BEFORE GOOGLE

Gather ’round, my children, and listen to a tale of long ago, and far away! In those far away, long ago times, there was electricity, yes, and telephones as well (although they were anchored to the walls of our homes, by “wires”). Why, indeed, we even had the Goddam Noisy Box, which you young ‘uns call “TV”.

Once upon a time, I was volunteering at a free clinic, serving as a nurse therein. The volunteer physician would interview, and examine the patient, and then provide orders for the treatment indicated. In those days, should one have symptoms of gonorrhea, the therapy was two injections of procaine penicillin g.

This turned out to be around 3 cc each, of a very, very viscous fluid, made particularly slow flowing because it was kept in the refrigerator.

At this point, I had been an RN for several years, working full time in ER. I had administered many, many, many injections intramuscularly as well as intravenously. I was familiar with injections, as well as strategies to mitigate patient discomfort while they were administered.

So, one gentleman was diagnosed with gonorrhea, and I received an order to administer two injections of 2.4 million units, each, of procaine penicillin g. I secured the medication, verified it’s outdate as well as the order, and made sure that the other medications the patient took, as well as his allergies, did not contraindicate this treatment.

I entered the room, and checked that the patient had been told of our plan of care. His reply? “Doc, doc, just shoot it on in!”

I informed him that he did NOT want me to “just shoot it on in”, and he would very much not enjoy the result of my doing so.

He reiterated his demand. I told him,” Sir? You are going to get two of these shots. You do not want me to simply ‘shoot it on in” because you will find it to be way, way more uncomfortable than it needs to be.”

Unmoved, he repeated his demand.

“Sir, how about I do as you insist, for the first injection. Then we can talk, and see if you would like to try it my way for your second shot, okay?”

He stated that he would not change his mind. I injected the first syringe of medication, rapidly, as he had insisted. It took some effort, because the penicillin was very thick, and did not want to flow through the needle at all rapidly.

My patient was very, very impressed by his first injection. Not at all favorably.

He stood up, once I had removed the needle, and commenced to hopping around and swearing. “Goddam! That really, really hurt! Shit, shit, shit! Doc, let me cool myself for a while!”

I corrected him. “Sir, I am an RN, not a physician. Once you calm yourself, you have another injection coming. Why don’t you allow me to administer it in the way that I know I ought to, and you can tell me how it is compared to the first one?”

He soon calmed himself, and I administered the second injection, steadily and slowly. The advantage of doing so correctly, oddly enough, is that the deliberate pace of administration allows the medication to spread out, rather than remaining a single, irritating ball of foreign material in the muscle, eliciting a cramp and muscle spasm. A cramp about which my patient had testified loudly.

Once I was done with the second injection, he stood, adjusted his clothing, and rubbed the second injection site. “Ya know, doc, that second one was not anywhere near as painful as the first one!”

Gooll-llee, Sergeant Carter! Just as if I had gone to school for this stuff, or something!

“Engendering Collectivity In Nursing”

So, TINS, TIWFDASL, and I had been admitted into the BHSU College of Nursing. I had moved on from Da City’s EMF (“The ‘Mergency Muthafuggers!”, as we had been so colorfully denominated on so many occasions), and was nursing in the ED of one of the nearly dozen small (at that time, around 300 beds) hospitals dotting Da City. I went from being chief steward of the union representing the medics, to a staff peon working nights.

Another of the nurses working with me was also pursuing her BSN, and so we study buddied up. We both had been old schooled in The Wisdom Of The Student, as so found ourselves in the rear 1/3 of this cavernous several hundred seat lecture hall, where the Blue Hive State University held it’s class on “Transitions in Nursing”. This was aimed at those of us entering the BSN program. The instructor of this particular class appeared enamored of Florence Nightingale, the Victorian English woman whose work caring for wounded and ill British soldiers in The Crimean War laid the foundation of contemporary Nursing.

This infatuation was reflected as this instructor read to us all from a book of Nightingale’s life. Amusingly, from time to time, she (the instructor) would hold the book above her head, turned towards us so that we could “see” some illustration or another, and detail the citation accompanying the illustration. (“Did you bring your binoculars?”)

From our seats, some 50 or more meters away, this was not as informative as our instructor appeared to consider it.

Once she had exhausted her store of Florence Nightingale trivia, she (the instructor, not Ms. Nightingale) moved on to instruct us in the advantages to be found in group efforts to improve the workplace. She described these efforts as “engendering collectivity” (and, do we not all wonder if, forty years later, in The Enlightened Twenty First Century, if the Thought Police would allow any of us to speak in those terms?), and appeared to believe that this was an unmitigated Good! Thing!.

Let me follow a tangent, if you please, for a brief intermission. I had mentioned that I had been a steward for the union representing Da City’s EMS. Interestingly, my father in his own youthful years, had had a hand in the formation of the American Newspaper Guild, which was a union for (surprisingly) newspaper folks.

So, I kinda grew up steeped in old school, Democrat political world view (think Scoop Jackson and Jack Kennedy, Not Occasio Cortez or Gavin Newsome), including the value to be found in an organized workplace. In that world view was the “real politik” perspective of the cost paid by the organizers initially struggling to create that organization. Examples such as The Fight Of The Overpass as the UAW attempted to unionize the Ford Motor Rouge Plant, or the Homestead Steel Strike, and other struggles as folks attempted to start, and foster, unions, including organizers being blackballed, being intimidated or outright assaulted.

So, as the instructor droned about “engendering collectivity in the workplace”, I eventually let my boyish enthusiasm overcome my naturally shy nature.

I raised my hand, was called upon, and stood. “Ma’am, I was a steward for the union representing EMS in Da City. My father helped organize the American Newspaper Guild. In the professional labor circles with which I am acquainted, we have a technical term for those who seek to engender collectivity in a previously unorganized workplace. That term, is ‘unemployed’.”

I sat down. Oddly enough, I was never again called upon, for the balance of that semester!

PRE REQUISITE OF THE MONTH CLUB AT BHSU

As I had mentioned previously, I pursued, and earned, my BSN some time ago. Oddly enough, THAT is another occasion for one of my stories.

Living in Da Blue Hive, I elected to attend Blue Hive State University, here in The Un Named Flyover State. They had a nursing school, and, indeed, I, myself was a nurse! How convenient! In addition, I lived a mile or three away from the campus.

I therefore hied myself to the admissions office, applied, got accepted (with none of that “we don’t allow our nursing students to work” idiocy), and picked up a copy of the prerequisite courses for starting my journey to BSN-dom. Easy-peasy, I signed up for a class.

Having completed that class, I signed up for the next on my list, secure in the “knowledge” that I was making progress towards my goal. Then I attended some meeting or other that was required for prospective BSN students.

Once there, I picked up a copy (another copy, or so I thought) of the prerequisite list. Idly perusing it as the speaker droned on about whatever, I noticed a course on the required list, that I did not recall being on that list previously.

Once home, I dug out my old list, and compared the two. Yep, sure enough, the list had changed. Indeed, one of the classes that previously (like, 4 months prior) had been required, was now elective.

Fast forward a year, another two classes in my repertoire, and another “prospective nursing student meeting”. To my disappointment, there was ANOTHER evolution in the required list, and, indeed, one of the classes that had been required, that I had indeed taken and passed, was not on the list at all, any longer.

I made an appointment with the dean of the Nursing school. The secretary inquired as to the topic I wished to discuss with the dean. “Career counseling” was my reply. “I’m considering earning my BSN, and I want to discuss it with her, please.”

Okey-dokey, appointment made.

I showed up at the appointed hour, introduced myself, and made my opening conversational gambit. “Ma’am, I’m presently a medic with Da City’s EMS. I’m considering earning a BSN, or else earning a bachelor’s in chemistry. I’d like you to help me make that choice, please.”

“What sort of things are driving you to one election or the other”, she inquired.

“Well, ma’am, I enjoy science, and like knowing how stuff works. On the other hand, I enjoy health care, and seem to pretty well at it.”

She asked, again. “So, what drives you to chemistry as a major?”

“Well, ma’am, one of the attractors is that it appears that chemistry pre-requisite course list is static, in contrast to the seemingly dynamic, changing-every-semester nature of the nursing pre-requisite list.”

She pulled a catalog or something off a shelf, flipped through it, and mused. “It appears that we have changed our list a couple of times in the past couple of years. How is that a problem for you, Mr. McFee?”

“Well, this past week I learned that one class that I took last year, as a required course for entry, is no longer required. Now, I don’t really care one way or the other about your pre-requisite list. What would be very helpful would be a static required course list. Maybe something like, ‘Here’s our required list. If you start on this date, and complete the list by that date, you will be held to this list, right here, for entry to our program’. Because, to tell you the truth, the next time you folks change the pre-requisite list, I’m going to become a chemist.”

I sooner or later completed the required coursework, with satisfactory grades, and completed the program at Blue Hive State University, being awarded my BSN, and living happily ever after, fighting disease and saving lives.

And our school cheer was “Buzzzzz!” Even before marijuana legalization.

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 r
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 o
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 s
in to chat with security.  

Sure enough, as I had expected, Mr. Man put on his c
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. I
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 aids 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 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!

Bradycardia and The Cough

TINS©, TIWFDASL©, nursing in the ED of this community hospital in Northern The Un-Named Flyover State. A gentleman arrived, somewhere in his forties, and he told his tale of chest pain. He shortly thereafter sported the latest fashions in IVs, EKG monitoring, oxygen, and much blood drawn and sent to lab for analysis.

Two things you should know about me. I am a bottomless well of generally useless trivia, for one. For example, the relevance of which will become apparent shortly, I read a bunch of stuff, including a report, years and years and years ago which asserted that individuals undergoing a cardiac catheterization would be instructed that, should they be commanded to do so, they should cough vigorously and repeatedly. This would, or so the article asserted, increase pressure inside the chest, compress the heart, and thereby expel blood from the heart. This was important because occasionally the catheter, introduced into the heart, could produce irritation sufficient to produce fibrillation. (an uncoordinated trembling of the heart, which produces no blood flow. A Bad Thing.)

Once they drew in another breath preparatory to coughing once again, the negative pressure inside their chest so produced would encourage their heart to again fill with blood, which would be expelled with the next cough. This could temporarily produce enough blood pressure to keep things idling along, until the cath lab staff could intervene and set things right.

The other thing about me, is that I am somewhat chatty. (“No! Say it isn’t so!”). Okay, very chatty. So, there I was, chatting with this gentleman, and noting his cardiac rhythm and heart rate as displayed upon his cardiac monitor.

I noticed that his heart rate, originally in the 90’s, was trending downward. (normal is around 60-80). Once it dropped below 55, I stopped congratulating myself on wonderful patient care, and began to worry.

He began to report feeling dizzy and weak. I directed him, “When I tell you to cough, do not ask any questions, simply do it!”

He, of course, asked me why, but at that point his heart rate had dropped below 30 (Very Not So Good!), and I was a bit terse. “Stop talking, and cough!…Cough!…..Cough!….”

I repeated myself at about one second intervals. Now, I am sure that the other nurses heard me, and wondered what variety of insanity had afflicted me. Once they came in to investigate, and I waved my hand at the monitor, continuing my coxswain like commands of “Cough!….Cough!….Cough!….”, they noted his very, very slow intrinsic heart rate. That, coupled with this guy, eyes fixed upon me, coughing every time I commanded him to do so, told them everything that they needed to know, and things got considerably more active in short order.

He soon received a temporary external pacemaker and and an ICU admit.

And we all lived happily ever after!

WuFlu, Kung Flu, Chinese Flu, or Coronavirus: It IS a big deal, but not for the reasons you likely have been told!

The number of projected deaths, when all is done, is not THE PROBLEM. At north of a million people (that’s one million, or more fathers, mothers, brothers, sisters, sons, daughters, grandfathers and grandmothers. And aunts, uncles and husbands and wives.), that is certainly bad enough. Particularly if someone you love is enumerated in that group. Life changing. Reality altering. Leaves a hole in your heart, your life, that you cannot imagine, unless you have lived through it.

BUT! THAT is not THE PROBLEM. THE PROBLEM, is the follow on effects, as a tsunami of ill inundates our already (on a good day) marginal health “system”, that it is in no way prepared for.

“Just in time” inventory systems will not bite us in the ass. Nope, not at all. Rather, the shortfalls and absent supplies will make us yearn for simply being bitten in the ass. Indeed, the “bite us in the ass” problem will more closely resemble the “bite in the ass” one might receive from a hungry great white shark, or, maybe, a ravenous tiger.

Ragarding the magnitude of THE PROBLEM, you need honest numbers, and then you NEED TO UNDERSTAND THOSE NUMBERS! See Lawdog’s blog, here , for an explanation of testing error (false positives/negatives, and the implications thereof).

See Aesop’s articles, here, for his description of the second order effects, and how it will make a clusterf…er, HUG! look like a picnic with your Bible study group. I do not know about timing, but, based on 30 + years as an ER nurse, and a dozen as a PA, and several as a medic, well, his assessment of effects is certainly defensible. I pray he is wrong, but I do NOT believe that he is wrong. (While you are there, read his other posts, about the follow on effects, about how this has been mishandled since, oh, 20 or more years ago, and about missed opportunities).

(and, READ HIS COUNSEL [in other posts] ABOUT PREPAREDNESS, BOTH LOGISTIC AND TRAINING! AND TAKE IT TO HEART!)

Good fortune to you all, and WASH YOUR DAMNED HANDS! NOW, DO IT AGAIN! AND AGAIN!

Ham radio at Fort Custer State Park.

So, TINS©, TIWFDASL©…well, Ok, I wasn’t, really. TDW-Mark 1, our kids, and I were away on vacation, camping in Custer State Park, in South Dakota. TDW-Mark 1 had planned on a drive across the northern tier of states, culminating in a visit to Mount Rushmore, The Crazy Horse Memorial, and generally seeing the sights of Not The Un-Named Flyover State. So, there we were, cleaning up after dinner, and the air got surprisingly still, and felt, well, “heavier”. There had been thunderstorm warnings earlier in the afternoon on the broadcast radio, and I figured that a little visit to Ham Radioland was in order.

I turned the car on, powered on the amateur radio, and set the radio to one of the several Ham Radio repeaters in the area of the park. TDW-Mark 1 wandered over to see what her husband was up to.

What I was up to, was taking notes on the “weather net” in progress. There were reports of rotation on the observed thunderstorms, and occasional reports of funnel clouds. TDW-Mark 1 decided that it would be clever to get all the clean up done, and everything put away. She corralled the kids, and set them to work.

One of the other campers wandered over, likely thinking that I had found “The Game” on the radio, and appeared surprised that I did NOT have the broadcast radio on, in my vehicle.

“Whatcha listening to ?”

“The local radio amateurs are weather spotting, and calling their reports. Some of them have seen funnel clouds, others have seen rotation in some of the thunderstorms that they have seen.”

“What’s that mean?”

“That it is very likely that one of these storms may touch down, and the folks near there will have a tornado to call their very own!”

“That sounds like it could be bad!”

“Yep. That could be very bad.”

Right around this point in the tutorial on Weather Spotting In America, And Amateur Radio’s Role Therein, TDW-Mark 1 returned, both to inform me that our campsite had been battened down (or, as battened down as a pop-up camper was going to get, anyhow), and inquire as to what was my brilliant contingency plan in the event that all our little family was to be offered a trip to Oz, by Thor himself.

I had noticed, upon our arrival, that the bathrooms appeared to be very substantially built. Fine brick structures seemed well suited, in my estimation, to the task of sheltering my family from the storm. I so instructed TDW-Mark 1. “If it appears that we are going to get heavy weather, we will hit the showers, select a toilet in the middle of the building, and call it home for as long as necessary.”

“Any sign that things are heading our way?”

“Presently all the funnels, and all the rotation are to our east, and northeast, so we are unlikely to catch any of it. If they close the weather net in the next several hours, we ought to be clear.”

The other camper, overhearing all this, began to turn his head, just like at a tennis match, goggle eyed at our seemingly tranquil acceptance of the potential of holing up in a toilet against some tornado or other. “Aren’t you guys scared at all by this?”

TDW-Mark 1 had his answer. “What good would that do? He’s a medic and ER nurse, I’m an ER nurse, he’s keeping an ear on the weather for us. Tell you what: keep an eye on our campsite. If you see us scurrying to the bathrooms, gather your family and join us, because it is unlikely that we all will catch the trots simultaneously!”

The look on his face was nearly priceless.

Even better? The fact that we heard the Skywarn Net stand down, around a hour later.

Random Thoughts III

Story “A”

You may recall my delight at marijuana legalization, correct? Because, “medical marijuana” wasn’t ENOUGH of a cluster f*&k, right? Of course, there is my recurrent delight at the discretion, great judgment, and common courtesy displayed by the genuii who stroll (nay, stumble) about, reefer fumes pouring from every fold of their clothing, if not every pore, in a nigh overpowering display of Poor Life Choices On Parade.

So, TINS©, TIWFDASL© when this braniac arrived, spawn in tow. My poor clerk registered the Named Patient (actually, plural, as in both kids), and then let me know that the chart was ready for me to lay some healing upon them. As if.

So, my first clue that Things Were Not Right, was when the nominally 3 year old child, named Adam, was sitting upright reading some (non picture) book. My second clue was that the nominally 12 year old child, was around 36 inches tall, and appeared to be around 40 pounds. And, did NOT appear critically malnourished.

I asked the reading child, “Please, tell me how old you are?”

The reply was “I’m 12!”

“How old is your brother?”

“Oh, he’s 3!”

I excused myself, and asked my clerk, “Did you know that Adam is 12, and Brady is 3?”

She looked at me, and informed me, “I asked the mother, and asked her twice, which child was which, and who had what birthday. It did not look right to me, but she repeated herself, same birthday both times, for each child. That is what I put down.”

“Well, it is wrong. Please, fix it, and double check it, all over again. Please try to sort out what else she fucked up in registering the kids, please.”

Once the clerk asked the 12 year old for his school id, the mystery was resolved.

My new Life Rule! If you are so stoned that you cannot remember your own gorramned childrens’ birthdays, and you successfully mix the TWO of them up, either stay the Fenomenon home, or WRITE IT DOWN!

Story “B”

Have you heard about Homeopathic Medicine?

“What Is Homeopathy?“

“Homeopathy, also known as homeopathic medicine, is a medical system that was developed in Germany more than 200 years ago. It’s based on two unconventional theories:

*“Like cures like”—the notion that a disease can be cured by a substance that produces similar symptoms in healthy people
*“Law of minimum dose”—the notion that the lower the dose of the medication, the greater its effectiveness. Many homeopathic products are so diluted that no molecules of the original substance remain.

(from: https://nccih.nih.gov/health/homeopathy )

Let’s keep “The Law Of Minimum Dose” in mind for a moment. So, I work in an urgent care clinic in The Un-Named Flyover State. It’s….quirky. Yeah, let’s go with that. So, our cleaners are some folks who are NOT from some national housekeeping chain. I do not know where the owners hired these folks from, but, well, they are, in keeping with the theme of the organization, quirky themselves.

Over the past several weeks, I have been noticing that the hand soap dispensed from pump bottles, has been appearing clearer, and clearer. Similarly, it has seemed less viscous, and less viscous, from week to week.

In keeping with these observations, it has started to require more and more pumps to elicit enough soap to, ya know, WASH MY HANDS!

One of the MA s clued me in to what is happening.

“The cleaners never pour more soap into the dispensers, they just add water. It’s free, unlike the soap that costs.”

I wondered, out loud, “What happens when it is simply only water in the “soap” dispenser?”

She told me, “I dunno, maybe, finally, they’ll buy more soap?”

I corrected her. “NOPE! We will be told, that this is the latest public health innovation! Homeopathic soap!”

Story C

A long time ago, in a county far, far away, I was working as an ER nurse. I overheard one of the clerks engaged in a telephone call.

Now in this agency, at that time, Administration did not want us providing “medical advice” over the phone. I was on board. My stock spiel, when I was trapped into answering some such call, was along the lines of “If you think you have an emergency, you ought to come to the emergency department. If you do not think that you have an emergency, perhaps your problem could wait until (the morning)(Monday), at which time you could arrange for your family doctor to address it. If you do not think that your problem can wait until (the morning)(Monday), well, at this time of night, your only option is to come in to emergency.”

I, myself, often would be the recipient of some query at that point, along the lines of “Well, how do I know if it is an emergency/can wait until Monday?”

My answer would be “You are there, you have sense (Yeah, I was lying through my teeth!), and only you can make that determination. I am not there, and I cannot see what you can see, since you are on the scene, and I am not.”

So, I heard the clerk speaking to some Brain Truster. Attempting to explain, repeatedly, how and why she could not tell him whether his laceration needed stitching. Mr. Telephone was persistent, and I could tell, from my clerk’s responses to him, that he was saying stuff like “Well it’s (insert length here) long, and about (insert depth here) deep, and it’s (insert some indicator of severity, like bleeding or suchlike here), so why can’t you tell me if it needs to be stitched?”

She finally had had her fill of his idiocy. “Sir, what color blouse am I wearing?”

“How the hell would I know what color blouse you are wearing?”

“So, how am I supposed to have any opinion worth anything about your cut?”

Suburban Community Hospital (or) Be Careful What You Ask For!

Another time, with dispatch whimsically sending us on a scavenger hunt all over Da East Side of Da City, we had occasion to transport sumdood to Suburban Community Hospital. This was a fairly sizable establishment, even by the standards of the day, and the ED was pretty busy upon our arrival.

We handed Mr. Dood over to the nurses, gave report, and began to prep the cot for the next lucky contestant. One of the nurses ambled over, and engaged us in conversation.

“How come you guys only bring us drunks? We can handle anything TBTCIDC can handle!”

Doug spoke up. “Uh, Ma’am? That’s kind of the majority of what we bring to TBTCIDC, ya know? Most of our runs are sick folks and drunk folks.”

She wasn’t gonna let this go. “Aw, c’mon! How come we never get any good trauma! I know you guys take all the trauma to TBTCIDC! Howzabout occasionally bringing us some of the stuff you always are taking to TBTCIDC?”

We mumbled something that maybe could have been taken as assent, and she meandered off to fight disease and save lives, or something.

As Kharma sometimes deigns, our next run was not too far from Suburban Community Hospital. Indeed, the Grin of Kharma must have been epically large, as the next call was for a very drunk, very loud, very combative inebriate.

Once we had him restrained and in the truck, we conferred. Consensus was, we were about to return to Suburban Community Hospital. After all, they had ASSURED us that they could handle ANYTHING that TBTCIDC could handle.

Well, to paraphrase Bill Engvall, “Heeerrreee’s yer patient!”

When the nurses began to chastise us about our patient selection, as well as our destination selection, our refrain was, “Well, you told us that you were perfectly capable of handling anything TBTCIDC could handle! This fine young man, right here, is completely typical of their patient population!”

And, then we scurried away……