Fun With Suits! · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Interview Skills

A long, long time ago, in a Galaxy not so very far away, TWWWBTP (The Woman Who Would become The Plaintiff) had graduated LPN school, and was starting her LPN-to-RN studies, and I was seeking a change of employment. I was looking to add ICU to my resume, since the grad school I had my sights on required it. This one hospital was recruiting, and proclaiming that nurses who accepted positions in their ICU, would receive a $10,000 sign on bonus.

I investigated, and learned that one half of this bonus would be paid upon completion of one year of employment, and the second half would be forthcoming after completion of the second year of employment. Sounded good to me, and so I arranged an interview.

Since TWWWBTP, at that point TDW-Mark I, thought that it would be problematic should I accept a job requiring me to drive halfway across the state, as this position would, perhaps she should investigate employment (and schooling) opportunities there, as well.

Sounded good to me.

On the appointed day, she and I arrived for our interviews. I learned of the position, and they told me, “You do know, don’t you, that we require a two year commitment from nurses in order to qualify for this bonus, right?”

I acknowledged that I did, indeed, comprehend this aspect of the arrangement, and stated, “Yep, I expect that I can wait two years before going to grad school!”

They acknowledged my comment, and we proceeded.

So, we concluded our interview, TDW-Mark I and I, and we sat in the lobby, awaiting their offer(s). We were summoned, and received the news: TDW-Mark I was offered a PART TIME, LPN job. As for me, well, I did not receive an offer. They informed me, “We are looking for nurses who want to come here, and settle down here, in our community. With your grad school plans, well, you do not appear to be a good fit for that sort of longevity.”

Cool story. We drove home, TDW-Mark I composing her “Thanks but no thanks” letter in her head, and I remarked, “Ya know, honey, I believe that I have figured out what I did wrong!”

She replied, with some side-eye, “Oh, really? What was that? Other than being truthful about your higher education plans, I mean?”

“Well, you see, I should have walked in there, paused just inside the door, and, James T. Kirk like, spread my arms in an all encompassing gesture, slowly turned, taken in a deep breath, and declaimed, “I…I..feel, I feel as if I have come….HOME! I….I want my children…to grow, TALL, under these…these Blue ! Skies!…I want to spend my days….Breathing! This! Clean! Air! I…I want…my..bones, to rest…to, REST…beneath …these green hills! I…I feel as if…I am…at..HOME!”

I looked over at my bride. She smiled, and responded, “So, you are telling me that you should have lied your ass off, right?”

“Of course, right!”

Fun And Games · Having A Good Partner Is Very Important! · Life in Da City! · Pre Planning Your Scene

“Reading the Room”, or, Situational Awareness

So, TINS©, TIWFDASL© as an ED RN. At this point in time, the ED employing me (which was Middling Freestanding ED (MFSED) was an entertainment subsidiary of Enormous Hospital System With Delusions Of Grandeur (EHSWDoG).

My subsidiary hospital had the system’s psych ward upstairs, and therefore we appeared to be the psych intake for the three or four county area at which we were the center. So, this one night, an enormous dude, dressed in a three piece suit, perfectly buttoned etc, and BACKWARDS appeared. There were no police accompanying him (so I assume he was not a police psych hold). For some reason, Mr. backwards Suit had decided that he needed to go for a stroll.

As I became aware of the excitement, I noticed a cloud of nurses, as well as several security, negotiating with him to lay back down for assessment, and so forth. Somebody had given him a pen (for Ghawd only knows what reason), and he was appearing to become more excited as time passed. I noticed him only paying attention to the officers, with his (pen holding) hand behind him. He was standing in a doorway from one hallway to another, and I was down the one hall to his right. I strode past him, as if going down that hallway, and, as I passed, I snatched the pen from his hands, and continued down the hallway, as if that were the only reason for my passage.

Mr. Backwards Suit soon de-escalated, was assessed, and (unsurprisingly) admitted for psych evaluation. And, nobody else gave him a pen.

Pains in my Fifth Point of Contact

Cletus and the sick note

Perhaps you have heard of The Cornosvirus, aka The Wuhan novel Coronavirus, aka the WuFlu, aka The CCP Pox, aka The Shanghai Sniffles. Now known, PC-ly, as C.O.V.I.D. (sounds like a Bond villain, don’t it?). So, TINS©, TIWFDASL©, and Cletus, trivially ill, wandered in, requesting a test for the Coronavirus as well as a return to work note (he related that he had called off sick for a couple of days, and, and needed a doctor note in order to return to work). He related that he had run out of paid time off, and needed to return to work.

The next day, my registrar hunted me down, and presented me with the dilemma: his employer had called, asking what to do about Cletus. Cletus had evidently informed his employer that he, Cletus, had been tested for the WuFlu, and they (the employer) were asking what to do about Cletus returning to work?

“My note stated that he was medically released to return to work, once he had a negative coronavirus test result in hand.”

My registrar returned, “But his result won’t be reported for another 4-5 days.”

“Yep. And, once he has that negative result in hand, he can return to work.”

“I told them that. They are on hold, still asking me what to do about Cletus.”

“Lemme talk to them!”

I picked up, announced myself, and asked what I could do for them?

“We don’t know what to do about Cletus, since he does not have his test result, but your note says that he can return to work.”

“Ma’am, my recommendation is that you follow your organization policy regarding employees who have been tested for coronavirus, and pending results.”

“But, he doesn’t look sick, and we don’t know of any exposure to C.O.V.I.D.!”

“Uh-huh. So, what do you folks do about any other employee who has been tested for coronavirus, and does not have results yet?”

“They have to quarantine at home, until ten days or a negative test report.”

“Perhaps it would be a good idea to follow your organization’s policy in this regard.”

Fun And Games · Gratitude · Life in Da City! · Pains in my Fifth Point of Contact

Random Thoughts Part VI

Assessment of the elderly, sounding confused.

When I am assessing a patient, and ask, in my interview, ref location/day of month/day of week/name/etcetera, when you are not the patient, and YOU answer, talking over the patient, please realize that IDGAF about YOUR mentation, and when you coach the patient, it really, really interferes with my assessment. Plus, it is entirely likely that I myself KNOW the place/day/date/season/etcetera, because, you can bet your ass that if it were NOT Tuesday March the 41st, I would certainly be somewhere else, doing something else, other than attempting to struggle my way through your interruptions of my evaluation of your parent.

In a similar vein, when I ask Jim-Bob where he hurts, probably, when you coach Jim-Bob, admonishing him to “Tell the doctor where you hurt”, you are not really contributing any value whatsoever to the interview. If Jim-Bob indeed comprehends my question, you are only adding noise and distraction and likely, that is NOT helpful. If, on the other hand, Jim-Bob does not understand my query, your repeating it IN THE VERY SAME FREAKING WORDS, neither adds to the information that I require, so that I may care for Jim-Bob properly, nor facilitates timely implementation of that care. So, unless Jim-Bob does NOT speak Engrish, himself, please STFU, and allow me to interview the patient. Or, perhaps, go boil some water, gather a fresh newspaper and some clean shoelaces, right now, please.

Which will, of course, require you depart the exam room and allow me to complete my interview and examination.

Thank you.

Thoughts about Cost vs Price:

Lowe’s “bargain bin” AA battery powered cell phone charger: $10

Having several in your Bag-O’-Tricks at work, so you can hand one to a patient you’re sending to ED via ambulance, whose phone is dead: Kharma.

Having that guy get my cheap-o, bought-on-a-whim charger back to me, with a thank you: PRICELESS!

EMS LAW OF ALTITUDE: Patient’s weight divided by number of floors above street level equals a constant, “K”. Therefore, a 300 pound inert patient on the first floor is roughly equivalent to a 1200 pound patient on the 4th floor. With no functional elevator. And the first due engine company out on a working fire.

(redacted)’s Law: (I don’t have permission to use his name, but it’s not *MY* formulation) When responding to an EMS call, and you are pretty sure that you are on the correct block, but, for some reason, folks in this neighborhood do NOT have any house numbers, seek out the most tumbledown anonymous house on that block, and knock, Your patient awaits inside.

(redacted’s partner)’s Corollary Number One: The one house on the block with ghetto gates (bars on the doors and windows), is your call.

Corollary Number Two: Occupants of the house with the gates KNOW who is performing all the neighborhood B & Es.

Corollary Number Three: There is nothing inside the grilled house worth stealing. The decor is milk crates, cast offs, soiled mattresses on the floor. Even odds that the smell makes the place a haz mat scene.

Final Thought”

Please, please, please! If your physician has ALREADY prescribed a medication for your affliction, take the freaking med, BEFORE your come to my clinic stating that you require treatment for that selfsame affliction! Because, it could happen that my self control may lapse, and I may, indeed, ask you just how exactly I may help you, when you not only were prescribed, but physically picked up, the very medication that I would have prescribed (and, indeed, wound up prescribing) for your problem.

But, OF COURSE, you weren’t here to get a work note! Totally!

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

Kharma

This looks like it’s going to be a lengthy spiel. Hope y’all are ready!

Perhaps, in previous ramblings, I have touched on the assertion, I credit it to Ragnar Benson, relating that, if one were to consider the deaths and illnesses attributable to contaminated water supplies, it is not unrealistic to consider that it is entirely likely that plumbers, and assurance of safe water that is their stock-in-trade, have preserved more lives, and done more to alleviate human illness and suffering, than all the physicians ever born.

I remember this thought every time that I am credited with saving lives, or some such stuff. I am as good as I am, in large part due to the folks with whom I work.

And, then there is the lay-of-the-land aspects that can accompany cordial relations with your co-workers.

So, TINS©, TIWFDASL© in a walk in clinic in Da Nawth Country. It had been somewhat tumultuous , negotiating with my locums company, as they had contracted that I start on “Date A”, yet, 4 or 5 days prior to “Date A”, had informed me that things were not organized as needed, and some aspect of my credentialing was awry, and therefore I was not going to start on “Date A”. Therefore, I was not going to be getting paid, starting on “Date A”.

I acknowledged this tidbit. I asked when they anticipated my starting work, and starting receiving pay.

My recruiter could not tell me.

I noted that I had a contract stating that I would be working for The Locums Company, starting on “Date A”, and I anticipated starting to receive pay from The Locums Company, beginning on “Date A”.

The recruiter protested that, since I was not fully credentialed, I could not work, and therefore I would not be getting paid until all these wonderful things came together, and I was, indeed, working.

I set a limit. A hard limit. “Well, simply so that you understand how things will work, *SOMEBODY* is going to be paying me, starting on “Date A”. Your input into this conversation, is will it be The Locums Company, or will it be somebody else. And, just to make everything even plainer, whoever is paying me on “Date A”, will have my loyalty. That means that, if you folks are *NOT* the ones paying me, and you abruptly get your shit together, and invite me to start working at your client’s clinic, well, I am not about to pimp the folks who are providing me with a paycheck, simply because your organization is so grabasstic that you cannot get your credentialing in a group, by the date that *YOU* specified.”

He sputtered, “We have a contract! You have committed to work for us!”

I had read that contract. “Yep. You committed to pay me for my clinical services starting, oh, next Monday. Now come you, to inform me that you are not planning to pay me, starting next Monday. Now, I am not a lawyer, I do not play a lawyer on TV, and I did not stay in a Holiday Inn last night, but it certainly appears that you are proposing to breach one of the foundational elements of your contract, and thereby nullify the entire thing. If you are paying me, then my time is yours. If you have breached that contract by not paying me, then you can go piss up a rope.”

He continued to sputter. “I cannot simply approve paying you for not working.”

“Cool story. Howzabout you speak to somebody who can, indeed, authorize you to abide by the terms of your contract, and let me know how that turns out? As for me, I’m looking for work. If you get your shit together before I find other work, perhaps we can move forward in a mutually profitable way. If not, well, toodle-oo!”

The call terminated. I placed a call to Another Locums Company, with whom I had worked, and who had demonstrated that their stool was, indeed, in a pool. That recruiter and I had a cheery chat, and she promised to see what they had available, and call me back as soon as possible.

The next day, The Locums Company recruiter, who triggered this rant, called me back, breathlessly informing me that they *WOULD* pay me, as if I was working 40 hours, 9-5. In return, I would be on a 24 hour alert to report to the client clinic, upon The Locums Company’s notification that all had been ironed out. His tone was consistent with “…and don’t you try to weasel your way out of it!”

My response was, “Well, if you are paying me, then my time is yours, and I will be available to report for work as soon as is reasonable. 24 hours sounds reasonable.”

So, I hung around, puttering around, and after a couple of days, received The Call, shortly followed by a call from The Client Clinic. These worthies articulated concern. “Uh, you know we are up north, right?”

“Yep. I kind of had figured that out, in the course of the interactions with The Northern State Licensing Authorities. Those conversations led me to assume that this placement would be in The Northern State.”

“So”, they continued, “It’s January, and, well, we get snow here.”

“I had assumed that snow had something to do with your state’s reputation as a skiing destination.”

“So, have you ever driven in snow?”

This was surprising. If somebody had read, oh, the FIRST 6 INCHES of my FREAKING RESUME, it is exceedingly likely that this reader could figure out that I had spent considerable time in A Northern Fly Over State, wherein, every year, there was an abundance of snow on the ground for, oh, heck, 5 or 6 months of the year. My response did not, however, convey this surprise. “Uh, yeah, some.”

“Are you comfortable driving in snow?”

Another aside: it occurred to me that this particular line of inquiry might have been useful, say, during the freaking phone interview. Not the goddamned day before I was to drive my clinical ass up to start work. Again, my response was milder than my thoughts. “Yeah, I’m Ok with driving in snow.”

But, they were not going to let this go. “Are you sure? We really get a lot of snow, you know!”

I was over this line of conversation. “Look, I grew up in A Northern Fly Over State, we get assloads of snow every winter. If you have seen my resume, you will realize that, not only did I learn to drive in that state, I worked my way through Nursing school working for EMS in Da City in that very state. My children were born there, and every one of *them* learned to drive in the winter, in the snow. Since this is not Fairbanks Regional Medical Center, I am pretty sure that I have seen me some snow, and that I can handle it.”

I packed up my stuff, and set out for The Client Clinic.

I got oriented, and was introduced to the EMR. On my first day in clinic, I introduced myself to the registration staff, and the floor staff. Between patients, we swapped stories. This MA was prepping for Nursing school, that one was in undergrad for business. This other one was a survivalist, and prepping for The Zombie Apocalypse. (Kindred spirit, right there!)

A couple of weeks into the contract, things were tranquil. My MA asked me if I knew why my predecessor had quit, abruptly.

I allowed that I did not know all that much about it, simply that this soul had departed with inadequate notice.

Her eyes lit up. “Ahh! You need ‘The Rest Of The Story’!” She informed me that my predecessor had discovered that he, the clinician, had not been accredited with two of the most common third party payors in that area, and, since they were something like 70-80% of the payor mix, not receiving payment for care of those patients would present a cash flow problem of significant proportions.

It seemed that the clinic had elected to have this clinician’s visits billed as if another, credentialed, provider had in fact seen, interviewed, evaluated, diagnosed, and treated those patients. Since this was not exactly accurate, it potentially could get ugly. Very, very ugly.

When it appeared that this clinician would not see that situation remedied, right stat like, that clinician elected to remove himself from that particular pot of stew, immediately. Hence, the opportunity which featured me fighting disease and saving lives.

I spoke with my recruiter at once, and observed that, he either would provide satisfactory evidence that I was, in fact, credentialed with these payors, or I would unass that scene so fast that The Flash would ask, “What the fuck was that, that streaked right past me?” And, he did not have a lot of time to convince me that this was actually so.

An hour later, he not only effusively professed my actual credential-hood, he e mailed me copies of supporting documents, such that my black heart was grudgingly convinced that it was truff! (pronounced “True-ff”)

And that, boys and girls, is one reason that I treat my floor staff, and other co workers, nicely. That, and it is simply good manners.

Fun And Games Off Duty

More Mangled Machine-glish

Occasionally, a post will write itself. I recently received the following “comment”.

vui cung dafabet20 hours ago

Pretty section of content. I simply stumbled upon your weblog and in accession capital
to claim that I acquire in fact loved account your blog posts.
Anyway I will be subscribing to your feeds and even I
success you get entry to constantly quickly.”

Now, I am by no means the smartest guy on the block, nor am I the most literate. I do, generally, do OK for myself in those regards. I have to admit that I cannot tease any meaning out of the word salad that this “comment” is made of. I have, in fact, had more useful conversations with actively psychotic individuals, mid hallucination, than this series of words portends.

Thought experiment: what would the vocabulary equivalent of a random number generator look like? I suspect very much like this.

And, we continually get told that machines will take our jobs.

I doubt it, unless they teach AI to snark, and drink.

Fun And Games Off Duty · Fun With Suits! · Pains in my Fifth Point of Contact

Phone Company Follies

I had moved from Da City, to a more rural corner of the state. I accepted a job there, as a nursing supervisor. Since my medic license was active, I planned to volunteer with the local rescue.

In the course of securing housing, I arranged for utilities: electricity, propane delivery, and phone. Given the very rural nature of this county, and the presence, here and there throughout the state, of party lines, I inquired about same. Indeed, my question to the person taking my phone order was, “Since I am going to be a nurse for the local hospital, as well as a volunteer with the local rescue, having a private line will be very important. Will I have a private line?”

Her reply, verbatim, was “Private line? No problem!”

I subsequently learned that in Bugtussle, or wherever this particular numbnut was, the meaning of the phrase, “no problem!” was altogether different from the meaning I had become accustomed to.

I learned this when my phone rang (and, differential ringing was whole ‘nother mystery, that I did not understand at that point in time!), I picked up the handset, and found somebody-indeed, two different, and stranger to me somebodies, at that!- greeting each other.

I inquired of my colleagues at work, they being wise in the ways of rural living inasmuch as they were, well, already doing it. I learned that there was such a thing as differential ringing, that in my corner of the county there were, indeed, party lines and that it certainly appeared to be the case that I was the proud subscriber to one!

Against my will.

With this insight in mind, I telephoned the local office of the telephone company, and asked about my “private line”. I learned that the plans called for me to get a private line sometime after the year 2000. This, in a conversation taking place in 1989.

I was not (favorably) impressed.

I next called the regional office, and spoke to the Schmoe In Charge Of Taking Calls From Disgruntled Customers. This schmoe informed me that the new millennium could be celebrated, likely, by me placing calls on my new, and private, telephone line.

I reviewed the “Private line? No problem!” statement of the employee, the fact that I did not, in fact, have a private line, and that due to work and volunteer considerations, this was, and would remain, unsatisfactory.

While it was not phrased that way, the resulting communication could be summarized as “Tough luck!”.

I next uncovered, and called, the number for the Midwest Schmoe In Charge Of Taking Calls From Disgruntled Customers. I learned that the the construction plans for this telephone company did NOT include building out private lines in my corner of the state until after 1999, ten years hence. I reviewed my previous conversation with the order taker, and suggested this was inconsistent with what that worthy had stated would be fact.

Again, while it was not phrased in these words, I was told that that would be my tough luck.

So, I called my Un-Named Midwestern Fly Over State Public Utilities Commission, and was connected with the gentleman charged with fielding complaints regarding, among other things, the telephone companies.

He introduced himself. “Nikolai Tesla. What can I do for you?”

I suggested the position was ironic, given his name, and he agreed. I began my plaint. I reviewed the “Private line, no problem!” misdirection, and my unsatisfactory climb up the chain of command, seeking redress from the phone company. I interjected, “You know, it is ironic that I am calling you in the first place. I tend to be small government, minimal regulation, best government is least government sort of guy.”

He paused, then asked, “Do you mind if I savor that irony, for just a minute?”

“By all means, savor away!”

We resumed our conversation, and Mr. Tesla took my contact information, and promised that he would keep me posted on new developments.

I next called my representative in The Un-Named Flyover State, State Legislature. I spoke with a legislative assistant, and reviewed the material, presented above. I told this soul that my desired outcome was that my representative’s office would hound the PSC over my complaint about the phone company, and that I would be invited to any hearing, the next time the shitweasal telephone company wanted any sort of rate increase. The aid promised me that they would make a few calls, and look into things.

I spent the next couple of weeks fighting disease, and saving lives. (Bet you wondered if I was gonna work that in, somehow! Well, wonder no more!) Since I was working 3-11, I tended to rattle around my residence for several hours after work, before going to bed, awakening generally at the crack of noon. So, I was surprised one morning around 0800 to be awakened by the noise of a barely muffled engine, seeming to arise from the end of my driveway.

I dressed, and walked to the street, asking the workmen there what it was that they were doing?

“We’re putting in a private line. You did want a private line, didn’t you?”

“Sure did! Thank you, gentlemen! Carry on!”

I was tempted to ask him if I had overslept, and it was 1999 already?

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

Whenever I Start to Think That I am The Smartest Guy in The Room, I am in the Wrong Room!

Another time, I was fighting disease and saving lives as the afternoon nursing house supervisor. Start of shift stuff had been done, I had made some rounds, and arranged for staff to get off the unit to eat. I was piddling around with some paperwork of some sort, and heard an overhead page of “Code Red: 1 East!”

At that time, in this facility, 1 East was our psych unit. I phoned the switchboard, and she told me that there had been a pull station activated on the unit, and I needed to go verify it before she could call the fire department.

Uh, excuse me? WTAF??!! I directed her to call 911 right freaking now, and communicate the alarm at once. “But, our policy is to wait until the supervisor verifies the fire!”

I told her that, employing the telepathy that had stood me in such good stead in years on the Fire Department’s EMS division, I had just this second confirmed the alarm, and she needed to stop dicking around, and call the fucking firefighters.

I hung up, and took off at a trot for the nursing unit, and unlocked the door.

Immediately, I was happy that the alarm had NOT been delayed. The unit was quite smoky, and the smoke was starting to bank down to about shoulder height. I found the charge nurse, and asked her for report. She reported that every patient had been accounted for, and every one was presently in the day room, with two sets of smoke doors between them and the fire room. One of the patients had, somehow, ignited his mattress, and then things got exciting.

The security supervisor and I did another sweep of each room, double checking that nobody was on a floor, or draped over some furniture. Happily, nobody but the two of us was there. Oh, yes: the two of us and the first due engine company.

The firefighters trundled the smoking mattress out of the unit and into our alley, whereupon they performed a sort of urban baptism ceremony, pouring The Healing Waters Of Engine 56 upon the Sinning Mattress.

The next morning I had a stern chat with my boss, and the phrases “NFPA standards” and “fire code for health care facilities” were flung about. Along with the observation that the reported SOP was ABSOLUTELY inconsistent with the prevailing standard of care.

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

The Reveal!

You may not be surprised to learn that I spend considerable time meeting folks, and some of those folks do not bowl me over with the force of their intellect.

Occasionally, somebody who does not otherwise impress me as being particularly dull witted, appears to decide that The Reveal is needful, NOW!, and therefore proceeds to impress me that they are, in fact, an idiot.

So, TINS, TIWFDASL, and I was interviewing some soul about his particular malady. As is my usual practice, I inquired about what symptoms had precipitated today’s office visit, duration of symptoms, what had been done prior to visiting me to address the symptoms, simply as a beginning.

So, this soul related that his symptoms had been treated on a couple of previous occasions, in the past month, and had transiently improved, and then returned. He had, so he told me, been treated with “an antibiotic”.

“What antibiotic?”

He did not know. “The antibiotic that they prescribed for me.” (as helpful as THAT is….)

“How long did the doctor have you taking that antibiotic?”

“Until it ran out.” (Certainly. Of course.)

I attempted to discern how long it had taken before the antibiotic had run out, since treating Malady “A” might call for a 5 day run of The Z Pak (boo! Hiss!), whereas Malady “B” might be addressed by 28 days of Doxycycline, for example. Ya know, just as if I cared what had elicited this gentleman’s symptoms, with an eye toward, oh, gosh, I don’t know, maybe TREATING HIM EFFECTIVELY, or something.

At this point, he felt it relevant to review some of the high points of his resume. For some reason.

“I’m college educated! I’m not an idiot!” (uh, sir? First, college educated maps poorly onto “not an idiot”. Not a very high correlation. Secondly, in circumstances where you wonder if it might be appropriate to reassure somebody that you are NOT an idiot, it is very likely that you are about to reinforce the impression, that you ARE an idiot. That certainly has been my experience in my own life, you may want to consider if there might be some parallels in your own.)

I somehow got back on track, and began my review of systems. At this point, he revealed that, in his estimation, “You are being dismissive of my concerns!”

HUH? Inquiries about your allergies, medications, and medical history are not “my attitude”. That’s how I attempt to avoid prescribing something to you that you either are allergic to (and you did not mention to my nurse….), or that might interact malignantly with your regular medications. For example, I dislike eliciting a GI bleed (stomach bleed: think bleeding ulcer) simply because you did not think that it was relevant that you take coumadin (a blood thinner), now that you are here for your orthopedic injury. Should I prescribe ibuprofen (popularly known as Motrin), that in combination with your coumadin might lead to a life threatening GI bleed, and I feel that to be a bad thing. Occasionally, that review of systems elicits something kind of important, like chest pain or difficulty breathing, that you forgot to mention, because your ankle pain is the only thing that (for some reason) you are concerned about.

But you are paying me to be concerned about that other, life threatening, stuff, and have the wit to not miss it.

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

Parenting Skills

I was interviewing a soul, who had brought their spawn along with them (because, why WOULDN’T you bring your 5 year old to your urgent care visit?). Said spawn (of course) had no self entertainment skills, likely due to the screen the named patient/parent placed into his hands immediately upon his whining that he wanted the phone, right now! While I was endeavoring to elicit nature of present illness (eg: what are your symptoms, and why did you determine that coming to urgent care was the thing to do?), duration of present illness (and, please Ghawd, please, say something more specific than “a good little while!” Pleasepleaseplease!), and provocative or palliative factors affecting this illness, said sprat was entertaining himself with the phone, and, it developed, felt the burning need to experience the sound track in his very marrow. In order to accomplish this task, he set the volume at eleven. Of course, in the confined space of the examination room, it was deafening.

I stifled my initial impulse to wrest the device from his hands, dash it to the floor, and grind it beneath my heel, all the while shrieking “Kill! Kill! Kill! Kill!…”, and then, settle upon my seat, and, calmly, ask, “Now, where were we?”

Instead, I continued to ply my patient with the appropriate questions, in a normal, soft, tone of voice. Of course, the named patient could not hear a damned thing I was saying. I smiled, and repeated my queries in the same, soft, calm tone of voice.

Still, the cacophony drowned out my every word. I smiled, and paused. The light began to dawn in my patient’s eyes. She turned to Little Jimmy (or whatever this child’s given name was), and directed him to silence the device.

He whined that he could not hear, should that happen. She repeated herself, and he again whined.

Then, in a feat of effective parenting nearly unsurpassed in my clinical experience, she retrieved the phone, silenced it, and pocketed it. Little Jimmy whined and groused, but his mother turned to him, directed him to quiet down, lest they “have a chat” in the vehicle, and turned her gaze, again, in my direction.

Miraculously, Little Jimmy settled down. I completed my examination and interview, and everybody went their separate ways.