IT: RTFM. HEALTHCARE: PATFQ

(Read The Freaking Manual)(Please Answer The Freaking Question)

TINS, TIWFDASL some time ago, and I interviewed this soul.  

(Me) “How long have you been sick?”

(Them) “Well, all my kids were sick last week.”

(Me) “So, how long have you been sick?”

(Them) “I guess it was going around the school, last week.”

(Me) “So, how long have you been sick?”

(Them) “My (wife)(husband) was sick all last week.”

(Me) “So, how long have you been sick?”

(Them) “ Oh- do you mean, how long have I been sick?”

(Me) “So, how long have you been sick?”

(Them) “Uh, around 3 days.”

Ermagherd! 

“It’s Natural!”

Long ago, and far away, I was working in a clinic, and my partner had the opportunity to chat with a soul who reported vomiting several times a day, for several weeks. During her interview, she determined that her friend reported that he had been smoking marijuana for, lo, these many years. He reported an abundance of marijuana intake every day.

As an aside, let us recall that there is this thing, known as “cannabis hyperemesis syndrome”. While the folklore of marijuana asserts that it is useful for nausea and vomiting, excessive use can elicit vomiting. Similarly, overuse of Tylenol or Motrin for headache, can elicit headaches.

So, my friend, knowing this, counseled this soul that ceasing marijuana use would resolve his vomiting.

He was not seeing it. He asserted that he had been using marijuana, multiple times a day, for years and years, and had never had a problem with nausea or vomiting.

She replied that this problem develops after some duration of frequent use.

Her correspondent replied, “That cannot be true. Marijuana is natural! It grows out of the ground!”

I observed that poison ivy is natural, it, also, grows out of the ground. I speculated that, should I roll him a blunt of poison ivy, would he consider firing it up, and breathing the resultant fumes?

Should he consider such, I would encourage that he wait for me to exit the room and seal the door, before he put fire to paper.

Please.

Odd Conversations

A long, long time ago, in a un-named fly over state not so very far from here, I was dating a young woman, let us denominate her as “Elsa”, who was a nurse in one of the emergency departments into which we would run.

As things developed, she had such a lapse of judgment that she moved in to live with me.

One time, my partner and I were hanging out at her hospital, chatting in the parking lot, when another medic approached me.

“Do you know Elsa?” was his question, after initial greetings.

I replied, “Yeah, I guess I do, sort of.”

“Do you know her well?” asked my interlocutor.

I attempted to deflect him. “How well does anybody really know somebody else?”

He was not having it. “Do you know if she is seeing anybody?”

I was trying. Really, I was trying to gently deflect him, but I failed, with my answer, “I guess she is seeing somebody. At least, that is what I hear.”

My partner, who knew very well that Elsa and I were An Item, attempted to stifle his grin.

The inquisitive fellow persisted. “Do you know if she is seeing anybody, steadily?”

I answered, “Yeah, I suppose it is kind of steady.”

Powering straight ahead, he asked, “Well, is it serious?”

I was done with subtle. “Serious? Well, we like to think that it is serious!”

Today’s Tangents

Yes, today I actually counseled a two year old that he should not run around my exam room.

It was every bit as helpful as you would imagine.

ON ANOTHER TOPIC: A long, long time ago, I nursed in an ICU, on nights. It happened that many of my colleagues smoked. Most of them smoked several times a night, heralded by the question, “Would you watch my patient(s) for a few minutes for me, while I go out to smoke?”

What followed was that the nurse in question would exit the department, only to return on the order of 20 minutes later.

This would repeat nearly every hour. It progressed to the point that several of us who were non smokers, suggested that we ought to take up smoking in order to have a 20 minute break every hour.

One time I was speaking with the department manager, and suggested that, should hospitals never hire smokers, the units would find that their productivity would rise around 30%.

Kitty Parkour

Since we live in The Un Named Flyover State, said state laying in the
northern tier of states, we have this particular meteorological
phenomenon, I believe the locals call it “winter”, every year.
The sky turns cloudy, the air gets cold, and generally the
sunbathing-and-picnicing-season, is over.
In order to moderate the percentage of my paycheck I must send off to
The Utility Company, TDW-Mark II and I place plastic film over our
windows. I am disappointed at the amount of billowing that this film
does, once we have “sealed” each window.
We have noted slices in this film, lately. Since our Cat Ranch has had
surgical removal of the front claws (what with me being a
anticoagulated geezer, that seemed prudent), we were puzzled at how
this transpired.

Until today. TDW observed that one of our cats, whose “spirit animal”
is Dart, had graced her with a display of Kitty Parkour, involving
sprinting about the house, a graceful leap over the couch, and a
springlike rebound from the (film covered) window, leading to another
dash to points unknown.

The film suffered in that encounter, subsequently demonstrating slices
identical to the last several repairs that we had effected.

A more definitive solution is as yet undetermined.

SNOWMAGEDDON! (Part II)

With reference to my previous post, “SNOWMAGEDDON!”, let us review the McFee Stages Of A Snow Emergency:

Level 4: wear your damn boots

Level 3: bring a coat, bring a shovel and a scraper

Level 2: do the s#!t you have to do and go the hell home

Level 1: Ermagerd! French toast by candlelight!

So, TINS, TIWFDASL, and the shift was creeping to an end. It had snowed, some, and I was contemplating my journey home. I consulted the Some Fly Over State Department of Transportation Drive Map (I think that their numeric address would be simpler than their URL of “SFOSDOTDM.Gov”, don’t you?) to discern their assessment of the state of the roadways.

A couple of interesting features of this map, is (a) they can overlay colored highlighting indicating the speed of travel, including red for stop-and-go, and (b) they have webcams in the plow trucks, so that you can see the road from, in effect, the passenger seat of the plow.

Let me go off on a tangent here, and praise the folks who get up before oh-dark-thirty, deliberately drive out in this crap, spending hours in this slippery shit, simply so that you and I can go (home)(to work)(shopping)(to granny’s house)(other). Ladies and Gentlemen, thank you very much. You are a vital part of keeping our roads open, and that facilitates things from dramatic (firetrucks, ambulances getting through) to mundane (the delivery trucks can bring me my whatnot, to WalMart, Kroger, Meijer, Albertson’s, etcetera).

Thank you, all.

So, back to my story. The cameras that I accessed demonstrated opacity of swirling snow that was, well, it stimulated second thoughts. In concert with the red and yellow highlighting, it promised a lengthy drive home.

So, when the weather is sunny and 70 degrees, my commute is something like 75 minutes. Tonight, not so much.

I saw the others off into their cars, clicked on 4 wheel drive, and tuned my Ham radio to monitor the local Ham repeater, as well as monitor fire dispatch in my little county.

That is handy, like when they dispatch firetruck, after firetruck, after firetruck, to vehicles off the road, and/or on their sides/top. Sort of distant early warning.

I got onto the expressway, and settled into my own 40 mile an hour groove. I smiled at those folks who passed me on the left (noticing that the left lane was CONSIDERABLY less well cleared of snow and yutz, than the somewhat dicey right lane, wherein I was driving.

I hands-free-phoned The Darling Wife, and advised her of the fact that I was on my way, and was likely to be later than she normally would anticipate. She acknowledged, and we terminated the call.

I was surprised that the first vehicle I saw in the ditch, was something like 30 miles into my trek.

Of course, failing to take that lesson, I subsequently felt the need to pass a few folks who were puttering along in the right lane, at around 30 miles an hour. I was unable to further avoid that memo, as my driver’s side front tire caught the crusty snow closer to the ditch, and began to suck me away from the traffic lane, and ever closer to the fog line, and the snowy destiny that reached for me.

The Almighty was watching (of course), and had other plans for me that evening (Thank You, Sir!), as reflected in the fact that I was able to feather back, just a bit on the throttle, gently ease my wheel to the right (and away from my own personal snowmageddon), and slowly ease back toward the, ya know, TRAFFIC lane.

I intended, at that point, to re enter the right lane, but I had not altogether passed the driver I had thought that I was overtaking, and so that would not work, from a no-two-objects-can-occupy-the-same-space-at-the-same-time perspective.

I attempted to slightly accelerate, and allow me to clear him, but, again, the siren call of the ditch overcame my truck, and I again sort of drifted towards the left, and destruction. (no, that is not really a political metaphor…well, not this time, it isn’t!).

Once again A Higher Power allowed me to overcome the ditch-tropism that my truck seemed to have developed, and, this time, I passed Mr. Right Lane sufficiently as to ease away from the crusty snow, and my own fate as another “dummy in the ditch”.

I voiced a Prayer of Thanks, and continued on, until, shortly before my exit, I found a patch of glare ice, and commenced to yawing hither, and yawing yon, and hither again, until I was idly wondering if I was going to end up stopped, crosswise on the expressway, in the dark, or perhaps windup in the ditch, this time for reals, and maybe on my top just for giggles.

It was not to be, I would like to claim credit for my steely nerves and Years Of Professional Driving Experience, but, truthfully, it was an intersection of middling driving skill and PDFL (Pure Dumb Freaking Luck) that saw me right my course, sidle to the exit, depart the expressway, and tiptoe my uneventful way home.

Sometimes, I would rather be lucky, than good. If The Savior elects to reach out His hand, and flick me away from mishap, I will (gratefully) accept that, as well.

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It’s A Small World. Full Of Assholes.

A long, long time ago, one of my kids had a friend who, for Ghawd Alone knows what reason, felt it necessary/appropriate to interject the declamation “Jew” into his conversation, at intervals, for a purpose that I could not discern.

I mean, it was “Jew…” this, and “Jew…” that.

Finally I had had my fill. I invited the lad to sit, and brought him up to speed. “So, Name, you do realize my wife’s maiden name is Goldberg, right?”

He had not so realized.

“And, her grandfather escaped Wherever-ia, just ahead of the Nazi death camp round ups, didja know that?”

Again, he had not so realized.

“Furthermore, Name, under the laws the Nazis used to define who was a Jew, and therefore bound for Treblinka, or not, my wife, and all my children are Jews, and would be on a cattle car bound for death. Do you suppose that I might not think kindly about that sort of plan?”

He supposed that I would not be fond of that sort of plan.

“So, Name, consider that there are folks right here in America, who think that the Nazis had a pretty good idea, who think that the Jews who populate Israel ought to be wiped out, every man, woman, and child of them. Those folks would likely plan that my wife, my children, would be headed for the ovens. You should know that, while in all likelihood my family would be wiped out, I would be dead, in a large pile of spent cartridges, surrounded by as many Nazi motherfuckers as I could kill, before they killed me. Now, just how happy are you to be associated with that sort of asswipe scum?”

He stuttered for a bit.

Finally, he took a deep breath, and said, “I…didn’t…mean anything..by it..sir. I’m sorry.”

I smiled. “Think, before you speak. Thousands of men died, stopping assholes who believe, in their bones, the sort of foolishness you have been spouting. More will die, should that shit pop up again. Some of them will die atop heaps of spent cartridges. Others, fighting with clubs and bricks. But they would rather die with assholes blood on their hands, rather than in a trench or an oven.”

To his credit, the boy never, ever, again, in my hearing, used that particular turn of phrase.

The Museum: No Problem!

A long, long time ago, in a galaxy so very far away….uh, well, ok. Something like 30 years ago, and across the state, The Woman Who Would Become The Plaintiff (“The Darling Wife, Mark I”) and I decided that taking our kids to The Museum would be a good idea.

We did not allow the fact that this soiree would require driving in Da City dissuade us. Indeed, I played upon my experience living and EMS-ing in that very city, to keep my family safe. This is, of course, notwithstanding the fact that, in my years in Da City, I not only was a bachelor, but had no children into the bargain. Kind of changes your acceptance of risk.

So, TINS, Tiwfdasl…well, driving along the interstate-which-transformed-into-a-parking-lot on that fine summer day, and I realized, Hey! I used to work this side of town! Why, I will simply drop onto the Rutherford Expressway, exit at Big Ass Road, and then tootle merrily into town, hop on the Going Thataway Expressway, and Voila! There we are, at The Museum! No problem!

Remember those words.

So, exiting on Big Ass Road, we motored along, as I gave my family a commentary. “See there? That is Medic 7’s quarters, along with Engine 56. I ran out of that house for a couple of schedules. See that? That is Kahuna High School, named after The Big Kahunas who invented doppelgangers, and made a fortune assembling them here. And that is….a big ass fence with razor tape along the top……”

The first of many big ass fences that I saw, along with lengthy stretches of razor tape along the top of those fences.

We passed a McDonald’s, and the kids began to announce that they were hungry. The Darling Wife-Mark I joined in the chorus, adding, “Why didn’t you stop in there? We all could get something to eat!”

I asked her, “Did you see those three guys, standing at the curb along the entry to the parking lot?”:

“Uh-huh. Why should I care?”

I asked her, “Do yo think that they were standing there, handing out the Watchtower, or might they have something entirely different in mind?”

She got it. She turned to the kids, and directed them, “Now, y’all shut up, keep your hands in your laps, and do not-DO! NOT!- make any sort of fuss. Is that clear?”

One began to protest. “But, Mom…!”

She directed The Stare at him. He shut up. She asked, “Is there some part of that that is not sufficiently clear? No? So, Do! WHAT! I! TOLD! YOU!”

She turned to me, and sweetly asked, “So, have you dressed for this adventure?”

I, chagrined, admitted, “Um, well, I did bring my 8 shot .380…”

She asked, “Any spare magazines?”

“Er, um, no…”

She noted, “Nice. Good planning, there, Einstein!”

Our trip concluded uneventfully, with a different route home, well away from the Watchtower distributors.

Quirky Co-Workers

The other day, I was working with The (relatively) New Guy. He had graduated shortly before starting here, and had taken to the job quickly, given his new grad status. He had come along nicely.

So, TINS, TIWFDASL, and I emerged from an exam room, to find him charting on one of his patients.

“Oh, hey. Your MA just roomed a guy, and I told her that you’d want a strep, a covid, and a flu test on him.”

My response was, “Uh, OK. So how did you know this?”

He paused, and smiled at me. “I’ve watched you work,. I knew you’d want those tests on a guy with a cough, fever, and body aches. And, well, I have come from the future to observe your people.”

I asked him, “So, if that is so, howzabout you let me in on the lottery numbers for next week?”

“No can do, that would be a black letter violation of The Prime Directive! Starfleet would never let me hear the end of it!”

Macguyver, The Patron Saint of Medics

So, TINS, TIWFDASL in Da City. At that time, so very long ago and very, very far away, standard care for spine injured patients was to carefully secure them to a long board (called, surprisingly enough a spine board, or a backboard), and to immobilize their head with two blocks, and either straps designed to anchor to the board and hold the head (and blocks preventing turning one’s head) still, or immobilize everything, blocks, head and all, with abundant use of 2 inch cloth tape. (and this was the everyday process, because the purpose built straps either broke from overuse, or were lost)

As it developed the same malignant Strap Fairy who made off with the straps, also made off with the blocks. Inasmuch as Da City could not/would not/did not supply replacements, well, we observed that, from reviewing our textbooks from medic school, these mythical “block” things were firm, and roughly rectangular, and were found, in some mythical land, in pairs. Except for the “pairs” thing, this sounded to us like the bricks that were abundant about Da City, due to the Forces Of Entropy winning their war against the whole two-stones-piled-one-upon-the-other thing.

My partner observed that having such a hard rocky thing crammed against the sides of your head would be uncomfortable, and so we took our purloined bricks, added 6 ABD pads (think thick, absorbent 5 in x 9 in absorbent pads for dressing wounds producing fluids at an enthusiastic rate), secured the one thing upon the other thing, and, voila’! We had a head block! As a bonus, if we lost one, the fixings for creating another were readily at hand!

This drifted back into my memory, when the other night, I macguyvered an infant nebulizer set from an adult set, by means of occluding the short end with the bag the set came in, securing that plastic with tape. My field expedient infant neb set would cause the medication to billow out of the unobstructed end, so that the parent could direct it into the infant’s face, allowing him/her to breathe in the medication, reduce wheezing, and (I hoped) allow us to send him/her home with new prescriptions, rather than to emergency.

On an entirely different track, let us contemplate the societal benefits that are realized from the legalization of “recreational” soma…er, I mean, marijuana. If my first thought, once I enter your exam room, is, “Who knew that Bob Marley, Willie Nelson, and Snoop Dogg were getting the band back together?”, the likelihood is very, very high (so to speak….) that You Are Doing It Wrong.