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 · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

Health Care Stagecraft

So, I see children from time to time. Commonly, they are dubious about the entire “Going to the doctor” thing (yeah, I DO realize that I am not a physician, I am a midlevel. May I observe you explain that distinction, to an anxious child?) With that as a starting point, you can imagine that my approaching said anxious child with a stethoscope, and then with an otoscope (“the ear looking thingy”) might not end well. Yeah, me too.

One of the lessons I learned on Da Street (besides knock from the side of the door, and always have a second way out of any room I enter, and always have a knife, and…well, the important lesson is…..) is misdirection. On the street this manifested itself as changing the topic of conversation, as, on a hostile scene, announcing, “WE have to go and get the stretcher!”, and then both of us doing so, and motoring merrily away from the threatened free fire zone. Returning, if at all, with police.

In a more sedate clinical setting, this manifests itself with my (now) stock spiel for kids.

“This here (hold stethoscope up) is my body tickling thingy. Now, this is really, really tickley, but I only have one, right? That’s not enough to share. So, if you laugh, everybody will know how much fun it is, and they will be sad. ‘Boo-Hoo! (insert child’s name here) got tickled, and I didn’t! That is so unfair! I am so sad!’ Now, we don’t want them to be sad, do we?” (generally, toddler-sober negative head wag) “So, try very hard not to laugh, so that they are not sad! Okay?”

(generally, “ok”)

Once heart and lungs are auscultated, I continue with my misdirection. “You did so very, very well in not laughing, now we move up to the ear tickley thingey! Same rules, try not to laugh so that they do not know how much fun it is, and they are not sad that I cannot share, okay?”

Generally, again, “Okay.” While the child is trying to identify what the heck is so darned tickley about otoscopy, I finish.

One bonus point, is, even if the child screams and kicks and writhes, I can congratulate them. “Wow! You did so very well! I don’t think that they even suspect how much fun that was! You can stop pretending, now! You have successfully finished! Well done!”

Sometimes it is healthcare stagecraft, that lets you complete your job.

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.

Gratitude

Thanksgiving

This is, fundamentally, a repost of a blog entry from 13 Dec 2019.

Several years ago, TDW-Mark 2, Second Son Charlie, and his wife and I were out to dinner one night. Charlie had asked me how work was going, and I fell into my reflexive recitation of complaints about my employer. Yada, yada, yada, bitch, moan, and complain.

After a couple of minutes, I stopped to take a breath. Charlie looked at me, contemplatively, and asked me, “Dad? Can I ask you a question?”

“Sure. Lay it on me!”

“Do you suppose that, say, Cuban refugees, having entrusted their families, and their own, lives to rafts made, oh, out of a pickup truck and old water bottles, stagger onto the Florida shore, join hands, and ask each other, ‘Doesn’t McFee’s life really suck?’”

I considered my son’s question. “Really, I doubt that they spend an entire second on that concern.”

He smiled upon me, as if a Jedi Master upon a Paduan. “Yep, Dad. First World problems!”

Today’s deliberation is that, while there are, indeed, problems galore in America, please let us all consider the fact that, in most of the rest of the world, those things that we consider “problems”, are counted as blessings. It is like a real world experience of Bill Cosby’s bit about growing up poor in Philadelphia,

“Man, I got to share a bed with my brother! It is awful!”

“Man, YOU have a bed?”

“And, I get hand-me-down shoes, also! The worst!”

“Say what? YOU have SHOES?!?”

Etcetera. Sort of a reverse “The Dozens”.

May all of you have a pleasant, peaceful, tranquil, thankful, Thanksgiving Day.

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 Off Duty · guns

Op Sec and The Belt

My charming and talented youthful Darling Wife, Mark II (hereinafter TDW Mark II) is both short statured and full figured. Holding a CPL (license to carry a concealed pistol), she is presented with challenges that I do not face. She employed the gunbelt I had purchased for her, but found that it hurt her back. She resolved that problem by carrying in a much modified appendix carry, but the buckle of the belt I had purchased interfered with positioning her pistol. She and I went to the store, in search of a belt that would function for her.

She found a candidate belt, but, wanting to be certain it would fit and function, wanted to try it on. Doing so in the middle of the store would make unmistakable the fact that she was carrying (no longer concealed), so she thought to use the dressing room.

The employee supervising the access to the dressing rooms asked why she needed to use a dressing room to try on a belt. Thinking quickly, TDW-Mark II informed the employee that “I have an apparatus on me that I would be embarrassed to show everybody, and if I pull up my shirt it will be fully revealed.” The employee, saying “I’m so sorry”, ushered her into the dressing room, where she found that the belt in question fit and performed suitably. We made the purchase.

After she regaled me with the details of her conversation, I told her that her response was perfect: absolutely truthful, not overly informative, and completely misleading.

Fun And Games Off Duty · Fun With Suits! · Having A Good Partner Is Very Important!

The Bat Story

It must have been around 3 years ago: the animals are now due for their rabies booster.

So, TINS©, TDW-Mark II and I were lolling around in the living room, she was watching some program or other, I was reading. She nudged me, at one point, and directed me, “You ought to see what it is that has your fat cat running! You know that he never runs!”

She was referencing one of my two cats, that I had acquired as kittens, brothers, and had attached themselves to me. They would, of an evening, begin to direct me that it was time to go to bed, by sitting in the middle of the doorway to the bedroom, and yowling. If that failed to direct my attention where they wanted it, one or the other would sit on my lap, and head butt me, meowing plaintively. The one, Laurel, was, well, “calorically enhanced”, let us term it, and not the most active feline in the neighborhood. His brother, Hardy, well, he would direct me that it was time to play “fetch” wherein I would toss a yarn ball off a ways, he would retrieve it, dropping it at my feet, and then sit as if waiting for me to toss it again.

The night in question, once my Darling Wife had directed my attention from my book and towards my environment, I did, indeed, note the heavy galumphing footsteps of Laurel. She was right, he rarely ran for any reason. I got up, and found him and Hardy settled in, as if pointing, with their attention directed at a small brown furry thing huddled in a corner of our bedroom. Once it moved a bit, I saw the wings, and realized that we had a bat in our house.

I had been an ED nurse for decades at this point, and had the opportunity to administer RIG (Rabies Immune Globulin: an antibody rich solution, to arrest the ability of the rabies virus to infect you), as well as Rabavert (the vaccine, which allowed your own immune system to produce antibodies to prevent developing the disease. The protection provided by RIG is short term, only). I was familiar with the experiences of the patient receiving these medications. In most cases, an unprovoked attack by a dog “that was acting strangely” was the precipitating event. The rest were folks who had handled, been bit by, or had been asleep/intoxicated/helpless in the room with a bat.

Therefore, there was no way I was going to handle any bat for any reason. I left to retrieve my shop vac.

Upon my return, both the bat and my cats, now joined by TDW’s dogs, were collected in a different corner of the bedroom, with TDW providing over watch. I realized that KNOWING where the bat was, would considerably enhance our efforts at containing him, and so I retrieved my inspection camera. This is a camera on the end of a fiber optic stalk, such that you can twist it into a corner not readily visible, to see what is there. I had previously employed it to find, and avoid, wiring and pipes in the wall I was fixing to hammer a nail into. Now, it was my (sorry…) Bat Scope!

The animals appeared to be congregating around one end of our baseboard hot water heating radiator, so I peeked in there. With the scope. Yep, there he was! I handed the scope to TDW, and attempted to entrain him in the air the vacuum was sucking up, but no joy (for me…). I suggested that she poke him with the stalk, to see if he’d move, lose his grip on whatever he was clinging to, and wind up in the vacuum.

Well, once she did, he snarled.

THAT was unexpected!

She was ready to draw down on him, and send him to Bat Heaven on a 9 mm carriage, but I wondered if exchanging an intact (and possibly rabid) bat, for a haz mat scene of scattered bat bodily fluids, each droplet potentially rabid, was really any sort of improvement, at all.

She did not think so, either, after a moment’s reflection.

So, she poked the bat, again.

Of course, he snarled, again, but, this time, he was dislodged, and sucked into the vacuum.

Realizing that this was a good thing, I unplugged the vacuum, sealed the end of the hose with a baggie and duct tape, and secured our unwelcome guest out on the porch. In December. In The Un-Named Flyover State. Where it was around 20 degrees Fahrenheit.

The next morning, I was off, and we took the critters (the ones we wanted to keep, that is!) to the vet. He listened to the story, and agreed that updating rabies vaccination was a good thing. He asked, “You did not handle the bat, at all, did you?”

“Nope!”

“You certain?”

“Yep, damned certain.” Then I regaled him with ED nursing experience on this very topic, and my lack of enthusiasm for recreating it in my own household.

“Do you have the bat?”

“At an undisclosed location, yes.”

“Can you bring it to me, for testing?”

“Yep. See you in an hour!”

One hour later, he returned from his back office, and regaled me with his assessment of things. “It’s a good thing you sealed the end of the hose, because I found him, frozen, about halfway up the hose, as if he was trying to escape.”

The bat was sent off to whatever lab The Un-Named Flyover State employs for this sort of testing, and, shortly thereafter, Things Got Interesting.

I received an anxious phone call from TDW, on the office line (because I shut off my cell phone at work), relating the fact that she had been the recipient of NUMEROUS phone calls from the state Dept of Agriculture, the state Health Department, the Local Veterinary University, our county health department, and those were simply the ones that she had written down the number for.

All these folks were evidently quite concerned that our friend, The Bat, had turned out to be, indeed, rabid, and every one of these folks asked, multiple times, if we had had any sort of contact whatsoever with said bat. TDW had explained multiple times that, no, we had not touched the fracking thing in any way, and elaborated my clinical experience with folks who had not acted from that sort of plan.

That was all cool. What got her wound up, was one soul who had stated that her cat, the one that she had inherited when her father had died, would have to be euthanized and examined for rabies, because she, TDW, did not have vaccination records at hand for this cat.

TDW explained that this cat was NOT going to be euthanized. The caller then directed that the cat would have to be quarantined for six months (or some such). We could do that, keeping the cat indoors (no problem, she was an indoor cat in any event, not going outside at all).

Nope, said TDW’s correspondent, said cat would have to be quarantined at the vet’s office. That meant boarding the cat, for six months. Lessee: that’s six months, at, say, 30 days each, leading to 180 days of boarding. Boarding a cat costs $30/day in our neck of the woods, so that would mean spending (lessee: carry the ‘nought, ‘nought goes into ‘nought, square root of eleventeen…) !!5 thousand, four hundred dollars!!

Holy stool! I suggested to TDW that contacting the vet her father had frequented might be a pretty good idea, long about RIGHT FREAKING NOW!, and seeing if vaccination records could be forthcoming.

She got right on it.

The Patron Saint Of Inherited Cats smiled upon us, as not only did TDW find her dad’s vet, said vet had vaccination records, and said records included vaccination for (Ta-DA!) rabies. Our vet received the records, The Inherited Cat got updated rabies vaccination, and we all breathed a sigh of relief.

I subsequently called a Bat Guy, seeking extermination (er, I mean, REMOVAL!) of all bats from my domicile. When I explained the urgency of the query (ie, RABIES!), I was told that “bats never pass rabies from one to the other.”

Rreeeaaalllyyy? So, bats do not groom each other? (uh, they do) Leaving behind spit? (uh, how would they avoid doing so?) And, saliva does not carry the rabies virus? (uh, THAT would be how humans acquire rabies from bats, ya know! Bat saliva into an open wound of any sort.) Therefore, he wasn’t worried about it.

Nice. That would be one of us, not him, developing rabies.

So, nobody developed rabies, animal or human. No further bats have been seen hereabouts.

Yet.

Fun And Games · Fun With Suits!

The Boiling City Ballet, and Gaps In My Classical Arts Education.

This one time, I was nursing on nights in a Rural ED. TDW-Mark I and our little family were living “Up North” in a small town, outside of a little town outside of a middling sized town that served as the commercial center for that corner of the state. Our small town, let’s call it “Boiling City”, had a bar, a short distance from our no-stop-light town center, and their claim to fame was serving as the region’s titty bar. We locals called it “The Boiling City Ballet”, as a snide reference to the exotic dancers that were it’s main draw.

At this point, I had something like a 15 years of nursing experience, as an ED nurse, ICU nurse, nursing supervisor, all on top of my years on EMS in Da City. I was kind of proud of my “been there- done that” self image.

Remember that thought. As well as the ancient aphorism that “pride goeth before a fall”.

So, TINS©, TIWFDASL©, and registration let me know that there was a patient with a knee injury. I meandered up front, collected the chart, summoned the patient, and invited her to join me in the back. I asked her what had prompted her visit to ER.

“Well, I was doing a pole trick, and landed wrong, and fucked up my knee.”

I goggled at her. “Uh, what?”

She giggled. “I was dancing, I did a pole trick, I landed wrong, and my knee gave out on me!”

BTDT fail on my part. “Uh, what is a ‘pole trick’?”

She filled that gap in my life experience. “I dance at the Roadhouse, out side of Boiling City.”

Ahhh! The formal name for the “Boiling City Ballet”!

“And?” I prompted.

“So, a pole trick is where I do something on the pole, like spin around, and this time I just landed with my foot placed wrong, and my knee started to hurt!”

“Uh, OK. Here, here’s a gown, and I’d get the doc so we can get you examined and x-rayed and everything.”

She was having fun with my norminess. “So, you **DO** know what I do for a living, right?”

“Uh, kind of…”

“So, why do I need a gown? I’ll just whip my pants off, right here and now, just like this…”

I backed out of the room, and shut the door. “No, that’s alright! Just put on the gown, and I’ll get the doc…”

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

SPOUSAL ADVICE

A few years ago, I was working a locums gig Up North. TDW-Mark II and I had lived our entire lives in The Un-Named Flyover State, and one recurrent feature of the winter news coverage was the seeming obligatory photograph of the snowy expanse of the northern part of the state. Now, I had grown up in Da City, largest in the state, nestled among the northern tier of states, and figured that I knew me some snow.

Well, it turns out, at least from the photographs of nigh unto 12 foot walls of snow adjacent to the roadways, featured in these photos, I did not know squat. So, when the opportunity arose to work on the shores of Lake Superior, and with this gig an opportunity to see, for reals, these selfsame walls of snow, well, off we went!

When you work 12 hour shifts, you get 4 days off every week. My placement was accommodating, bunching my days into a 3 on/4 off arrangement. That TDW and I plenty of chances to tour the area.

Unfortunately for our intended snow tourism, the winter had been mild, and that snow which had fallen, was paltry. To be honest, we had more snow downstate, than in The Great White North.

Whatever. There was still abundant history and scenery to take in, and we set out to do so. One of our tours took us to the norther edge of the state, to a lakefront town. It was pretty, although, surprisingly, with all the tourists gone, nothing was open.

So, this episode of our curiosity sated, we headed back to our hotel. Cleverly, I suggested that we return along the lakeshore road, which ran along a bluff and overlooked, you guessed it, the lake.

Remember that this was late December, and in Da Nawth, in winter, sunset blasts past you, and night drops upon you like a net. Or, so we experienced.

Simply to make everything nice, it had begun to sleet-mixed-with-snow. Let us review the scene, now: Night? (Check!) Snow/sleet? (Check!) Unplowed Up North roads? (Check!) Slush accumulating on the roads? (Check) And, certainly not least, Anxious Wife overlooking the drop off onto the icy, rocky shore of The Lake?(Why, yes, CHECK!)

So TINS ©, There I Was, Driving Along and Making Time towards our hotel, when I splashed through some accumulation of slush. Our vehicle jogged, just a little, and TDW emitted a shriek.

I suggested that, since it was black outside as a politician’s heart (should such a thing really exist), and I generally had this under control, perhaps declamations of impending doom, absent clear indications of said doom, might distract me from successfully managing to move forward, while maintaining our position on the pavement. Some might consider failure to accomplish this to be A Bad Thing.

She apologized, and I returned to navigating and aviating (so to speak).

A little while later, a county road commission salt truck/plow overtook us (and, yes I WAS driving that slowly!), passed up, and in doing so sent a moderate sized spray of slush and whatnot onto our windshield.

TDW shrieked, again.

I slowed even more, came to a stop on our nearly deserted stretch of icy snowy roadway, and turned to my bride.

“Honey”, I began, “I realize that you have concerns about the wisdom of driving on this road, under these conditions, tonight. However, since we are something like 30 miles from our hotel, and I am unwilling to spend the night sleeping in this car, driving to the hotel is out only reasonable alternative.”

She nodded.

“In addition, you DO recall, that I have driven in snow, for something approaching 50 years, right? And, therefore, know just a little bit about driving in these sorts of conditions, right?”

Again, she nodded.

“While I realize that you want to do your part to help our drive be safe, efficient, and trouble free, I want you to realize that, whatever you may think, it is really not particularly helpful, and nowhere near as helpful as you appear to think it is, when you scream at seemingly random intervals, while I’m driving unfamiliar roads, in pitch black night, in snow and sleet, along a cliff face.

Please, stop!”