Duty · Having A Good Partner Is Very Important!

PROFESSIONALISM, PART II

So, Carmen, my grand daughter, had a couple of additional Magical Mystery Tours of Peds ICU. Brenda, her mom, wound their way through the maze of physicians, and specialists, treating, and attempting to diagnose, what was underlying our recurrent Monday-evening-Grandpa-visits.

Eventually, one of the specialists determined that a surgery would mitigate Carmen’s breathing difficulties, and so a surgical date was set, in a distant Big City Medical Center. Brenda told both of her parents, and her conversation with me went along the lines of “Dad, so Carmen is going to have surgery on (date), at Big City Pediatric Hospital.”

(Dad): “uh huh. I’ll be there.”

(Brenda): “Uh, Dad? So, Mom is gonna be there, too.”

(Dad): “Uh huh. Why would there be any question about that?”

(Brenda):”Well, I know you guys are going through that divorce, and things might be…tense..if you were both in the same room.”:

(Dad):”Well, Honey, your mom is a grown up professional, I flatter myself that I am a grown up professional, and while we are there with you, for that time, what I think about your mother, or what she thinks about me, well, nobody cares. This is about you and Carmen, and nothing else is on my plate for that time. I don’t anticipate any drama coming from either of us. I know I won’t cause any drama, and I am confident that your mother will not, either.”

So, we met at the appointed time, and greeted each other. Carmen received her IV, and was pre medicated, and rested on her mother’s lap, soon falling asleep. I have a photograph, somewhere, of Carmen, relaxedly asleep, on Brenda’s lap, Brenda appearing fatigued herself.

Carmen went for her surgery, and returned, post operatively. Carmen had an uneventful post operative course, and Brenda took her child home. Today, a dozen years later, Carmen is newly adolescent, The Big Sister, and perfectly healthy.

Oh, and my pre and post op interactions with The Plaintiff? Benevolent, professional, and child (and grandchild) focused. No drama.

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

Guardian Angel, Working Overtime

So, TINS©, TIWFDASL©, working a weekend gig in a very, very rural corner of The Un-Named Flyover State. I was a mid-level in, completely out of character for me, a very, very rural hospital’s (VVRH) walk in clinic. I was working with an LPN, a woman of sense, alertness, and industry. Sometimes, Blessings are not obvious.

So, mid morning, she gave me report on Our Next Contestant. Late 20’s fellow, had complained of back pain for a week or two, and he attributed this pain to “I pulled my back, working out doors”. So, this was long about February, and in VVRH’s catchment area, it was mighty freaking cold. Snow, long about hip deep, lined the roadways, and the roads, themselves, had been plowed, and, in keeping with Flyover State Rural Road Commission Operating Procedures, had *NOT* been salted. Since everybody got their water from wells, and most of us thought that salting our water was ill advised, the roads had some sand applied, “upstream” of intersections.

I listened to the vitals, and noted her assessment that “this guy doesn’t look right”. I entered the exam room, introducing myself. He told me that he had started to hurt a couple of weeks prior, the pain in his back, described as “Like something tearing”, had increased with time, despite his employing the ever popular intervention of “ignoring it, hoping it would go away”.

Having concluded on this beautiful sunny 8º F day, that is was *NOT* going to get better, he had WALKED three miles into town, by his estimate, seeking help.

He had muscle spasm in his back, true enough, but something about his story sounded several degrees out plumb. I palpated his belly, and felt something therein pulsing away. He also reported that my pushing on his belly, made his back pain worse. I was not certain what it was, but I was pretty sure that this was way, sway above my pay grade.

I phoned the ED physician, spun my tale of oddness, and he accepted my patient. My nurse wheeled him down the hall to Emergency, and we plodded through the rest of our day.

Nearing the end thereof, the ED physician walked in my door, and told me a story, featuring my long walking friend. He, the physician, had also thought that the examination, along with the back pain, was odd, and so he, the physician, had CT’d my patient. That study revealed a honking big, seriously dilated abdominal aortic aneurysm (a dilation of some part of the aorta, in this case in my patient’s abdomen).

For those in the studio audience who are not medically inclined, the aorta is the single largest, highest pressure, artery in your entire body, running about 2 cm in the area just below your diaphragm, about at the level of your renal (kidney) arteries. Those of us who have studied the US Military’s tactical trauma care course, or have had some sort of “care under fire” training”, will have learned that, should the aorta be penetrated, either by projectile or through a rending of it’s wall, the entire blood volume of an adult male (running around 5 quarts) can empty out in something approaching a minute, plus or minus. One thing that places you at risk of experiencing that, besides the projectile-through-your-aorta thing, is having a large aortic aneurysm abruptly rupture.

Of course, in VVRH, there was no abdomino-thoracic surgery service. My friend the ED doc attempted to arrange a transfer for this fellow, only to be SOL (Surenuff Outa Luck). The roads in our corner of the state were being snowed in, and therefore ground transport to pretty nearly anywhere was not going to happen.

Doc cast his net more widely, and more widely. Adjacent State Big Time Medical Center would accept him, but, alas, we would have to figure out how to beam him up transport him there. Middling Outstate Medical Center could not accept him, since they had no vacant ICU beds, which our new friend would certainly require, assuming he survived (a) the trip, (b) the surgery, and (c) the post op period. Any one of which could end him.

Next Up Upstate Medical Center, alas, similarly had no ICU vacancies, and so, finally the physician negotiated a transfer to Downstate Academic Medical Center, who, miraculously, sent a fixed wing aircraft and critical care transport team to our little single runway county airstrip.

A couple of weeks later, I was working a weekend as was the physician in question. He made a point of strolling over , and relating the above to me, both because it was remarkable that the patient had not only survived the trip, as well as the surgery, and the recovery, into the bargain, but was home, and evidently neurologically intact. The doc knew this, because this fellow had come into ED seeking care for a sprain or some such thing, that he had newly acquired, working outdoors!

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

“Show Me Some Teeth!”

One afternoon, I came in to my shift as a nursing supervisor, and the director of nursing had, it appears, JUST finished receiving a phone call asserting that somehow, the hospital staff had lost some patient’s dentures. Of course, I was the High Value Target in that particular free fire zone, and I caught the assignment. “McFee! You find out what happened to this patient’s dentures! Do not rest until you find them!”

I promised my best efforts, and was reprimanded. “I do not want your best efforts! I want you to show me some teeth!”

Uh, Ok. Yes ma’am!

I inspected the patient room, freshly cleaned by housekeeping. No dentures. I went to billing, the keeper of the valuables, and searched for property that had remained unclaimed. No dentures.

I interviewed our laundry folks, and inquired regarding foreign objects in the washer or drier. No dentures.

I inspected the patient intake form, cataloging the patient’s property at arrival. Of course, there was indeed a notation that the patient had brought her dentures with her to the hospital.

I took a break, and visited the security supervisor. We chatted for a bit, until he asked why I had not been wandering around, and had not been in evidence that shift.

I told him the Story Of The Missing Teeth, and my efforts to transition that tale into a dental retelling of The Prodigal Dentures: “Rejoice! My teeth, that have been lost, have been found! Kill the fatted calf, prepare the feast!”

Along with my, thus far, horrible fail in accomplishing it.

He sat back, and a thoughtful look crossed his face. “So, Reltney, do you need to find THE teeth, or just any teeth?”

I observed that the patient in question might feel a little, well, odd, wearing somebody else’s teeth.

My friend the security supervisor opened his safe, and extracted some ancient dentures. He then clarified things for me. “See these green teeth, here? Now suppose they were inadvertently dropped outside the door here, in the driveway, and some inattentive security officer, like, say, me, were to accidentally run them over, like, six or eight times? I doubt that anybody would put the shards into their mouth, you could show your boss teeth, albeit broken teeth, and so she would be happy, the complaining patient would get new dentures, so they would be happy, and your boss would stop breathing down your neck, and so you would be happy. How many opportunities do you think you will get to make that many people happy, all at once?”

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

Whenever I Start to Think That I am The Smartest Guy in The Room, I am in the Wrong Room!

Another time, I was fighting disease and saving lives as the afternoon nursing house supervisor. Start of shift stuff had been done, I had made some rounds, and arranged for staff to get off the unit to eat. I was piddling around with some paperwork of some sort, and heard an overhead page of “Code Red: 1 East!”

At that time, in this facility, 1 East was our psych unit. I phoned the switchboard, and she told me that there had been a pull station activated on the unit, and I needed to go verify it before she could call the fire department.

Uh, excuse me? WTAF??!! I directed her to call 911 right freaking now, and communicate the alarm at once. “But, our policy is to wait until the supervisor verifies the fire!”

I told her that, employing the telepathy that had stood me in such good stead in years on the Fire Department’s EMS division, I had just this second confirmed the alarm, and she needed to stop dicking around, and call the fucking firefighters.

I hung up, and took off at a trot for the nursing unit, and unlocked the door.

Immediately, I was happy that the alarm had NOT been delayed. The unit was quite smoky, and the smoke was starting to bank down to about shoulder height. I found the charge nurse, and asked her for report. She reported that every patient had been accounted for, and every one was presently in the day room, with two sets of smoke doors between them and the fire room. One of the patients had, somehow, ignited his mattress, and then things got exciting.

The security supervisor and I did another sweep of each room, double checking that nobody was on a floor, or draped over some furniture. Happily, nobody but the two of us was there. Oh, yes: the two of us and the first due engine company.

The firefighters trundled the smoking mattress out of the unit and into our alley, whereupon they performed a sort of urban baptism ceremony, pouring The Healing Waters Of Engine 56 upon the Sinning Mattress.

The next morning I had a stern chat with my boss, and the phrases “NFPA standards” and “fire code for health care facilities” were flung about. Along with the observation that the reported SOP was ABSOLUTELY inconsistent with the prevailing standard of care.

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

Phone calls that make you go”WTAF??!!”

So, TINS, TIWFDASL as a nursing supervisor in a small hospital in Da City. I had checked our afternoon staffing, and accounted for all the staff. I had wandered around, meeting and greeting my staff, and made arrangements such that everybody could eat. I checked in with security, and, as usual, there was nothing happening.

I was back in the nursing office, completing some paperwork or other, and received a call from the switchboard. The operator informed me that Channel 69 news was calling, asking about some patient who had fallen out of a window at our facility. I told the operator to send the call to me, and stat call the security supervisor to meet me in my office, RFN.

The call was odd. (Now THAT is a surprise, idn’t it?) The caller identified herself as a reporter for one of the local stations, and that they had received a report that a patient had fallen from a window, and landed on a roof of part of our building. I responded that this was inaccurate. I knew this to be inaccurate because, in the event that such a thing had occurred, the staff would call me immediately, no such call had been placed, therefore no such thing had happened.

We concluded our conversation, and I turned to my friend the security supervisor. I asked him to immediately inspect our roofs, either in person or with one of his officers doing so in person, and ascertain the absence of anybody (or, any body) on any of our roofs. He hopped right to it.

Next I called each of my charge nurses, and ordered them to immediately, with no delay, personally lay their eyes on each and every one of their patients. They were ordered to immediately call the switchboard to report that they had indeed personally laid eyes on every one of their patients, or stat page me overhead in the event that any patient was not physically on their unit.

One charge nurse protested that she was too busy to perform this task. I noted that this was what we termed “a work order” in our employee handbook, and her options were to get to it, right now, or prepare their soliloquy for 0900 the following morning, wherein they would have the opportunity to convince the director of nursing that they should, indeed, continue their employment at our hospital. Because ANY other response other than “Let me go, so I can get to this”, would result in their being clocked out and escorted from the building, right about now.

Surprisingly, that elicited compliance.

The security supervisor paged me, requesting that I meet him in the cafeteria, that being about the center of the hospital. I arrived and he briefed me: his officers had inspected the roofs, and noticed nothing awry. A couple of his officers had shanghaied the maintenance man, and secured a ladder. They were going to climb up and re-inspect the accessible roofs, to verify what their preliminary survey had suggested. And, nobody/no body had been found.

I physically went to each nursing unit, spoke with each charge nurse, and had them show me their census, along with a report of their actions to inspect each patient. No missing persons. Hallelujah!

I phoned my immediate supervisor, and gave her the short form report. Of course, the long report, in five part harmony, with full orchestration, with circles and arrows and illustrations to fully communicate the entirety of the affair, was waiting on her desk for the morning.

Fun And Games · Pains in my Fifth Point of Contact

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!

Fun And Games · Fun With Suits! · Pains in my Fifth Point of Contact · School Fun And Games

“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!

Fun And Games Off Duty · Fun With Suits! · Life in Da City! · Pains in my Fifth Point of Contact

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.

Fun And Games · Pains in my Fifth Point of Contact · Pre Planning Your Scene

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. 
Fun And Games · Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact

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!