like experience, and a fool will learn no other way”, and figured that OTHER PEOPLES’ EXPERIENCE would work just fine for our own educations, thankyouverymuch!

That touching little parable, leads into a tale of (nearly) my own. I was, at the time of this tale, working a three medic house, with Marielle, and Tim. Tim was a new hire, and had come to the department as a transfer from being a bus driver for Da City. It came to pass that I had/took a day off, for one reason or another, and, when I returned, I entered the firehouse to find an very, very agitated Tim.

“You sunovabitch! Where the hell were you yesterday?”

“Uh, I had the day off?”

“Yeah! And you left me with Marielle! Did you know that she is crazy?”

“Uh, she hasn’t struck me as significantly more crazy than any of the rest of us.”

“Well, let me tell you what happened, yesterday! We caught a shooting, and once we were on the scene, found that this dude had been shot in the head. Pretty bad, most of his cranium had been emptied. It was my day to drive, and so she was on the bag (doing the patient care). So, she sauntered up to this dude, looked him over, and turned to go. I was a bit behind her, and so didn’t really contact the guy, myself, at all. I heard her say that he was dead, and so we wouldn’t be transporting him. While she was standing up to go, he took an agonal breath. Well, the cops freaked out, and started yelling, ‘He’s alive! He’s alive!'”

“She turned back to him, shined her light into the gaping hole in his noggin, showing that there was not hardly any brain left, and said, ‘Oh, just wait a while. He’ll stop that!'”

“Dude! I cannot afford to be suspended for a month and a half! You gotta talk some sense into her!”

Nice. Don’t give me a Herculean task, or something!

Fun With Suits! · Pains in my Fifth Point of Contact · School Fun And Games · Sometimes You Get to Think That You Have Accomplished Something!

Again, with not fitting the mold!

Remember my fun filled interview for Nursing school? So, nearly 30 years later I applied for PA school. Among the requirements was 500 hours of patient contact experience. So, I had worked as an RN for (shockingly enough) 30 years at that point, and had accrued, with overtime, something on the order of 63,000 hours of patient care.

So, I went to interview for the incoming class, and they asked me if I had 500 hours of patient care experience. I had included my resume detailing my schooling and work experience as part of my application, so I assumed that my work history was not a surprise.

I asked, “Do you mean, in the past 3 months? or overall?”

“How about, overall?”

“Well, something like 60,000 plus hours, I guess.”

The reply? “Well, alright then! Let’s move along!”

I succeeded, and so got to deal with the financial aid office.

I filled out the form, complete with the birthdate revealing that I had been born some 50 + years previously. I ignored the part where they sought my parent’s tax forms.

When I turned in my application, the gosling behind the counter reviewed my papers,  and looked my elderly ass right in the eye, saying, “You don’t have your father’s tax form in here!”

She sure was quick! “No, ma’am, I do not.”

She was, albeit, persistent. “You have to include your father’s tax forms.”

“Ma’am, I am not going to submit my father’s tax forms. For one thing, he has not filed in 13 years. ”

“He hasn’t filed in 13 years? He has to!”

“Ma’am, perhaps you could call him up, and let him know that. But, it’s going to be kind of a long distance call. And, when you reach him, please tell him that I love him, and miss him every day.”

Perhaps, she was not so quick. “Huh?”

“Ma’am, my father died over a dozen years ago. You will not be receiving his tax forms.”

Undeterred, she demanded, “Well, we will need your mother’s tax forms!”

I was over this. “Ma’am, you are not going to receive my mother’s tax forms, either. She is pushing 80 years old, I have lived on my own for 30 years, and the only tax forms you will receive are those belonging to my wife and me. Perhaps I should talk to your supervisor?”

After several minutes, an adult appeared. I reviewed my position. “Ma’am, this young lady insists on my providing my parents’ tax forms. That is not going to happen. I have supported my own family for nearly a dozen years. I am not about to provide my parents’ forms, nor have they supported me for longer than this nice young lady has been alive.”

The adult looked at me for a moment. “And, you are Mr. McFee, correct? And, you are the student? Not one of your children?”

“Ma’am, if you look at the applicant’s birthday on the application, you will see that it matches my apparent age.”

This soul indeed perused the applicant’s birthday, and regarded me. “Uh, sir? I think we have everything we need here. You will not be asked again to provide your mother’s tax forms. Thank you, and have a nice day!”