cats · Fun And Games Off Duty · Life in Da City!

SNIPPETS PART IV

I hope that nobody is surprised to learn that, since The Un-Named Fly-Over State is in the northern tier of states, it snows here in the winter (And the fall. And the spring.) That has been the case for certainly the past nearly 70 years that I have been here. Therefore I would hope that my neighbors would have figured that shit out, by now.

On the other hand, there is abundant evidence that my hope in this matter is misplaced.

So, TINS, TIWFDASL…well, OK, I was driving in to work one snowy winter day in order to begin my day of FDASL. I was listening to the amateur radio in my vehicle, and monitoring the county’s fire department dispatch. No ill tidings from that front.

I did notice a car off the road, into the ditch, but I figured that the county deputy already on the scene had things well in hand.

So, there I was, listening to the FM radio, and waiting for any alarming traffic on the HAM radio, when I saw this guy, no shit, skate his compact pickup truck completely across the 3 lanes of expressway traffic, having apparently originated from the on ramp. My guess was that he had entered the ramp at speed that was excessive for the conditions. (did I mention that it had snowed the preceding night? Well, it had. Likely had something to do with the other guy in the ditch.)

Anyhow, once he reached the median shoulder, he started to wifferdill his way along that shoulder, inching his way into the median’s ditch. He did manage to stay upright, so, that was nice…..

The thought crossed my mind, “coefficient of friction: words to live by!”

@@@Snippet The Second@@@

You may recall my tales of cat-herding (Farming? Wrangling?). In any event, one of the cats had a recurring conjunctivitis, such that our local vet voiced concern regarding the potential of a ruptured globe (eyeball breach, with vision-destroying loss of the fluid-vitreous and aqueous humor that is within the eyeball), versus a vision damaging occurrence of scars on the (supposed to be) clear portion of the eyeball.

So, we arranged an appointment with a veterinary ophthalmologist.

Of course, this doctor practiced in an office something like three counties over from our home. Of course, on the appointed day, it was a balmy 33 degrees (f), and could not decide to snow, rain, sleet, or what.

Fun times.

I learned on this trip, that driving Trixie T. Cat anywhere, was very much akin to driving your small, furry, outspoken, elderly, mother-in-law somewhere. I was the recipient of a running series of corrections, spoken (of course) in Cat, that likely would have sounded like “You’re driving too fast!”, “You’re driving too slow!”, “Why can’t you stay in one lane?” (this as I signaled, eased over into the -clear-adjacent lane, and in the course of doing so, ran over the ridge of slush built up between the lanes. So the truck jerked.), “Why aren’t we there yet?”, and the ever popular, “Where the hell are you taking me? I don’t want to go there! Let me out of this damned cat carrier!”

That is, would have sounded like that, if I spoke Cat.

As you might imagine, first off, back seat driving is oh, so very welcome at any time at all. Secondly, such corrections are even more welcome when the driving is, oh, gosh, I dunno, HAZARDOUS! Thirdly, let me take a moment to congratulate TDW-Mark II. She successfully suppressed her baseline impulses to shriek, gasp, or otherwise demonstrate her appreciation of her/our impending DOOM! Probably figured that the cat had that well covered.

Duty · Fun And Games Off Duty

It’s All In How You See Things!

Sometime towards Mom’s 98th year, we, her children, began to consider, and present to her as a possibility, the idea that perhaps she ought to live in an assisted living establishment of some sort. She had owned up to some difficulties with traversing the stairs to and from the basement, where the laundry facilities of her home were located. In addition, there were no blood kin anywhere near her.

She was unimpressed. First off, she was unenthusiastic about moving from the home she had shared with our father, her husband, for a dozen years, and where she had lived during the following thirty years.

Secondly, she had grown accustomed to her home, and did not want to leave her home, in any event.

Third, her solution to “all your children live a thousand miles away, if not on the other side of the planet”, was that one, or all, of us should simply relocate to The Un-Named Maternal State, forsaking our present homes.

Not happening. Brother The Second had his own business, and that sort of thing is not readily amenable to simply relocating halfway across the country. I was not gonna live under the way liberal regime of said state, anyhow, and that was not even considering the fact that all my children resided in The Un-Named Fly Over State. Grandkids, as well.

Finally, Mom presented her (in her view) closing argument: “I simply do not want to live with a bunch of old folks!”

(silent rejoinder: “Mom! You are ninety-freaking-years-old! Rilly?”)

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

Everybody Brings Sunshine Into My Life….

From time to time, I determine that an antibiotic will be helpful in resolving whatever ill is present in my patient. For example, folks with dental infections, and who are not allergic to beta lactam antibiotics (those related to penicillin), get amoxicillin. It is what our dental colleagues have directed me to employ as first line, and pretty nearly always gets the job done.

So, TINS, TIWFDASL, and my patient-du-jour had a dental infection. I presented my spiel, winding up with the observation that I would be sending over a prescription for amoxicillin.

This soul stated that they had received amoxicillin several years ago, and “it didn’t work”.

May I step back for a little bit of dental anatomy? Any surgeon (and, dentists are surgeons of a particular specialty) will tell you that antibiotics are wasted on any abscess, due to the fact that the overwhelming majority of the pathogens are afloat in the pus filling the abscess, and, since no abscess has any sort of circulatory system, any antibiotic will only make it to the periphery of the lesion, and not the the seat. Indeed, surgeons generally are of the opinion (an opinion probably developed during years of residency and 20,000 to 40,000 hours of patient contact) that the foundation of resolving an abscess is to drain the abscess. That will both greatly, greatly reduce the population of germs remaining to cause mischief, but also place those germs in close proximity to tissue that, indeed, has circulation, and therefore provide the antibiotic the ability to access, and damage, the germs.

GUM abscesses are potentially susceptible to intervention by clinicians such as I myself am. TOOTH abscesses, including dental pulp and/or dental root infections, are immune to my attentions.

Therefore, plausibly, this soul’s historic experience with amoxicillin could have been due to the infection remaining inaccessible to the antibiotic.

Back to my story. This child of God requested “something stronger” than amoxicillin.

Two competing thoughts sprang into my mind: First, amoxicillin is the drug of choice. Prescribing something else is akin to purchasing a full ton passenger van to transport your gravel, because “big vans are stronger!”, or something. Really, using the proper tool for the job makes so much more sense.

Secondly, there are several reasons why clinicians do not simply “prescribe something stronger”. One if them is NOT that we are all assholes, who want people to be/stay sick. Rather, for example, gentamicin is used all the time in ICUs for patients who are terribly sick. (wonder if that has anything to do with the reason that they are in ICU to begin with?) These folks get regular blood draws, to be sure that the concentration of drug in the blood is within certain bounds. Too little, and it is less effective than needed. Too much, and deafness and/or kidney failure can result, among other bad things.

So, for certain values of “stronger”, gentamicin is, indeed, “stronger”. On the other hand, deafness as a consequence of your long delayed dental care appears, to me, to be a risk out of proportion to the anticipated benefit. Particularly when I can anticipate the same benefit, with rare risk, from, gosh, er, um, oh, I dunno, AMOXICILLIN.

Back to my story, backing away, a little, from my rant-du-jour: I asked this soul what antibiotic had been beneficial, for past dental infections?

The answer, I swear to Crom, was, “I don’t know. You’re the doctor, don’t you know?”

Words. They fail me.

Duty · Gratitude · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

Telemedicine: Threat, or Menace?

One fine day, I was at work, FDASL, and received a text from my daughter, let’s call her Brenda. She related that her second child had developed what looked like pink eye, to Brenda’s assessment. She (Brenda) had contacted whoever, and that medical soul had video chatted/e-visited/virtually visited/some other bullshit with my grand daughter, and had prescribed an ophthalmic antibiotic.

Brenda was not altogether certain that this assessment was spot on, and wanted her clinician dad’s take on things.

As you may have surmised, MY take on non patient contact, not in the same room “visits”, is not filled with much enthusiasm. There is something to the gestalt of being in the physical presence of somebody, that provides you with clues that are neither evident, nor are they provided across a video screen of any sort. (Ever smell the fruity breath of diabetic ketoacidosis? Ever smell it over a phone?)

Placing that aside for a moment, I asked for some pix. (I am aware that this amounted to the very same thing I had just, 11 words ago, railed against. Wait for it.) My grandchild’s eye appeared red, and (uncommonly in pink eye), so did the tissue surrounding her eye.

I asked if this grandchild could move her gaze left and right, upwards and downwards, painlessly. Was there any change in her vision?

The response I received was that the vision in her affected eye was “blurry”, as well as “it hurts when she looks up”.

My response text, verbatim, was, “Who is going to see her in person, in the next half hour?”

Brenda took her child to our local urgent care, which clinician, to THIS clinician’s credit, is reported to have entered the room, taken one look at my grand daughter, and turned to her mother, and said “So, I’m not going to charge you for this visit. Do you know the way to Big City Referral Hospital? Good. Do not dawdle. Go directly there, now. Yes, I mean the emergency department. Thank you. Drive safely.”

THOSE folks examined her, CT’d her, and started an IV (a process that Grand Daughter did NOT approve of!), and IV antibiotics, and admitted her for several days. The CT had revealed a peri orbital cellulitis (mild, but, nonetheless…), which responded to the medication.

She is now home, sassy, and none the worse for the experience. Take home points: Brenda demonstrates many, many of the affirmative attributes of The Plaintiff: she is smart, decisive, has a finely calibrated and high functioning “shit don’t sound right” detector, and is a bulldog advocate for her children.

I loathe “telemedicine”.

Sometimes I am both blessed and lucky. This time, to the benefit of my grandchild.

Fun And Games Off Duty · Life in Da City! · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

THE PLAINTIFF AND THE HOUSE.

Long ago, and far, far away, I was sitting in a conference room with my attorney, The Plaintiff, as well as her attorney. We were discussing asset distribution. Her attorney announced that THEIR plan was that we sell the house, split the proceeds, and ride off into the sunset, separately.

Okay, that deserves some context. We had purchased that house something like 8 months prior to this conversation, it was in 2008 (remember those days? Housing values were plummeting like a drunken frat boy off a second floor porch), and we had obtained a “zero down” mortgage. I had kept an eye on housing values, and had noted that this house was worth less than considerably less than owed on the mortgage. We also had, between us, a camper trailer that had been paid off. I suggested, instead, that she take the house (simply so our boys would have their home, in a stable manner), and I would take the camper. I added that she could then, when she deemed it proper, she could sell that house, and keep all the proceeds. Alternately, as I observed, she could consider the market, and realize that the house was worth considerably less that what was owed. In that event, I would accept no responsibility for that shortfall. And, I’d take the camper.

Her attorney was aghast. “You cannot tell me that the house is worth as much as the camper!”

I said, “No, I am not telling you that the camper is worth as much as the house. In my appraisal the camper is worth considerably more than the house, but, it is about what your client wants, after all, isn’t it?”

To make a long story short(er), I kept the house, she got the camper, and no money changed hands in this matter.

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

KITTEN TAILS, PART V

We have a couple sets of cats that closely resemble each other. Momma Kitty, Max, and Oliver are all alike enough, that a second (or third) glance is required, sometimes, to discern which cat is (on the cat tree)(trying to excavate the bag of Cat Chow)(teasing Little One). Similarly, Olivia and her sister/littermate Henrietta are nearly identical. To remedy this IFF (Identify Freaking Feline) problem, TDW-Mark II thought that should Cat “A” be wearing a red collar, and Cat “B” be wearing a blue collar, the IFF problem would be eased.

One of the younger kittens was not altogether “down”, as the kids say, with the collar thing. Oh, he allowed TDW to place it upon him, but, he is but a kitten, and thought, it seemed, that it required adjustment, and indeed required adjustment BY HIM.

Good News: He did so during “sick call” one evening, and, since he had managed to get it entangled with his lower jaw, and, being a kitten, promptly freaked the frack out in his efforts to get his mouth clear of the collar (which, of course, constitutes The Bad News), well, I tackled him, TDW disentangled him, I soothed, and cooed, and settled him, and he appeared none the worse for the experience.

Subsequently, we concluded that more careful collar fitting would allow IFF without the risk of getting his jaw trapped by a partially removed collar, and therefore we assumed (yep, THAT word, again!) he would be safe wearing a collar.

Remember that thought.

So, TINS, TIW sleeping my ass off, when my alarm went off, on a day off. I awakened, turned off the alarm, and stumbled into the kitchen, to start the coffee.

I am not particularly bright, but I did recognize that the blood spread over an area of my kitchen floor approximately 2 feet x 3 feet, was not normal. Once I noted what appeared to be kitty foot prints therein, and saw bloody kitty pawprints on my counter, I assumed that one of the cats had cut his/her foot on Ghawd Alone knows what, and some further assessment was needful.

Since several cats sleep on the bed, in rotation, I started there. I saw a couple of bloody paw prints on the bed, and therefore determined that there was no dog injured since none of the dogs could get onto the counter, nor off/on the bed. None of the cats on the bed had injuries to their paws (remember THAT bit, as well!), and I enlisted TDW to assist in further cat triage.

Now, my Darling Wife is a lovely woman, kind and loving. She has NOT worked ER, has NOT worked Da City as a medic, and otherwise has led a rather sheltered life. So, when she entered the kitchen in search of un triaged cats, well, the blood on the floor caught her attention.

Indeed, it immobilized her. Her words were, and I quote, “Oh My God! Oh! My! God!”

Being accustomed to seeing large quantities of blood in my workplaces, I was less distracted, and so suggested, “Honey? Perhaps it would be helpful if we identified which cat is the source of this blood, and then assessed that cat for nature and depth of injuries? Please?”

She found Oliver, and identified the lacerations on his mouth. Fortunately, they were not bleeding on our assessment, and he appeared un freaked out (good on him!). We removed (and discarded) the collar in question, and started to assess his lacerations progress at every med pass.

He has healed up nicely, and appears unfazed by his adventure.

cats · Fun And Games Off Duty

KITTEN TAILS, PART IV

As it develops, when you have a herd (or, is it “a flock of cats”? I am not sure…) of cats, when one develops conjunctivitis, well, EVERYBODY goes along for the ride. Therefore, should your Mark I, Mod Ø Stretcher Ape attempt to medicate the sick cats, well, THAT leaves a reservoir of untreated, and, it seems, soon-to-be-infected cats. Reminiscent of a circle jerk, of sorts.

So, TDW-Mark II came to the realization that, should sick call include all the cats, there would remain no susceptible population to serve as a next stop for the Train O’ Pink Eye that appeared to be making the rounds.

Loyal Readers likely have already recalled the “sick call” nature of such an adventure. She and I would corral a couple of kittens, medicate them, provide canned cat food as a treat, and then open the bathroom door, planning to hunt down, corral, and carry away to the bathroom, the next contestants. There, to medicate and treat (in both senses of the word) those cats, and then repeat until no unmedicated cats remained.

Well, we would open the door, and the most recent contestants would ease their way out, and, par miracle!, two more would saunter in, as if to say, “I say, old fellow: I had heard that there were treats to be had? Could you help a fellow out?”

With this as a backdrop, we had assumed that Reluctant Cat would be cool with his turn at antibiotic-ointment-in-the-cat’s-eyes. You all do remember how to spell “Assumed”, amirite?

Yep. Reluctant Cat abruptly forgot the entire “cooly saunter into the bathroom/clinic” thing, and decided that what I really, really needed, was a venotomy on my dominant wrist. (since he did not have either a IV catheter, nor thumbs with which to manipulate it, he couldn’t have been thinking that I needed an IV, anyway.)

BAD NEWS: I am on blood thinners.

GOOD NEWS: He really had a crappy angle on my radial vein. Plus, in a display of reflexes that I have not demonstrated since I was in my twenties, I snatched my hand away just prior to the letting of blood could really get into full swing. As it happened, I only sustained a couple of fairly superficial scratches, which stopped bleeding after, oh, maybe a half an hour or so.

As for Reluctant Cat, well, HE went into the bag, head exposed, got his med, got his treat, and got shown the (bathroom) door.

Fun And Games Off Duty · Pre Planning Your Scene

Sleigh Bells Jingling, etcetera

So, TINS, TIWFDASL something like 60 northern Un-Named Flyover State miles from home. This was several years ago, of course, when we still had snowfalls (…he said, snarkily!) One night, I got out of work after 12 hours in our windowless ED, to find it had SIFAO. (Snowed….). AND, for bonus points, was still SIFAO. My daily driver was a 2008 FWD Hyundai Sonata.

So, it turns out that, at 45 mph, my typical 1 hour drive approaches 2 hours. Particularly when, SIFAO as it was, I followed the exit ramp, thinking I was still on the expressway.

You start to wonder about that, once the stop sign appears.

I re entered the highway, and plowed my way home, white knuckling it the whole way. I got home safely, the car gave me STELLAR gas mileage that trip, TDW-Mark II worried, and I galumped my crabby ass, along with considerable snow, into the house, unbruised.

Thanks Be To Chthulu.

More thoughtful observers, than I apparently am, might wonder why I simply did not obtain a motel room, and sleep my happy ass away, in the town that I was already in, and thereby allow the unsung heroes of the road commission and the state highway department, to work their magic and clear the roads?

Well, to be honest, that would require more foresight than, evidently, I possessed at that time. One might wonder if I had contemplated the McFee Four Stages of Snow Emergency. I had not.

To review, here are The McFee “Four Stages of Snow Emergency” Scale.

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!

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

Partners. Or, Not.

So, TINS, TIWFDASL, and it was approaching the end of my shift. The other midlevel was a locum (think: rent-a-clinician), and since I was busy with my side, I wasn’t paying a lot of attention to her.

One of my patients was pretty sick. As in, “Where is my ambulance”, sick. I also had a couple of other folks, who had to wait while I dealt with Mr.-or-Mrs.-pretty-sick.

Once the ambulance had departed, I tended to my other patients, and noted that the floor staff appeared pretty, well, relaxed. I asked them, “Doesn’t Little Mary Sunshine have any patients left?”

They looked at me. “Uh, no. She beat feet out the door while you were in with your emergency. Oh, and one of her patients did not get their antibiotic. The pharmacy called, and would like you to fix that.”

I did a literal double take. “Say what?”

The MA repeated herself. There was still 10 minutes in the shift.

They tell me, several months later, that I got very, very quiet at that. Concerningly quiet.

Duty · Fun And Games Off Duty · Fun With Suits! · Gratitude · Life in Da City!

Snippets Part III

I have a flexible spending account at work, so as to be able to pay my copays, deductibles, and suchlike with pre tax dollars. Late last year, I noticed that the card by which such expenditures were paid for, was getting declined. I assumed that I had spent all the money and thought no further of it.

Then, I began to get messages from the administrators of the account. Finally rousing myself to speak to them, I learned that the card had been frozen, because, I was informed, they required hard copy receipts for 3 or 4 of my expenditures. This included purchases from my optometrist for, oh, gosh, GLASSES, as well as at the podiatrist, for TDW-Mark II’s ingrown toenail.

It puzzled me, Visa, nor Mastercard never had such issues. I assumed that, just like the commercial banks, that the electronic billing that led to the vendor of, say, my gasoline, getting paid, had all the information required, kind of like a grocery store receipt.

Perhaps I was wrong. Or, perhaps, somewhere in this favoured land, folks go to their podiatrist, or their optometrist, when they feel the need for hookers and blow. (I wouldn’t know, myself, and Hunter Biden was not available to comment on that possibility) So, I guess, I will have to remain puzzled.

@@

Occasionally, I am humbled. Just the other day, I had such an opportunity. The lady bringing the pre school aged children in for whatever their complaint that day, was approximately my age (and, I am by no means of child rearing age. Hell, my youngest grandchild is already in primary school!) She reported, in the course of the conversation, that “My husband and I both got them when they were very, very young.”

Just, matter of fact. No inflection, dry fact.

As I was charting later, I noted that the parent was identified as the grandparent.

So, let’s contemplate that. Some of us are anticipating retirement, with few responsibilities, plenty of free time, and no pressing concerns.

Others, around us, are raising a SECOND family, at our ages, and not flinching.

Some of us are facing demands of duty, and stepping up to those demands, and in doing so are protecting, and nurturing, the most vulnerable among us.

@@

So This Is No Shit (TINS), There I was Fighting Disease And Saving Lives (FDASL), long, long ago and far, far away.

Well, okay. REEEAAALLLLYYYY!, I was shopping in Farmer Jack, in Da City, on one of my off duty from EMS days. I was pushing my shopping cart down one aisle or another, occasionally consulting my shopping list, and a fellow approached me.

He greeted me. “Hey! I know you!”

I did not just recently develop my aversion to Humanity. I spent years perfecting it. “Uh, no, you don’t, sir.”

He, on the other hand, was undeterred. “No, I know you! You work for the fire department!”

“You have the wrong guy!”

“No, really! I remember you  You saved my brother’s life!”

“Yep! That’s me! That’s how I spend my days! How is your brother?”