THE WISDOM ASSOCIATED WITH HINDSIGHT!

So, the other day, My Best Man and I went to the range together. He had recently acquired a Garand that he had not yet shot, so, by way of introduction, I brought mine, along with some other guns that merited airing out. A good time was had by all, as range time = good times. “Group therapy”, so to speak.

My friend is a bit of a raconteur, so the stories never end. He told several tales regarding the CEO of his employer, and these stories revealed a soul steeped in the tradition of leading from the front, and taking care of your people = taking care of business, which equals, in our line of work, taking care of patients. Well. Taking care of them, well.

From him, with our history, these were tales of high, high praise, indeed. (He is the originator of the observation that “Little Mary Sunshine is *NOT* a force multiplier!”)

Eventually, we had shot everything that we had brought along to shoot, and noted that it had clouded up, with occasional rumbles of thunder to draw our attention. Therefore, we safed the weapons, packed up the ammunition, cased the firearms, and paraded to our vehicles.

Once everything was settled into our vehicles, well, the skies opened. We were at my conservation club range, and so I got the opportunity to exit my vehicle, unlock the gate, open the gate, exit the gate, and relock the gate. This, of course, required that I exit my nice, warm, dry truck, wade through the slough that our driveway had become (soaking my feet in the process. I *HATE* cold, wet feet!), fiddle with the lock, fiddle some more with it as I fail to correctly recall the combination, fiddle with the damned thing YET AGAIN, finally opening it. In the downpour.

As my partner exited the gate, I ran to my own truck, entered it, and realized that I had a poncho therein. I donned the poncho, and attempted to close my door.

As it developed, my truck will *NOT* exit park, and move, until the driver’s door is secured. That required me to remove the poncho from the door, and attempt, several times, to close the damned thing. Finally succeeding, I moved my truck through the gate, and re entered the cataract in order to re lock the gate.

It occurred to me, right about then, that donning my poncho (as well as, oh, I dunno, FREAKING BRINGING MY FREAKING FIRE BOOTS) might have gone a long way towards allowing me to open the gate, close the gate, lock the gate, and then return to my vehicle, without being, you might say, soaked to my damned skin.

Ah, the wisdom associated with hindsight!

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Random Thoughts, Part IV

You may have heard of the ChicomFlu. It has been all over the news, and, evidently it is all Mr. Trump’s fault. Interestingly, the same folks voicing concerns about Mr. Trump being a fascist dictator, who is planning on a putsch in order to become President For Life, also are criticizing him for failing to seize control of the economy, and not dictating the minutiae of our lives in order to Halt! This! Scourge!. Apparently, that entire Federalism thing, and Tenth Amendment thing, bypassed these commentators in Government class.

Or else, our government schools failed them. Again.

So, in clinical medicine, in 2020, we now have drive in care. Care, that is, of a sort. So, folks drive up (remember that point), announce themselves (no clown’s mouth, thankfully!), and our registrar trots out and registers them. Our MA does preliminary interview, and obtains most of the vital signs (except BP). I then suit up in an impermeable gown, goggles, N-95 mask, with another lesser mask over top of it to prolong it’s service life, and gloves, and stroll out. I interview them through the vehicle window, examine ears, throat, auscultate heart sounds and breath sounds (and, by the way, I can tell you things about your engine and transmission). With this information, I form a diagnosis, formulate a plan of care, and instruct the patient in that plan.

I nearly always ask if my patient smokes. If the answer is affirmative, my response if “Stop doing that!” Occasionally, when the answer is “No”, I have indisputable olfactory evidence that this is an untruth. If I can smell your marijuana fumes through two masks, you are doing it wrong.

*History Lessons*

If you live in Bagwanistan, or Cuomo Valley
 New York, or, really anywhere, KNOW 
YOUR DAMNED MEDS!

It's commonly considered to be A GOOD
 THING if I avoid prescribing a medication
 that, in concert with whatever crap you
 take daily, will turn you into a flaming 
zombie, or cause your ears to drop off. So
 write that shit down someplace where 
you can find it. This appears to be a novel 
insight to a significant fraction of the
 population.
 

And, while you're at it, ask your pharmacist 
what you're allergic to, and WRITE THAT 
DOWN, as well. 

And, for those of you who are thinking
 that “All that is in my record!”, uh, well,
 if your records are in, say FREAKING
 FLORIDA, it might be a bit difficult for
 me to access. Particularly on 
weekends, or after 1800 hours their time.
 By the way, this also applies to folks
 whose records are in Milwaukee, and are
 visiting Flambeau Hospital, since that is
 the nearest healthcare to Copper State
 Park in BFE, Wisconsin.  Big City Hospital
 in Milwaukee may not see us as an 
entertainment subsidiary of their 
megalithic hospital system, and your info
may well be securely hidden away, 
from us. 

Jes' sayin. 

The Fellow Who Would Not Go

A long, long time ago, in a Blue Hive not so very far from here (In truth, not nearly distant enough!), I was a nursing supervisor. This one time, TINS©, TIWFDASL©, and I received a phone call from one of my nursing floor charge nurses.

It developed that one of our physicians had written discharge orders for this one gentleman, let us refer to him as “Mr. Man”. Mr. Man was apparently of the opinion that our physician was mistaken, and that he, Mr. Man, was not sufficiently recovered to return to his home. I responded, spoke to the nurse, and then spoke to Mr. Man. He pretty much recreated the report that I had heard from the nurse, culminating in his ultimatum: “I’m not going anywhere, and you cannot make me!”

I phoned the physician and relayed my conversation. This doctor asked me a few questions, corroborating his assessment of the patient’s clinical circumstance. Having done so, he reiterated his plan of care: “Mr. Man does not meet the criteria from the insurance company, who is paying for his hospital stay, and they are not going to continue paying for his stay. He is discharged, I have written prescriptions, and arranged a post discharge office visit. If he has issues, we can discuss them at that visit.”

I relayed this to Mr. Man, and he again indicated his determination to remain. I returned to the nursing station, and invited my friend the security supervisor to show his smiling face, so that we could confer. My friend the security supervisor had no new input, although he sent a couple of officers to stand by the floor, in case Mr. Man decided that some interpretative dance, so to speak, would make his case more effectively.

Shortly, the med nurse was passing by, surprisingly enough, passing her afternoon meds. I stopped her. “Do you have any meds for Mr. Man?” She consulted he med book. “Yep, he has (whatever) due at 2 o’clock!”

“Hand it to me. I’ll take this one over from you.” I placed the meds securely in the med room, and returned to my chat with security. Sure enough, as I had expected, Mr. Man put on his call light, shortly after he noticed the med nurse pass by without stopping. I answered his light (security dawdled just down the hallway).

“Yes, Mr. Man, what can I do for you?”

“I am supposed to get (whatever) around this time. I just saw the nurse pass me by.”

“Why, yes you did, sir. You see, since the doctor has discharged you, you are no longer a patient here, you are now a visitor. It is not our practice to administer medications to visitors, and so the med nurse did not have any medications for you.”

“How am I supposed to get my meds?”

“Discharged patients usually obtain their medications from a pharmacy.”

“I bet you think you’re smart! You cannot make me leave! I’m staying right here!”

“Yes, sir, I understand what you are saying. Is there anything else?”

“No. Go away!”

With a smile, I departed. A couple of hours later, supper time arrived. I removed Mr. Man’s tray, and sent it back to dietary, with the admonition that he had received orders for discharge, a therefore would not require meal service. Indeed, shortly he noticed the aides passing supper trays, and, again, he engaged the call light. Again, I responded.

“Mr. Man, what can I do for you?”

“You could serve me my supper tray!”

“Oh, sir, I’m sorry! We do not feed visitors. You have been discharged, and therefore are present here as a visitor.”

“How am I supposed to get something to eat?”

“A lot of people find that a grocery store is helpful in this regard. Other folks find restaurants to be more to their liking.”

Again, I was dismissed.

In our facility at that time, visiting ended at 2000 hours. Our switchboard operator announced this fact, and bade all visitors a good evening. I popped my head into Mr. Man’s room, and reinforced this message. Security, this time in the person of the security supervisor, accompanied me.

“Sir, you will have to leave soon.”

“I dare you to throw me out!”

Security responded. “Sir, our usual practice is to ask folks to leave. Those who do not depart, are trespassing, and we ask Da City Police Department to handle that. I imagine the responding officers will ID such a person, run a LEIN check, and either walk that person out, or, if somebody were to have outstanding warrants, arrest that person, and lodge them in jail”

Mr. Man again indicated that our audience with him had come to a conclusion.

Outside the room, we heard one sided conversations as of telephone calls, and, from what we could discern, seeking transportation. Again, shortly, we were summoned by the call light. Mr. Security and I responded, and I (again) asked, “Mr. Man, what can I do for you?”

“I don’t have my prescriptions, and my ride will be here in a couple of minutes.”

“Yes, sir, I’ll get right on that!”

I secured his prescriptions and discharge instructions, and Mr. Security and I returned to the room, where I delivered the instructions and prescription, and then the security supervisor and I wheeled Mr. Man to the door, where he sprang from the wheelchair, entered a vehicle, and exited our lives. Whew!

Clem, Cletus, and Why Heavy Equipment Operators Require Functional Partners, Too

Many, many years after I had left the employ of Da City, I came to live in Small Rural Town. Our little slice of Heaven featured, among other things, a municipal water system. The town had been built out shortly after the Second World War, and the infrastructure was contemporaneous with that construction.

Apparently, the engineering lesson of corrosion occurring at the junction of dissimilar metals, had not percolated to the individuals who built the house in which we lived. This epiphany developed after I noticed one Friday morning that there was water pooling in our front yard, between the door and the street.

Side note. NEVER! call the water department with that sort of observation on a Friday. They will shut off the water. It turns out, the service line from your home to the main is YOUR problem. You will NOT get that problem resolved late on a Friday. Or on a Saturday. Or on a Sunday. Not having running water makes for a long weekend of work.

Monday, I was again working, but TDW-Mark I had successfully contacted the Knob City Excavating Company to respond and repair our service line.

This involved excavating my front yard, and, having accessed the service line, replacing it.

It appears that professional excavating practice involves having one individual operating a back hoe, with another standing by, inspecting the back hoe’s progress, apparently in an attempt to avoid engaging the service line with the back hoe’s bucket, reefing thereon, and using that service line as a leader to abruptly extricate all the plumbing from your home.

So, about that. Clem was the back hoe operator, and Cletus, evidently, was tasked with leaning upon his shovel so that neither he, nor the shovel, fell over. In that, he appeared to be successful. Clem DID notice the entanglement of his back hoe bucket with my plumbing, but only after he had begun to extract my plumbing from my house. Fortunately he had only JUST begun to do so, before he determined that Things Were Not Right, and stopped. That was about the point at which I returned home from a day of fighting disease and saving lives.

Things were at a standstill as I entered the house. TDW-Mark I was standing there, gazing into the hole adjacent to our foundation, looking decidedly unamused. Clem was there as well, while Cletus was a’holding that shovel, determined that it was NOT going to fall!

TDW pointed into the depths of the hole, calling my attention to the copper stretched out from the foundation to it’s junction with the iron pipe that, evidently, had been our service line. Another vehicle pulled up, disgorging a worthy who was, is seemed, Bob The Knob, owner and operator of Knob City Excavating. TDW beckoned me inside, where she showed me where the service shut off on our domestic water feed, formerly near our ceiling, was now located at the floor. I suggested to Bob The Knob that he might want to get somebody with plumbing expertise in to review the situation, and effect such repairs as seemed needful. On his dime. And, RFN. (Right Fucking Now)

He did not appear to think that this was particularly unreasonable, particularly if he were to consider the alternative, which would involve court, attorneys, attorney fees on both sides, and much bad Ju-Ju.

The next day, I returned home from work, and TDW-Mark I informed me that Some Dude had arrived, crawled around in our attic, and had pronounced everything shoreward of our shut off to be intact. This worthy had then replaced our shut off, and the associated piping, and Knob City Excavating had replaced our service line with copper, had installed a bimetallic junction (TDW-Mark I had asked/insisted) at the main, backfilled everything once the city building inspector had signed off, and we Now! Had! Water! (cue the rejoicing)

It turns out that Bob The Knob was satisfied with my check in the original, estimated, amount as payment in full. We did not have any leaks subsequent to this adventure, and we all lived happily, ever after.

Revelations

Recently TDW-Mark II was perusing Facebook, and noticed that Number Three Son, and his wife, had posted a couple of pictures. In the first, he was dressed in a nice suit, she in a nice red dress, posed all nice and proper.

In the second, SHE was in the suit, HE was in the red dress, and they were, again, posed soberly and portrait like.

TDW-Mark II called this to my attention, allowed me a couple of seconds to deliberate over this vignette, and then opined, “He loves his wife way more than you love me! You would never do that sort of clothing swap with me!”

I considered this, and observed, “Well, now you know!”

Dumpster Diving

This one schedule, Doug had elected to rotate onto day shift. Likely something about a wife, family, and wanting to spend some time with That Bright Thing all up in the sky, while he was awake, might have figured into his calculations. In any event, TINS©, TIWFDASL© on night shift at Medic 14 (let us say). I was partnered up with Johnny Wadd (not his real name), who was, even among the collection of characters that made up the crews of EMS in those halcyon days, a character. He was book smart, street wise, quick on the uptake, head on a swivel, and, despite a very crusty persona, good hearted.

So, this one time, at band camp….uh, wrong story. So this one night we were cruising around between runs, and, as commonly happens in my “sea stories”, well, we caught a run. In the misty distance of all these years, I cannot tell you what the nominal nature of this run was. I do, however, remember (a) that the police were NOT dispatched to this run, and (b) once we arrived, and began to understand what the happs were, well, item “a” began to appear to be a big, big mistake.

So, we arrived on the scene to discover not a light on in the alleged address. Calling on the scene, we verified that the house number on the house before us, was, indeed, the address dispatch wanted us to report to. Check!

I knocked upon the door, while Johnny looked around the front of the house. As he reached the edge of the house adjoining the driveway, he heard something from the back that caught his attention. We meandered back to see what was up (notifying dispatch, on the way, of our explorations).

The sounds Johnny had heard were moans, and they were emanating from a wheeled trash bin. That made sense, as my flashlight illuminated two legs protruding from the top thereof. Johnny peered inside, and beheld a gentleman curled up inside, much the worse for wear.

We figured that any conversation to be had, would be had with greater clarity should our new friend be extricated from the trash bin, and so we began to attempt to lift him by his legs.

BAD PLAN! At least, in his view. He screamed, convincing us that this was NOT the course of action we desired to pursue. I ran to the truck, and retrieved the cot, a backboard, and backboard straps. Johnny and I then slowly levered the bin onto it’s side, and tried to gently place Mr. Trash Bin onto the backboard so as to remove him from his nest with minimal discomfort (to him) as we could manage. In his opinion, we were not particularly successful.

Once he was out in the light, such as it was (MagLite light, it was!), we could discern from the angulation of his thighs that he had sustained two fractured femurs. Further evaluation revealed a couple of gunshot wounds, as well as several stabbing wounds.

We determined that further time on the scene, with our basic life support asses, would be unprofitable, and so secured our guest onto the board, strapped him onto the cot, loaded him up into the truck, and coded our happy way to TBTCIDC.

Once we had turned him over to the ED crew, and they were poking, prodding, needling, radiating, IV-ing, and generally getting to know him far, far better than anyone else in his life ever had, we cleaned up and restocked the truck. Johnny turned to me, reflection written deeply in his eyes.

“Ya know, Reltney, I wonder if someone, somehow, got a little angry at our guy there! Somebody does not seem to have had his very best interests in their heart!”

Backpacking Changes your Perspective

So, when I was younger, I enjoyed backpacking. In the Midwest, unless you are going to travel several, several hundred miles east (Appalachian Trail), or west (Rockies, or their foothills), or north (Northern reaches of any of the Canadian provinces), Isle Royale is pretty much a zenith destination.

Two other medics and I shared this enthusiasm, and we planned on a trip along the Greenstone Trail, after a detour south along the Feldtman Ridge Trail. Traveling from west to east, we planned to wind up at Rock Harbor, where we could shower, get a room at the lodge there, and catch the ferry back to Michigan.

Our first day called for 8 or nine miles of hiking. (remember, we were all south of 30, and pretty much in peak shape. I would bicycle 50 to 100 miles a day, a couple of weekends a month, for amusement, for example). We anticipated the daily mileage would be a challenge, but no tremendous thing.

We read, voraciously, trail guides, commentaries, and articles in the various outdoor magazines regarding Isle Royale. The consensus was that we ought to cut ounces, as over time ounces add up to ponds, and pounds add up to pain. So we turned to freeze dried foods.

After much prep work, and detailed planning, we arrived on Isle Royale, starting our trip at the western end of the island, at Windigo. After registering, we set out, arriving at out campsite after around 8 miles, at Feldtman Lake. We set up camp, washed up with filtered water, and prepared supper.

Our consensus was that the freeze dried meal was superior to not eating, but not by much. One of my partners summarized things: “This mess tastes like salty cardboard!”

In the morning, we set out again after eating and packing up. After another day of up hill and down slope, we arrived at Siskiwit Bay Campground having made around 10 miles on the trail. We set up camp, washed up, filtered water for dinner and the next day, and ate.

We reviewed dinner, afterwards. “This mess still tastes like salty cardboard!”

The next morning, awakened, packed up, headed out. If you are familiar with backpacking, the daily routine is, well, pretty routine. The payoff can be found in multiple areas. There is the being outdoors aspect, very attractive to those (such as me) who find being outdoors to be attractive. There is the scenery to be found as you stroll through nearly pristine wilderness. There is the enjoyment found in physical activity.

So, we walked our next day away, again arrived at our camp, set up camp, filtered more water, cooked supper, and appraised it. “This shit tastes like salty cardboard. You gonna finish all that?”

Again, slept the sleep of the righteous, awakened, breakfasted, and headed out, once we had packed up.

Another day, more beautiful vistas from the Greenstone Ridge Trail, Reaching our campsite, we again set up, filtered water, cooked dinner. For our last night on the trail, we provided another gastronomic review: “This shit tastes like salty cardboard! And, the portions! They’re so small!”