FPC: Phenomenal Phone Company

A long, long time ago, in a state capitol city not so very far from here, I was seated in the basement of The Enormous Hospital System Mothership, where She Who Would Become TDW-Mark II was undergoing surgery of some sort. I was seated next to, well, let’s simply call him my father in law.

At this point in the celebrations, the divorce from The Plaintiff had concluded, and she and I had a week-on-and-week-off child custody arrangement. My adolescent children had cell phones, and had both me and their mother on speed dial.

So, Number Three Son had occasion to call me, but I could not make out what he had to say, and my attempts to re connect with him were for naught.

I did not know if this was generic adolescent ‘gotta call dad’, or something emergent. That latter was very unlikely, but, after all, I have kinda spent my life in the “this is sort of an emergency” business, and therefore considering that possibility is an occupational hazard. Therefore, since I was NOT at home, and, should my children need me, their ability to communicate that to me in a timely manner was mission critical, well, The Phone Company, and their inability to connect a freaking call something like 12 blocks from the freaking state freaking capitol, well, to understate the thing, I found it unsatisfactory.

Father In Law offered the use of his phone, on Another Carrier. I entered the number of my son, hit “connect”, and, par miracle’!, just like that, I was speaking to my son!

We concluded our conversation, since it was a generic “ought to call dad” call, and I asked Father In Law if I could make one more call. He assented.

I then called “customer service” (spit!) of The Phone Company. I explained my problem, and how this was not acceptable. Phone Company Minion asked my location, and I described myself as being one floor down from street level, in waiting lounge of Enormous Hospital System Mothership. Minion then regaled me with a bit of RF theory, to wit: “You cannot reasonably expect a cell phone to have a reliable signal when you are underground!”

I asked Minion, do you have caller id?

Affirmative.

Could you tell me the originating telephone number for this call we are having, right now?

He read back Father In Law’s phone number.

Is that a Phone Company number? If not, what carrier services that number.

Why do you ask?, responded the Minion.

“Because, that is the carrier who is henceforth going to be receiving checks from me approximating $200/month, because my phone, my childrens’ phones, and the phone of every mo$%#r f@!%&er who will stand still long enough to hear this story, will be giving their business to this carrier, whose phone I presently hold in my hand, in this basement, as you and I converse!”

Having said that, I realized that there is no satisfying way to slam down a cell phone. I miss plain old wired phones.

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Gotta Scratch That Itch!

A week or two ago, my MA returned from her lunch, and showed me her parking lot find: a couple of dirty syringes, with bent needles. “I found them on the ground behind my tire”, she related.

My thoughts were, ‘what sort of fool, even among the universe of fools who inject drugs, leaves a freaking needle on the ground in a parking lot, where children come and go on their way to their own physician appointments?’

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So, just the other day, TDW-Mark II needed to recharge her cash card. Off to her bank we went. The gentleman attending to her transaction appeared to be somewhere in his twenties, whereas I, myself, am approaching 70 (and so closely approaching 70, that 70 has started to tap his brakes, and slow down, in hopes that I would not admire his bumper so closely anymore!).

TDW was making conversation with this gentleman, and he was owning that this sort of transaction was unfamiliar to him. TDW then up and chirps, “It must be hard on poor elderly people, who don’t have computers, or know how to use them! That whole smart phone, and computer banking thing can be rough on the elderly!”

I looked at her for a moment, and spoke up. “Am I not standing right here? You CAN see me, right? Really? I. Am. Right. Here!”

9-1-1 Follies

So, TINS, TIWFDASL…. er, well, OK: I was NOT FDASL, rather, this was long, long ago, and far, far away, and Doug, my partner, had his car in the shop, and so I picked him up, and we went to headquarters in order to pick up our paychecks.

I was driving him home, and we were chatting about inconsequentials, when I had stopped at a traffic light. Coming from our right, a soul had stopped in order to make a right turn, and once he attempted to make his turn, another idiot (wait for it!) had stepped out in front of the vehicle.

The driver slammed on his brakes, and chastised the pedestrian-idiot (who had not been paying attention), whereupon the pedestrian rejoined with some unwelcome insights about the driver’s mother, and her lifestyle choices.

The driver exited his vehicle, displaying a knife (that was clearly visible from across the street!), and chasing the pedestrian. He (the driver) was bellowing, “You sunovabitch! I could have killed you!”, as the pedestrian retreated around the parked vehicle, retreating for his life.

Just past this dance, was a pair of pay telephones (remember them? Another artifact from my youth!). Doug went to one, and dialed 9-1-1, and I took the other, deposited some change, and called our dispatch Bell line.

My call got answered first. Ronnie the dispatcher answered my call, took my information, and passed it to another dispatcher. Then, he chastized me.

“Mcfee, you DO get, that you are off duty. Right? Why don’t you let the other guys get some excitement, for a change?”

I laughed, said my goodbyes, and hung up.

Doug was still awaiting 9-1-1 to answer his call.

We got back in my car, and drove on.

SNIPPETS PART IV

I hope that nobody is surprised to learn that, since The Un-Named Fly-Over State is in the northern tier of states, it snows here in the winter (And the fall. And the spring.) That has been the case for certainly the past nearly 70 years that I have been here. Therefore I would hope that my neighbors would have figured that shit out, by now.

On the other hand, there is abundant evidence that my hope in this matter is misplaced.

So, TINS, TIWFDASL…well, OK, I was driving in to work one snowy winter day in order to begin my day of FDASL. I was listening to the amateur radio in my vehicle, and monitoring the county’s fire department dispatch. No ill tidings from that front.

I did notice a car off the road, into the ditch, but I figured that the county deputy already on the scene had things well in hand.

So, there I was, listening to the FM radio, and waiting for any alarming traffic on the HAM radio, when I saw this guy, no shit, skate his compact pickup truck completely across the 3 lanes of expressway traffic, having apparently originated from the on ramp. My guess was that he had entered the ramp at speed that was excessive for the conditions. (did I mention that it had snowed the preceding night? Well, it had. Likely had something to do with the other guy in the ditch.)

Anyhow, once he reached the median shoulder, he started to wifferdill his way along that shoulder, inching his way into the median’s ditch. He did manage to stay upright, so, that was nice…..

The thought crossed my mind, “coefficient of friction: words to live by!”

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You may recall my tales of cat-herding (Farming? Wrangling?). In any event, one of the cats had a recurring conjunctivitis, such that our local vet voiced concern regarding the potential of a ruptured globe (eyeball breach, with vision-destroying loss of the fluid-vitreous and aqueous humor that is within the eyeball), versus a vision damaging occurrence of scars on the (supposed to be) clear portion of the eyeball.

So, we arranged an appointment with a veterinary ophthalmologist.

Of course, this doctor practiced in an office something like three counties over from our home. Of course, on the appointed day, it was a balmy 33 degrees (f), and could not decide to snow, rain, sleet, or what.

Fun times.

I learned on this trip, that driving Trixie T. Cat anywhere, was very much akin to driving your small, furry, outspoken, elderly, mother-in-law somewhere. I was the recipient of a running series of corrections, spoken (of course) in Cat, that likely would have sounded like “You’re driving too fast!”, “You’re driving too slow!”, “Why can’t you stay in one lane?” (this as I signaled, eased over into the -clear-adjacent lane, and in the course of doing so, ran over the ridge of slush built up between the lanes. So the truck jerked.), “Why aren’t we there yet?”, and the ever popular, “Where the hell are you taking me? I don’t want to go there! Let me out of this damned cat carrier!”

That is, would have sounded like that, if I spoke Cat.

As you might imagine, first off, back seat driving is oh, so very welcome at any time at all. Secondly, such corrections are even more welcome when the driving is, oh, gosh, I dunno, HAZARDOUS! Thirdly, let me take a moment to congratulate TDW-Mark II. She successfully suppressed her baseline impulses to shriek, gasp, or otherwise demonstrate her appreciation of her/our impending DOOM! Probably figured that the cat had that well covered.

Everybody Brings Sunshine Into My Life….

From time to time, I determine that an antibiotic will be helpful in resolving whatever ill is present in my patient. For example, folks with dental infections, and who are not allergic to beta lactam antibiotics (those related to penicillin), get amoxicillin. It is what our dental colleagues have directed me to employ as first line, and pretty nearly always gets the job done.

So, TINS, TIWFDASL, and my patient-du-jour had a dental infection. I presented my spiel, winding up with the observation that I would be sending over a prescription for amoxicillin.

This soul stated that they had received amoxicillin several years ago, and “it didn’t work”.

May I step back for a little bit of dental anatomy? Any surgeon (and, dentists are surgeons of a particular specialty) will tell you that antibiotics are wasted on any abscess, due to the fact that the overwhelming majority of the pathogens are afloat in the pus filling the abscess, and, since no abscess has any sort of circulatory system, any antibiotic will only make it to the periphery of the lesion, and not the the seat. Indeed, surgeons generally are of the opinion (an opinion probably developed during years of residency and 20,000 to 40,000 hours of patient contact) that the foundation of resolving an abscess is to drain the abscess. That will both greatly, greatly reduce the population of germs remaining to cause mischief, but also place those germs in close proximity to tissue that, indeed, has circulation, and therefore provide the antibiotic the ability to access, and damage, the germs.

GUM abscesses are potentially susceptible to intervention by clinicians such as I myself am. TOOTH abscesses, including dental pulp and/or dental root infections, are immune to my attentions.

Therefore, plausibly, this soul’s historic experience with amoxicillin could have been due to the infection remaining inaccessible to the antibiotic.

Back to my story. This child of God requested “something stronger” than amoxicillin.

Two competing thoughts sprang into my mind: First, amoxicillin is the drug of choice. Prescribing something else is akin to purchasing a full ton passenger van to transport your gravel, because “big vans are stronger!”, or something. Really, using the proper tool for the job makes so much more sense.

Secondly, there are several reasons why clinicians do not simply “prescribe something stronger”. One if them is NOT that we are all assholes, who want people to be/stay sick. Rather, for example, gentamicin is used all the time in ICUs for patients who are terribly sick. (wonder if that has anything to do with the reason that they are in ICU to begin with?) These folks get regular blood draws, to be sure that the concentration of drug in the blood is within certain bounds. Too little, and it is less effective than needed. Too much, and deafness and/or kidney failure can result, among other bad things.

So, for certain values of “stronger”, gentamicin is, indeed, “stronger”. On the other hand, deafness as a consequence of your long delayed dental care appears, to me, to be a risk out of proportion to the anticipated benefit. Particularly when I can anticipate the same benefit, with rare risk, from, gosh, er, um, oh, I dunno, AMOXICILLIN.

Back to my story, backing away, a little, from my rant-du-jour: I asked this soul what antibiotic had been beneficial, for past dental infections?

The answer, I swear to Crom, was, “I don’t know. You’re the doctor, don’t you know?”

Words. They fail me.

Telemedicine: Threat, or Menace?

One fine day, I was at work, FDASL, and received a text from my daughter, let’s call her Brenda. She related that her second child had developed what looked like pink eye, to Brenda’s assessment. She (Brenda) had contacted whoever, and that medical soul had video chatted/e-visited/virtually visited/some other bullshit with my grand daughter, and had prescribed an ophthalmic antibiotic.

Brenda was not altogether certain that this assessment was spot on, and wanted her clinician dad’s take on things.

As you may have surmised, MY take on non patient contact, not in the same room “visits”, is not filled with much enthusiasm. There is something to the gestalt of being in the physical presence of somebody, that provides you with clues that are neither evident, nor are they provided across a video screen of any sort. (Ever smell the fruity breath of diabetic ketoacidosis? Ever smell it over a phone?)

Placing that aside for a moment, I asked for some pix. (I am aware that this amounted to the very same thing I had just, 11 words ago, railed against. Wait for it.) My grandchild’s eye appeared red, and (uncommonly in pink eye), so did the tissue surrounding her eye.

I asked if this grandchild could move her gaze left and right, upwards and downwards, painlessly. Was there any change in her vision?

The response I received was that the vision in her affected eye was “blurry”, as well as “it hurts when she looks up”.

My response text, verbatim, was, “Who is going to see her in person, in the next half hour?”

Brenda took her child to our local urgent care, which clinician, to THIS clinician’s credit, is reported to have entered the room, taken one look at my grand daughter, and turned to her mother, and said “So, I’m not going to charge you for this visit. Do you know the way to Big City Referral Hospital? Good. Do not dawdle. Go directly there, now. Yes, I mean the emergency department. Thank you. Drive safely.”

THOSE folks examined her, CT’d her, and started an IV (a process that Grand Daughter did NOT approve of!), and IV antibiotics, and admitted her for several days. The CT had revealed a peri orbital cellulitis (mild, but, nonetheless…), which responded to the medication.

She is now home, sassy, and none the worse for the experience. Take home points: Brenda demonstrates many, many of the affirmative attributes of The Plaintiff: she is smart, decisive, has a finely calibrated and high functioning “shit don’t sound right” detector, and is a bulldog advocate for her children.

I loathe “telemedicine”.

Sometimes I am both blessed and lucky. This time, to the benefit of my grandchild.

Partners. Or, Not.

So, TINS, TIWFDASL, and it was approaching the end of my shift. The other midlevel was a locum (think: rent-a-clinician), and since I was busy with my side, I wasn’t paying a lot of attention to her.

One of my patients was pretty sick. As in, “Where is my ambulance”, sick. I also had a couple of other folks, who had to wait while I dealt with Mr.-or-Mrs.-pretty-sick.

Once the ambulance had departed, I tended to my other patients, and noted that the floor staff appeared pretty, well, relaxed. I asked them, “Doesn’t Little Mary Sunshine have any patients left?”

They looked at me. “Uh, no. She beat feet out the door while you were in with your emergency. Oh, and one of her patients did not get their antibiotic. The pharmacy called, and would like you to fix that.”

I did a literal double take. “Say what?”

The MA repeated herself. There was still 10 minutes in the shift.

They tell me, several months later, that I got very, very quiet at that. Concerningly quiet.

SNIPPETS

So, TINS, TIWFDASL, and one of the registrars walked back, and informed us, “They say that there is a man out there with a gun!”

My response was to ask, “Is there any reason that you are NOT telling the police this, rather than telling me?”

“Oh, should I call the police?”

“Ah-yep! Right freaking now would be very nice!”

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If you have COPD (emphysema), it is likely not so very helpful to smoke marijuana.

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Me: “So, you’re here for your cough. When is your cough worse?”

Them: “When I cough.”

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Please, after I have explained my plan of care for your cough, which is caused by the irritation caused to your throat by the mucus in your throat, mucus originating in your sinuses, Please do not correct me with the observation that “My mucus is in my throat”.

It is very likely that, when I illuminated and inspected your throat, I DID notice, and, indeed, did comment upon, the tsunami of snot therein. Further, it is likely that every child of Ghawd that I have seen today has, also, snot streams running down their posterior pharynx: their throat.

So, when I explained to you that that mucus is irritating to your throat, since your throat is not well designed to tolerate that event, and that irritation manifests as a sore throat, or a tickle and a cough, or both, did you consider the possibility that the mucus originated, oh, gosh, I don’t know, IN YOUR SINUSES, AS I, INDEED, MENTIONED IN MY DETAILED EXPLANATION OF YOUR MALADY AND MY PLAN TO MANAGE SAME?

So, the nasal steroid that I recommended to you, over the counter, will suppress the inflammation (that I mentioned was the root cause of your woe), and thereby suppress the outpouring of snot which is the proximate cause of your cough, and, therefore, end (or really, really suppress) your cough, which was the ostensible purpose of your visit in the first place.

Sometimes, The Pucker Could Squeeze Diamonds

So, TINS, TIWFDASL at an urgent care out in Flyover Country. It was a typical afternoon, featuring a parade of sniffles, coughs, and poison ivy. Our clinic was on the south side of the road, east of Middling Sized City, and the Big Time Big Deal Hospital And Trauma Center. In other words, to get the the BTBDHATC, one would exit our driveway, and turn west (that is, LEFT!)

Abruptly, the registrar summoned me. My MA and I walked over, to behold a limp toddler. Very Not Good!

The MA escorted the male carrying the child to an exam room, and began to collect vitals. I examined the child, discovering a heartbeat (Crom be Praised!) and spontaneous respirations. The registrar collected demographic information, and I asked the adult what had happened, prior to arrival.

“Well, he started shaking, and then he stopped. He just wouldn’t wake up, so I brought him here.”

Well, the “wouldn’t wake up” part was still descriptive of the child, and I noted that I would have to call an ambulance immediately, because this could have several causes, none of them good. Indeed, “floppy child” is right up there in my Triage Catalogue Of Very Bad Things.

The adult male paused at this. “I don’t want to send him by ambulance. I’ll take him myself!”

I was surprised. I noted, “So, you *DO* realize that several of the things that caused this, could reappear, and he could stop breathing or his heart could stop. EMS is trained and equipped to deal with those things, should they occur. You, while driving, are not, right?”

He persisted. “I’ll drive him myself”.

We directed him to go there immediately, with no delay nor detour. We explicitly directed him to exit our driveway, TURN FREAKING LEFT (that is, west), and not stop until at the ED.

He stated that he understood, and would do so.

He scooped the child up, and exited the building. I sat down to chart, as well as call BTBDHATC, in order to provide them with forewarning of the sick, sick, sick child coming their way. That is, until my registrar called me, excitedly, to report that this sunovabitch had turned EAST! (exactly away from the hospital) upon exiting our driveway.

WTAF!

I had the clerk print a face sheet, and called emergency dispatch. I related the above information to dispatch, along with my concern that a critically ill child was *NOT* being taken to the ED. I provided the street address we had received, as well as the contact information.

I next called the child protective services emergency number, to report the above. I was assigned a report number, which I charted, and my own name and contact information was taken.

Several hours later I received a telephone call, from a gentleman asserting he was from CPS. I asked him to confirm the report number, the child’s date of birth, name and address of our record. He did confirm all these details.

He queried me about the particulars of the child’s presentation. I supplied the requested information. I asked how the child was. The worker paused, and said, “Well, I am not allowed to provide information regarding an ongoing investigation, particularly one where the child in question has been hospitalized. I’m sorry. “

My response? “Yeah, it’s too bad you couldn’t tell me if the child had been hospitalized or anything. I understand. Thank you.”

Questions Above My Pay Grade

A long, long time ago, back in Da City, I had left EMS, and was employed as a nursing house supervisor. In the course of my rounds, I stopped by ER. The staff chatted with me, revealed that things appeared to be under control, and they needed for nothing at that time.

One of the staff nurses drew me aside, and murmured, “Check out the ER doc that they sent us!”

I asked, of course, “Why?”, and was told, “Never mind! Once you chat with him, you will know!”

I approached him, introducing myself, and asked how his night was going. I was struck by the fact that he appeared to have several freckles about his face, each with a glint as of metal. Each, in fact, about the size of a pin head. I figured that was odd, concluded my conversation, and moved on.

I subsequently encountered one of the ER nurses in the cafeteria. “What did you make of Dr. Pins?”

“Couldn’t tell you. Never seen anything like it, before!”

So, a little later that night, I cruised through ER, again. (part of my “management by wandering around” strategy). The doc asked me if he could speak to me, in private. That was odd, but, sure, whatev’s.

So, back in the physician’s office, he began to describe a patient. I mean, as in how a resident (or a midlevel) would staff a patient with an attending. He wound up with his query: what did *I* (remember: the NURSING supervisor, with no provider chops whatsoever at this time) think that the patient ought to have done?

I tried not to stutter: I really, really did. I suspect that I failed, but I did manage to observe that other physicians had ordered this, or that test, and not uncommonly had discharged the patient with a prescription for this, that, or the other thing.

The following afternoon, my boss, the afternoon Nursing Director, and I had a chat. A lengthy chat. About Dr. Pins.