A long, long time ago, in a county very far away, I was a nursing supervisor. I had migrated into supervision after several years as an ER nurse.
afternoon I arrived at work, and the offgoing supervisor reported
that a gentleman had been brought in and admitted for his heart
attack. Now, in these far away days, there were no angioplasties, no
stents. There was no TPA, no other thrombolytics (“clot busters”).
Indeed, the state of the art, outside of referral hospitals, was
oxygen, hydration, rest, aspirin, and pain control. We had THAT, in
a couple of days later, one of the CCU nurses took me aside, and
informed me that this guy was, to employ her own professional and
finely tuned appraisal, “acting kinda squirrely”.
developed that the attending physician determined that this soul was
both having/recovering from a MI (heart attack), but, in addition,
was a florid alcoholic, and was entering into DTs. Like, classic,
textbook, tachycardic, hallucinating, writhing, pre-seizure
to make everything just nice, the internal med doc that the
cardiologist consulted did not believe in using benzodiazepines for
alcohol withdrawal. (that would be medications like Valium or
Librium, useful both for the sedating effects, as well as their
efficacy in protecting the patient from convulsions that might be
lethal.) No, he insisted in using antipsychotics, which weren’t
altogether effective in addressing his twitching nor his
he survived all this excitement, and, eventually (like, 4-6 weeks
worth of eventually) was ready to go home.
discharge planner discovered that our new friend was a resident of
Florida which we, in The Unamed Flyover State, were not anywhere
near. He had wrecked his vehicle in the initial confusion, and
therefore had no vehicle to get him home. In any event, what with
his MI, and his lengthy stay in Thorazine Land, was in no sort of
shape to (a) drive home to Florida, nor (b) master the intellectual
challenges inherent in navigating the interstate home, even if he was
strong enough to physically do so, Which he was not.
investigations revealed that none of his family was in any sort of
position to happily drive up here and retrieve him (which of course
begs the question of what was he doing here, with his pleasantly
confused self, something like 1200 miles from home? And alone?)
once the dust settled, he was still our problem, and The Suits
determined that springing for a flight home would end the financial
drain that he represented, since no insurance company in the Western
World would pay for him to reside at the Grand Hotel De Our Little
Hospital, once his medical need had resolved. I did mention that he
was squirrely, right? Well, our discharge planner hypothesized that
his heart attack, and DTs, had trampled his previously marginally
sufficient coping mechanisms, and he was, now, fully senile.
Therefore, putting him up, unsupervised, in a hotel, would not work
out at all well.
the plan was laid. Our discharge planner purchased a plane ticket.
He had specifically purchased a ticket on a nonstop flight,
determining that there would be fewer opportunities for him to wander
off, and get lost Ghawd Alone knew where. Then, she dumped it in my
lap. I called A Competing Ambulance Service, and spoke to a
have this guy, and we are going to fly him home. He is not
altogether there, and so he needs both supervision, and a chain of
custody. The flight is at 5 pm, so I want him at the gate at 4 pm
sharp. I want your crew to physically deliver him to the boarding
gate, physically observe him belted into his seat, and obtain a
signature as a receipt from the flight attendant who seats him. Can
you do all that?”
You just have to set it up with the airline. OK?”
I’ll set it up, and call you back.”
I called the airline. I spoke with a supervisor, and laid out my
problem, and my view of the solution. “Sure, no problem. We can do
that. Anything else?”
Can you get a receipt for my guy, from the folks who pick him up,
and then call me with the fact of safe arrival, please? Then,
mailing us the receipt would be wonderful!”
can do. Gimme your name and mailing address!”
called the Competing Ambulance Service back, and brought the
supervisor up to speed. “Oh”, I added, “One more thing. We’ll
hand the plane ticket to your medic, and also hand him or her the
chart. That HAS to go with him, and is part of the chain of custody
was the response.
on the appointed day, I was at the nurses station awaiting The
Competing Ambulance Service crew. Once they arrived, I reviewed all
the foregoing. Both medics nodded, and one opined, “Yeah, that’s
all according the the briefing we got from the supervisor. Where’s
the chart, and the ticket?”
charge nurse handed both items over. The medic made a show of
placing the ticked into the inside pocket of his jacket, turning so
both his partner as well as the nurse and I could see it settled
deeply into it. His partner tucked the chart beneath the pillow, and
they were off!
1630, I got paged to pick up a phone call. “Mcfee!” was my
Mcfee, this is Bob from The Competing Ambulance Service. My crew
just radioed me to let me know that your patient is on the flight,
seatbelt secured, and they have a signature form one of the flight
attendants. So far, so good. That attendant has you phone number,
and will phone you once he has been handed over to family at the
as promised, around 1930, the crew from The Competing Ambulance
Service arrived, hunted me down, and handed me a copy of their trip
sheet, prominently featuring the name, signature, and employee ID
number of the flight attendant accepting Mr. Man for his flight.
frost my cake of WIN!, the next day the night shift supervisor
relayed via days, that our patient had successfully, and
uneventfully, been handed off to his family at his destination.