Gratitude · Sometimes You Get to Think That You Have Accomplished Something!

The “Wrecks” Story (or) How I Met My Vet

A long, long time ago, TDW-Mark I, our children, our dog and I lived basically right down the block from where I type this today. This particular tale is about the dog. The children had been allowed to name him, thinking that we would spell the name the way that they would, as “R-E-X”. However, TDW-Mark I was possessed of a considerable sense of humor (at one time…) (after all, had she not been married to me for nigh onto 20 years?). SHE determined the spelling, “W-R-E-C-K-S”. This was due to the fact that he resided in a household with adolescent males, who were, themselves, high spirited. Therefore the dog was, himself, well, energetic is a kind way of phrasing it.

So, TINS, one morning we awakened, let the dog out on his chain, and settled in for breakfast. After several hours, we noticed that the dog had not barked to be let back in, his usual practice once he had had enough of The Great Outdoors. We looked to see what was up, discovering that the chain had broken, and the dog was not in evidence.

We searched the neighborhood, finding no trace of the dog. We produced “lost dog” flyers, and mounted them at intervals about our corner of our small town. That produced no results.

After a day or two, TDW-Mark I sent me to the local police department, The County Seat Police Department, and I learned that one of their officers had encountered a dog resembling our missing Wrecks, who had been struck by an automobile, and had been transported to a local vet.

I traveled to the vet’s office, and asked after our dog.

This vet confirmed that he did, indeed, have my dog, and that the dog was surprisingly uninjured after his encounter with the car the previous evening. This was determined after x-rays and examination. I asked him how much I owed him for his care. “Nothing. You don’t owe me anything.”

I persisted. “You spent no small amount of your time, and your expertise, on a dog that you had no idea if he would ever be claimed. I get that you do so out of the goodness of your heart, and as a service to the community. On the other hand, I can pay for the care you lavished on my dog. Indeed, if you insist on thinking of it this way, you can imagine that I am paying for the other critter, that goes unclaimed, such that you are not required to pay out of your pocket, for performing a public service, simply because you can do so, and it needs doing.”

I took a deep breath. “It offends me to think that you are going to be leeched off of by some schlub. I am not going to be that schlub. If for no other reason, please take my money because you ought no be penalized simply because you are a nice guy.”

He told me, “Thank you, but, really, you do not owe me anything. Thanks for the thought, but, we are good!”

I smiled and replied, “So, in that case, here is a check for $150. The next time somebody’s dog gets injured, and they cannot pay you for their care, let me help defray the expense you incur.”

And, he has been my family’s vet ever since, going onto 25 years.

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.

Duty · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

Health Care Stagecraft

So, I see children from time to time. Commonly, they are dubious about the entire “Going to the doctor” thing (yeah, I DO realize that I am not a physician, I am a midlevel. May I observe you explain that distinction, to an anxious child?) With that as a starting point, you can imagine that my approaching said anxious child with a stethoscope, and then with an otoscope (“the ear looking thingy”) might not end well. Yeah, me too.

One of the lessons I learned on Da Street (besides knock from the side of the door, and always have a second way out of any room I enter, and always have a knife, and…well, the important lesson is…..) is misdirection. On the street this manifested itself as changing the topic of conversation, as, on a hostile scene, announcing, “WE have to go and get the stretcher!”, and then both of us doing so, and motoring merrily away from the threatened free fire zone. Returning, if at all, with police.

In a more sedate clinical setting, this manifests itself with my (now) stock spiel for kids.

“This here (hold stethoscope up) is my body tickling thingy. Now, this is really, really tickley, but I only have one, right? That’s not enough to share. So, if you laugh, everybody will know how much fun it is, and they will be sad. ‘Boo-Hoo! (insert child’s name here) got tickled, and I didn’t! That is so unfair! I am so sad!’ Now, we don’t want them to be sad, do we?” (generally, toddler-sober negative head wag) “So, try very hard not to laugh, so that they are not sad! Okay?”

(generally, “ok”)

Once heart and lungs are auscultated, I continue with my misdirection. “You did so very, very well in not laughing, now we move up to the ear tickley thingey! Same rules, try not to laugh so that they do not know how much fun it is, and they are not sad that I cannot share, okay?”

Generally, again, “Okay.” While the child is trying to identify what the heck is so darned tickley about otoscopy, I finish.

One bonus point, is, even if the child screams and kicks and writhes, I can congratulate them. “Wow! You did so very well! I don’t think that they even suspect how much fun that was! You can stop pretending, now! You have successfully finished! Well done!”

Sometimes it is healthcare stagecraft, that lets you complete your job.

Duty · guns · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Self Defense Cost Benefit Analysis

TINS, TIWFDASL, I had caught the detail, and the happy go lucky soul with whom I was working that particular night on Da City’s EMS, decided it was time to ask me about my ballistic vest. Now, it was not any sort of secret among members of the department that I wore a kevlar vest. After all, in Those Days, Da City was known as “The Murder City”, and not without some justification. We chatted about the threat profile we confronted (although, the chat went along the lines of “What? Do you expect to be shot?” My response was “Nope. I wear this for those scenes on which I do NOT anticipate being shot. On those on which I anticipate being shot, I will simply refuse the run until the police have secured the scene!”)

This guy, no doubt thinking himself clever, pronounced, “Well, if the scene goes to shit, I’ll run out, and you follow me! That way, your vest will protect both of us!”

My rejoinder was, “In that case, you had best be certain that you do not slow down, lest you have my bootprints all up your back, as I run you over!”

Later, my partner and I discussed the vest and EMS. He asked, non-snarkily, how I had come to the conclusion that the vest was the way to go.

I noted that the vest cost me about as much as a Colt Government Model in .45 acp.

It was not a felony to wear the vest concealed, in contrast to the Colt.

It was not a black letter violation of department regulations, in contrast to the Colt (or any other firearm).

The vest would not inadvertently discharge, in contrast to the Colt, where that was a potential problem.

The vest was not going to drop out of my pocket, on the floor of the ED, in front of Ghawd and Everybody, in contrast to a handgun which another of our peers had won the opportunity to explain.

I would not in any circumstance hesitate to use the vest, in contrast to the Colt.

Finally, I was interested in meeting the soul who could relieve me of the vest, and hurt me with it, again, in contrast to the Colt.

So, I wore a vest. Others, or so I was told, elected to wear a firearm.

Pre Planning Your Scene

Reading Recommendation

https://eatonrapidsjoe.blogspot.com/2020/10/home-field-advantage-egress.html?showComment=1602787988156#c8439774302017330220

I don’t think that this guy needs *my* paltry recommendation, but, he has successfully drawn me in, and engaged me. His series-s are very, very thought provoking, in a Aesop’s “Tomorrow” sort of way. Lots of food for thought both at a “micro-economics” as well as at a “macro-economics” level.

Is your larder prepared for the presentation of spice? Metaphorically speaking, of course.

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

Improvise, Adapt, and Overcome!

TINS, TIWFDASL at Medic 13, and we caught a run. Initial dispatch information suggested that this was a heart attack.

We arrived on the East Side of Da City, at the stated address, and discovered out patient was awaiting us, upstairs. The folks who were encouraging us to step right up and set to business, were pretty excited. As we arrived and entered the bedroom wherein our patient awaited us, well, we could see why.

Our initial patient survey was, to be charitable, not encouraging. The bedroom was nearly entirely filled by a double bed, and that bed was nearly entirely filled by an unbreathing human being. Unable to detect a carotid (big ass neck artery) pulse, we concluded that this soul was in cardiac arrest. Doug and I knew that there was NO WAY we were going to move this person, let alone move them down the stairs, into our ambulance, continue a resuscitation en route, and offload same at DBTCIDC.

While I started CPR, as best as I could on the bed, Doug called dispatch on the handi talkie, and brought them up to speed. “Dispatch, we need an engine company, or two, for manpower. We have a active cardiac arrest, on a patient estimated weight of 800-1000 pounds. That is a stat call.”

Dispatch acknowledged our call, and responded, “We will send you help”.

Doug and I both set to resuscitating this soul, until our help, a second MEDIC UNIT, arrived. This crew, Mariel and Don, while welcome, came nowhere near the lifting power we anticipated in ten firefighters. Doug relieved me, and I shared this insight with dispatch. “Dispatch, we need at least one full engine company, perhaps two, and we need them several minutes ago! This is a working cardiac arrest, and there is no way we can move, let alone lift, this 800-1000 pound patient!”

Dispatch informed us that that would be a chief level decision, and I was happy to buy into their decision making process. “Very good dispatch. We need our superintendent on this scene, stat. This is a patient safety issue, and our patient is in full cardiac arrest.”

The field supervisor, a captain in our division, jumped in. “Dispatch, this is shift captain (insert name here). I am on the way to Medic 13’s scene code one. They need an engine company. Please dispatch one immediately.”

Soon, a DCPD scout car arrived, disgorging two of the single tiniest female officers I had ever seen.

Right behind them came our captain. He (the captain) edged his way through the crowd of civilians (who were, helpfully enough, insisting that we simply “snatch him on up, and carry him on down to the hospital!” (while NOT climbing the stairs to lend a hand!)

Our captain surveyed the four rescuer CPR taking place, and retired to his vehicle to have a chat with dispatch.

Mariel had removed our cot from our ambulance, securing it in their rig, wisely determining that our patient, upon the floor, would fill the entire module. As she returned up the stairs, bringing every backboard strap that she could find, the first engine company arrived.

The officer of that company trotted up the stairs, took one look, and about-faced, running down the stairs. Shortly, he returned with 5 firefighters, and a salvage cover. Everybody heaved, and the cover was stuffed ½ way beneath our patient. Everybody “Ho!’-d, and it was pulled out from beneath him. Now we had a carrying apparatus, and the firefighters set themselves at each corner, Doug in one middle, me in another, Don at the head, and Mariel at the feet, and we slowly maneuvered our patient down the stairs, and into our ambulance. Mariel and I climbed in the back, Don took off to meet us at the ER, and Doug set out.

I had the walkie talkie in my pocket, and I could hear his conversation with dispatch while Mariel and I CPR’d our little hearts out. Doug suggested that another engine company ought to meet us there, and that the ER ought to be notified of our patient’s girth. Initially, they seemed unenthusiastic, until our captain suggested that either they dispatch an engine company to the ER, or the Chief of the Firefighting Division, since he, the fire chief, would be the one explaining everything to the news media.

Engine 5 met us at the ER. TBTCIDC had lashed two cots together outrigger style, and everybody moved our patient onto the cot. Once he was in the ER, our part of the show was over.

We effusively thanked our captain, as well as the fire crew.

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.

Pains in my Fifth Point of Contact · Pre Planning Your Scene · Protect and Serve

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!

Fun And Games Off Duty · Pre Planning Your Scene

Back From Vacation. I Have Stories!

I just got back from vacation (well, by the time you folk(s) see this, I will have been back for a couple of weeks, but, anyhow…) So, here are two anecdotes, serving as a sort of “Cruise: after action report”

The elevator counseled “Patience!”

TDW-Mark II and I were on a cruise, earlier this year. I had worked considerable extra shifts, in order to avoid financing this adventure. So, TINS©, there we were, soaking up sunshine and living the life, and we were attempting to take the elevator from whatever deck that we were on (say, deck 3) to Deck 14 (which would be “The Serenity Deck”, relatively quiet as well as sunny).

There were numerous other people who had a similar idea (which, on a cruise ship with something like 2,000 + passengers, is likely to be unsurprising). So, when I pressed the button to summon the elevator, there appeared, after some time, to be no response. I again depressed the elevator call button, and was surprised to hear a typical robot like female voice emanating from the elevator, counseling “Patience!”

TDW was very, very amused.

Departure elevator lobby Hide and Seek

TDW-Mark II is, well, petite. At the end of the cruise previously mentioned, we arose early, got out crap together, and joined the lowing herd stampeding towards the gangway. As we were on a middle sort of deck, well, all the folks who had arisen around the same time as we had, and were on upper decks, well, the elevators were full up by the time that they arrived at our floors. (I, of course, lacked the insight that, should we enter the elevator ON THE WAY UP, well, we would ALREADY be on that elevator, once the upper floor folks tried to join us. Alas, THAT insight, however useful it might have been at the time of departure, did not occur to me until, well, just now. Good timing.)

In any event, soon there would arrive an elevator with space for one of us, but not both. After several such events, I directed TDW-Mark II to enter the next elevator, and I would join her downstairs once I myself became the room-for-one-more elevator passenger.

Great plan. Well, except for one issue. Recall that my wife is petite. Consider one readily foreseeable result of lots of people deciding that RIGHT NOW would be a good time to depart, luggage in tow. Yep, I arrived on the departure deck, waited for the crowd to move so far as to allow me to exit, and did not see my wife. She called to me, and I heard her, but could not place her in the lowing crowd.

I decided that this problem resembled the childhood swimming pool game of “Marco Polo”, wherein contestants were forbidden the use of their eyes, and had to find, and tag, other players. “It” would elicit calls from the other players, by calling out “Marco!”, requiring the others to respond “Polo!”.

I implemented my solution. “Marco!”, I called out.

“Polo!” responded TDW-Mark II. I placed her across the lobby, but still could not see her.

“Marco!”

“Polo!”. Ah, there she was, hand a-waving. We “swam” through the crowd, meeting just a little ways “downstream”, and therefrom making our way past checkout, and on to Customs. The rest of our trip home was uneventful, except for the guy who, in the left hand lane of the expressway, decided that he had to exit RIGHT FUCKING NOW!, and swerved, abruptly, across three lanes of traffic and onto the off ramp. Fortunately, it appeared that the other drivers had experienced this sort of shenanigans before, as they braked, and nearly seamlessly allowed Mr. Late Decider off the expressway, and out of our lives.

But, except for that, it was all good.