“State Employment Agency”. Yeah: About That….

Years ago, I was unemployed. Since I was unemployed, I registered for (surprisingly enough) unemployment insurance payments. THAT necessitated that I register with the state, for assistance obtaining employment.

THAT was a treat! As it developed the folks at the “find this guy a job” office, did not appear to comprehend that I was an RN. Ya know, Registered Nurse. College and everything like that. They persisted in pointing out that they had PLENTY of Nurse’s Aid jobs. “Uh, yeah, about that. I am licensed here in the Great State of The Un Named Fly Over State, as a Registered Nurse. Nurse aids report to the LPNs that work with, and supervise, them. My job is, among other things, when I am working, is to supervise the LPNs. Howzabout you find me a job like THAT, hmm?”.

You might imagine that I did not rely upon them to find me my next job.

Trying to facilitate my return to gainful employment, I observed that I also held licensure as a Physician Assistant. “Oh, yes! Isn’t that like a medical assistant? We have jobs for those!”

Sigh. Another explanation of the collegiate effort required in order to qualify to sit for the board examination. As well as the different responsibilities appertaining to medical assistants, versus physician assistants.

I found employment as a midlevel, through a locums agency. Fat lot of help the unemployment folks were.

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Snippets VIII

THAT LOOK WHEN the pregnant patient whom I am interviewing, trying not to get high myself as she emanates reefer fumes, asks me, “Is amoxicillin safe for my baby?” (This after I had diagnosed her UTI, and was in the middle of prescribing amoxicillin to treat same)

ANOTHER DAY, ANOTHER CHILD OF GHAWD relating that their malfunction is “I have a sinus infection”. I perform my usual review of systems, featuring denial of fever/chills, and no at home treatment over the 3 days of illness that drove this soul to my clinic.

Physical exam did NOT reveal any positive findings, except for mucus coursing down the back of this soul’s throat. I provided my assessment, and my basis for that assessment, including “…if you had a bacterial sinusitis, you would have leaped off the table and yelled at me when I tapped on your sinuses!”

This soul replied, “Oh, well, I NEVER get sinus tenderness with my sinus infections!”

Not being in a mood to argue, I smiled, did NOT observe that marked sinus tenderness is one of the CARDINAL signs of bacterial sinusitis, and said, “Here’s your augmentin prescription. Have a pleasant day!”

A FEW WEEKS AGO, TDW-Mark II had a migraine, and it took it’s sweet time resolving. I had to work, and came home to find my bride upright and preparing some soup (this being an improvement). I asked how her day had gone.

“Well”, she began, “the migraine was unpleasant, like they always are. This time, every time I woke up from my multiple naps, there were six cats perched on the bed, as if they were on watch. You know, if one or two others had joined them, I was going to call you and insist that you come home!”

Fortunately, her furry caregivers determined that, the next day, she only required 4 in attendance at any one time, and so, she recovered, as the cats weaned her off from a high level of feline supervision.

ONE DAY, my MA asked (it seemed to me, from out of the blue), “What do you want on your tombstone?”

I spread my hands, fingers wide, and stated, “Like this , with fewer fingers.”

She smiled. “Wow, kinda harsh! I meant on your pizza. THAT escalated quickly!”

Abandonment, and Trust Issues…

A while ago I had an MA assigned to me. She was (is) capable, focused, intelligent, and engaged; she maintained awareness of what else was occurring in the department, and reacted promptly and appropriately. (She was the protagonist of the tale of the early morning floppy child)

As things developed, she had an opportunity to transition to a day shift, Monday to Friday, 9 am to 5 pm, work-no-weekends-or-holidays job (in contrast to our present work-til-9-pm, every other weekend, every other holiday scenario). And! Get a raise in pay!

Naw, I cannot see why she would entertain such an opportunity for a single second, either.

So, of course, I teased her. “Oh, I see how you are! You would rather spend time with your husband, with your children! Oh, yes, I suppose all that is just fine for you, but what about ME?”

As you might expect, she started her new job, and, occasionally, took some overtime, working with me from time to time. Of course, each time I would tease her. “Oh, I see! Now that you are dead to me, NOW you come back, just as I was resolving my grief at your cruel abandonment of me!”

My partner joined in, observing, “You know, if you came back to work in this department again, you could never break up with him ever again! He has been an embittered husk of a man, since you left!”

(This is the same partner who observed, when I once wore a fleece prominently displaying the fact that it was an item from the National Rifle Association, by means of the 2 inch tall initials “NRA” over the left breast, let me know, “You know, they spelled your name wrong on your coat!”)(My name is “Tom”)

We reached a lull one overtime night, and I renewed my teasing. “You know, I taught you everything I know, while I was standing on one foot, and you abandon me! Oh, yes, you have a ‘HUSBAND’, and you have your ‘CHILDREN’, you have dreams, and plans for your life, but, what about MEE?!?”

She chuckled.

Serendipitous Connections.

Among the maladies that motivates folks to come visit me in the clinic, is that their infant has diaper rash, also known as diaper dermatitis. Should this persist past, say, 3-5 days, there is an increased likelihood of Candida (you may recognize it as yeast) joining in to add to the discomfort. Yeast (Candida) is commonly found in stool, and, well, with infants, stool in the diaper is a common occurrence. If there is diaper rash, susceptibility to candida climbs.

So, microorganisms really, really like a particular set of conditions in order to grow and proliferate. Generally, that includes warmth (like you might find beneath a diaper, for example), moisture (which just MIGHT be found, beneath a well fitted, and perhaps, oh, gosh, let’s spitball here: wet! diaper) as well as darkness, so that those pesky UV rays do not disturb the microorganism’s DNA, as well as that nasty old sunlight not drying out the area of operations.

This being The Un-Named Fly Over State, and deer hunting being nigh unto the State Religion, once you get into the outer ring of Big City Suburbs, most folks recognize the existence of a program known as Quality Deer Management (QDM). The premise is that, should the landowner provide for high quality food (acorns, or suchlike), access to water (ponds do nicely for this), shelter (like deer tend to find in a woodlot), AND you avoid hunting young bucks, then you tend to hunt, and harvest, larger, healthier bucks in later years simply because you provided an environment conducive to such bucks reaching maturity, in an environment providing them with their needs.

Therefore, when I suggest that parents who attempt to provide an environment that DOES NOT provide these elements to the germs in their child’s diaper, the child is likely to have fewer episodes of diaper rash, of shorter duration, and less likely to require my attention. That means, naked babies (generally in the kitchen, on the linoleum), kept meticulously clean using bland soaps and tepid water, with their (the babies) bottoms protected from the irritant effects of urine and stool by such means as petroleum jelly. That means, to those steeped in such things (like your Mark 1, Mod Ø deer hunter), that concerned parents do THE OPPOSITE of what QDM practitioners do for deer. Take you kid’s germs, and dry ’em out, blast them with sunlight, cool them out, and let Nature, and your child’s immune system, take care of business.

Serendipitous connections.

Tales From The Nightshift

So, TINS©, TIWFDASL© one night in The Maternal State, years and years and years ago. My father had taken ill, and of the three of us boys (the attorney, the contractor, and me, the nurse), it seemed that I was the best fit for the job of helping Mom take care of our Dad.

Well, that, and I was the one who did not have a family.

So, in order to keep my house and my vehicle, my creditors agreed that it would be nice if I were to continue receiving a paycheck, while I was 800 miles from home, and taking a voluntary leave of absence from my employment. So, I became a travel nurse!

This one night, I was working midnights at Some Suburban Megalopolis Hospital’s ED. It was way, way late, and we had cleared all the souls from our beds, and were engaging in my favorite slack time occupation, Story Hour.

So, one nurse was recounting how her boyfriend was failing to meet performance/behavioral expectations in one way or another. The other nurses (all women) responded, in a sort of choir, with murmurs of affirmation for the reporter. Except for one particular nurse.

This woman’s speech was rich with the cadence and harmonies of Da Islands, with a Caribbean note permeating her pronouncements.

“Aw, naw, ghurl! Ya no haveta put up with dem shenanigans! He gotta go, out de doah!”

The chorus affirmed this pronouncement.

The protagonist in our little Greek tragedy continued with her lamentations of Mr. Unworthy’s misdeeds, and our Caribbean Correspondent again provided her assessment: “Out de doah!”

Again, the call of more misdeeds, again the response from the congregation: “Oh, naw! Out De Doah!”

It devolved into a documentary of The Misdeeds Of Men, and along about that time, I found something I ought to be doing. At the other end of the department.

“Warn-A-Brutha”, in action.

So, TINS©, TIWFDASL©, and my MA, let us call her Maryann, exited the room that she had entered, shortly before, to assess and obtain vitals on a child.

“Reltney, this child here is working kind of hard to breathe, and he is coughing a lot: it seems to interfere with his taking a breath!”

I entered the room, and noted a child coughing approx every 10 seconds (and I mean a full throated cough, not some modest little “harrumph!” kind of thing), and, as I observed his breathing, noted a rate of around 60 breaths a minute.

Not so good.

We administered a breathing treatment, and he had kind of, sort of, maybe improved just a little bit.

I finished my assessment, and went to chart, intending to return and re assess him once my (generally 4-7 minute) charting was completed.

I did so, and noted that his breathing had dis-improved (is that really a word?). I invited the physician with whom I was working to lay eyes upon him, briefing her upon my observations and actions thus far.

Once she had assessed him, she was not favorably impressed. She, also, thought he was working kind of hard to breath. She, also, wondered if this was fixing to run him out beyond the end of his reserves, whereupon he would crash, likely biggly, and become a no shit emergency. She wondered if sending him to emergency, prior to that happening, might not be more wise than waiting until he did, indeed, crash.

I agreed.

I wrapped up my charting, once the child was safely on the way, and hunted up Maryann. I congratulated her. “You did good. Your prompt assessment that this child was not breathing right, set in motion events necessary to get him to the appropriate level of care, in a timely manner. Well done!”

The Heinlein Rule

Perhaps, I ought to initiate another tag, “The Heinlein Rule”. As Heinlein said, “Take a look around you. There never were enough bosses to check up on all that work. From Independence Hall to the Grand Coulee Dam, these things were built level and square by craftsmen who were honest in their bones.” (https://thisibelieve.org/essay/16630/)

I have spoken of Eloise in another post, as well as one particularly heads-up MA and how each of them, professional in their bones, acted on their own initiative and decisively to protect patients.

So, one day, TINS©, TIWFDASL©, when the registrar meandered back to the nurses’ station.

She opened her conversation, “Just checking. This woman reports that she is bleeding, and 3 days out from her delivery. You *DO* want her to go to emergency, right?”

Before I could contribute anything, my MA asked, “Does she look dizzy, or pale? Did she walk straight? Anything else going on?”

The registrar replied, “She looks pink, not sweaty, walked straight, no other complaints when I asked about any.”

My MA stated, “Please direct her to emergency.”

The registrar looked at me. I stated, “What she said. Does she have transport?”

“Yep, She is here with some family member.”

“Outstanding. She should be on her way, please.”

The Lord blesses me with partners who play “Heads UP!” ball.

Smoking is Bad, M’kay?

Several times a week I get the opportunity to “cheerlead” one soul or another along the path that ends with not smoking. Some folks are receptive, and they get the full orchestration. Others, not so much, and they get the admonition, “So, smoking is not health promoting behavior, is it? There, I’m done yelling at you about smoking!”

Those who appear receptive get told, among other things, that The Plaintiff smokes, She is a nurse, so it cannot be that she does not know the effects of smoking. And, if you ignore the fact that she married ME, and divorced me, well, ignoring those two errors of judgment, she is pretty smart. Finally, she has never been any sort of shrinking violet. As a mother, I enthusiastically applaud that sort of strength of character.

As The Plaintiff, well, not so much.

I move on to observe that this set of facts (see previous paragraph) tells me that stopping smoking is a monumental task, complex and demanding much of those who would make that journey.

Then, I observe that I worked, full time, in my Nursing school years. Spent two years on around 2 hours sleep a day, in my AD program.

Pretty worthwhile. Mighty difficult.

I conclude by observing that worthwhile things are seldom easy (cf. Raising children), and that easy things are seldom worthwhile (see: video games).

Occasionally, I will see some soul who was on the receiving end of that spiel, several months later, and some of those folks will tell me”I have really cut down, and am trying to finally quit, because of what you told me!”

Sometimes, you get to think that you have, indeed, made a difference!

Nursing School Lessons

NURSING SCHOOL LESSONS

So, TINS, TIWFDASL, years and years and years ago. I was in nursing school clinicals, and working for EMS in Da City. This was so long ago, that HIV/AIDS was not even on the horizon.

One day in clinicals, I was cleaning up an incontinent patient, and my instructor motioned me outside once I was done and the patient tucked in to a nice clean bed, and he, himself, was clean and dry and in a clean gown.

She began: “Mr. McFee, You did very well keeping the patient covered so that he would not get chilled as you bathed him. There is, however, one item I ought to call to your attention.”

“Yes, ma’am? What is that?”

“I noticed that you were wearing gloves. That concerns me, because your patient might feel insulted at your wearing gloves for personal care.”

I responded, “So, you are telling me that the fact that I am wearing gloves to clean a patient who has been incontinent, of stool at that, might be seen as insulting?”

“Yes, Mr. McFee, that is exactly what I am telling you.”

“Well, ma’am, I worked last night, on the ambulance. I spent the night crawling in and out of cars, and over broken glass, removing injured people. I probably have a thousand little cuts on my hands alone. I am pretty certain that any patient of mine will get over their hurt feelings way before I recover from Hepatitis B. But, you are the instructor, and I am the student. Let’s write down your directions for me in this matter, and make a couple of copies. We’ll both sign each copy. That way you will have a copy, establishing what you directed me to do, I will have a copy and therefore cannot claim that you never told me to do what you told me, and there will be no questions moving forward what I am to do.”

She looked aghast. “I am not going to write that down! No way!”

I smiled. “Thanks for the counseling session. I will certainly keep your words in mind, moving forward!”

SNIPPETS V

STORY THE FIRST

So, TINS, TIWFDASL, just a couple of weeks ago, and, as I entered the room, I was greeted by the younger of the two women seated in the exam room. “There he is! You saved my mother’s life!”

While that certainly was a welcome greeting, I admitted that I was confused. The younger woman, evidently the daughter, filled in the missing pieces. Several weeks previously, she (the narrator) had accompanied her mother (the other soul in the room while we conversed) to a visit to our clinic. She (the mother) had been having a cough of some sort, and I had felt that something in the experience did not sound right. After some assessment in clinic, I had sent the mother to ED, and those worthies had identified a 100% occlusion of one of mom’s coronary arteries (the arteries feeding the heart). Mother had received a stent, and been sent home, and was still among us. Indeed, she was here, today, due to another cough.

Thankfully, today’s cough appeared uncomplicated, and I recommended my usual measures to ameliorate the post nasal drip that seemed to be the source of the cough.

Sometimes I get to think that I really do, from time to time, positively impact people’s lives. That’s nice to think.

STORY, THE SECOND.

Just the other day, I was shopping. Such is the life of a life saving, disease fighting, internet blogging champion (of sorts). As it develops, I am middling tall: 5-7 or so. It turns out that the pasta I was hunting for was on the top shelf, and several other people had purchased some, before me. THAT meant that I could just barely not reach the boxes. I had just realized that I, a tool using animal, could open my knife and extend my reach, tipping over the needed number of boxes, and add same to my cart. That is, I had just realized it, when a gentleman, taller than I, reached up, grabbed a box, and handed it to me, asking me if I needed more.

I requested two more, and thanked him, moving forward with my shopping.

A few aisles over I observed a woman attempting to retrieve an item from a shelf beyond her reach. Before I could respond, another (taller) gentleman stepped up, retrieved the sought item, and handed it to her.

Everyday, plain folks, acts of civility and kindness.

STORY, THE THIRD

We visited my wife’s sister, and her husband, recently. They live in rural Kentucky, and it is rather a change from their previous neighborhood in Metropolis. Indeed, it is a considerable change from my table-flat neighborhood of Un-Named Flyover State.

We arrived, following the directions provided, and noted that the terrain was, well, “hilly” does not really do it justice. As a consequence of that terrain, roadways tend to meander, circling around this hill, or weaving their way up to, over, and down that ridge.

We had spent something like 45 minutes meandering , as the road took us up in elevation, when I noted a sign ahead, announcing “Curves Ahead!”.

I turned to TDW-Mark II, and exclaimed, “Wait, what? THAT was the STRAIGHT part?”

STORY, THE FOURTH: OOPS!

So, TINS, TIWFDASL, and, well, things had come to a slow down. I was working with a physician, on this day at this clinic, and she had never handled an adrenalin autoinjector. We had one handy, and I handed it to her so she could examine it.

I was not quite quick enough, to admonish her to not remove the guard, nor to handle the trigger, on the one end of the device. Therefore, she did, successfully, remove the cap, and then trigger it, sending the needle into one of her fingers, along with some of the adrenalin therein.

The Good News was that, since she was youthful, she promptly withdrew her hand, and therefore only received a fractional dose. The bad news is that adrenalin is a very, very powerful vasoconstrictor, and therefore her affected finger became very, very white, and also burned. Oh, yes, it burned. I cast about, wondering if we had any phentolamine. (an alpha blocker: used to reverse the effects of, among others, adrenalin, when injected into an end capillary bed, Like you would find in your fingers.) Since ours was not an ICU, nor an ED, we did not have phentolamine, nor anything that would serve.

The good news, such as it was, is that due to her youthful age, good health habits (spelled n-o-t s-m-o-k-i-n-g) and the fractional dose of adrenalin she had received, well, after around 20 minutes, her finger regained it’s color, the burning pain faded, and she returned to normal, simply just a bit more shaky than previously.

Subsequently, I obtained, and CONSPICUOUSLY labeled a trainer, specifically intended to harmlessly teach folks how to handle and operate an adrenalin autoinjector. This one has no needle, and no drug.

STORY, THE FIFTH

So, TINS, TIWFDASL….well, okay. I was NOT FDASL, rather, I was off, and, having accomplished all my chores (or, such fraction of “all my chores” as I was going to accomplish that day), my step son (son of TDW-Mark II) called. I had spoken to him about a range day, and he was off work that day, I was off work that day, and it was off to the range we went.

I took my Garand, my .380 pistol, and my 9 mm pistol. Of course, I grabbed the ammo can labeled 30-06 (for the Garand), .380 (surprisingly enough, for the pistol in caliber .380), and the ammo can labeled “9 mm” for, no doubt surprising, the 9 mm pistol.

Now, recall that I have been an RN for, lo, these many yeas. That I have passed uncounted thousands upon thousands of doses of medications, and double checked myself each time, so as to accomplish the “5 rights” of med pass: right patient, right drug, right dose, right route, and at the proper time. This was effected by reading the order, the med container, comparing each with the other, and then, DOING SO AGAIN.

So, we arrived at the range, uncased the Garand, and set up targets. Several dozen rounds later, we placed the rifle in the case, put the ammunition away, and took out the .380 pistol. Fun times.

When it came time to take out, and shoot, the 9 mm pistol, well, I went to the “9 mm” ammo can, opened it, and beheld something like 200 rounds of RIFLE AMMUNITION.

For those in the studio audience who are unfamiliar with Things Firearm, well, 9 mm is a pistol round, and rifle rounds are (a) the wrong size overall, (b) with the wrong projectile (bullet), propelled by (c) an entirely wrong charge of powder, leading to (d) entirely way, way more pressure once the cartridge is set off, for any common pistol to contain, meaning (e) should, somehow, a rifle cartridge be forced into the pistol that I had before me, anyone firing it, should they survive the resulting explosion, would forever after be known as “Lefty”.

Not mentioning the emotional distress I would experience should this pistol, one of my favorites, be reduced to shrapnel.

Sigh. It appears that I had horribly failed the ammunition labeling process, leading to jovial kidding from my step son. Other than that, a good day at the range.

And, the ammunition got re-(and correctly)-labeled.