Me

The hospital where I work has a money issue. That is, our department was more than a thousand hours over budget on staffing. As a result, the ED director was fired last year, and the new director has been swinging the budget axe. She laid off 25 nurses as her first official act a year ago, and we have been running understaff since. They took us from 3:1 patient to nurse ratios to 4:1. They also eliminated most of the nurse assistant positions. As a result, we usually don’t get lunches on our shift, nor do we get off work on time. This results in a 12 hour shift usually stretching out to 13 or 14.

Still, our department saw more than 150,000 patients last year, so we are raking in the money. My recent visit to the emergency room was billed at over $40,000, so do the math. Even if they only collect a quarter of what they are charging, they made billions from the ED alone.

On top of all of this, they don’t let us do required trainings during our shift, we are required to do them on our days off. This training is required by our employer, and is over and above the continuing education that we do on our own to maintain licensure. They tell you that annual NIH stroke scale certification is required, and you are subject to discipline if it isn’t completed, for example. So you do it on your days off.

In the past year, more than a quarter of our nurses have left. They are desperately trying to hire replacements, but the word has gotten out, and the only nurses applying for jobs are brand new ones out of school with no experience, because they are hungry for a job that isn’t med-surg.

Admin then tells you that they will pay for a maximum of 2 hours per week of training. The only problem is that they assign far more than that. This two week pay period alone, I have done 8 hours of mandatory training on my days off: a 3 hour class on NIH stroke scale, a 3 hour class on IV insulin, and a 2 hour class on ESI triage policy.

They are only going to pay for 4 hours of it, if they keep up their policy. In the past year, they have denied paying me for about 100 hours of mandatory training. I’m tired of it. I have screen shots of emails telling me the training is mandatory, screenshots of my online time card, and emails of the policy saying they will only pay for 2 hours per week.

I am turning them in to the state department of labor. I’m going to get my money. If they take any action against me, that is illegal and I will sue their ass. I am tired of being made to work for free because they have a “budget.” Well, I have a budget, too, and I expect to be paid for my work so I can make my budget.

I will admit that I have been a bit MIA around here lately. That’s because of the pool project. We contracted the building of the pool, deck, and birdcage to a company. The landscaping and irrigation were our responsibility. We went through a 57 day delay because we had problems getting a building permit.

Once we finally got our permit, the pool company was here the next day, and the pool was complete 57 days later. We couldn’t be happier with the progress. There is a 30 day wait between getting the pool done and the final inspection. What we didn’t know was that irrigation, grading, and landscaping is part of that inspection. That means we are in a bit of a crunch to get it all done.

I rented a trencher and dug trenches for drainage and irrigation. That was the part that put me in the hospital because I tried to do it all in a single day to save some cash on the renal charges. I learned my lesson there. When we get hot, we take a break and sit in the pool for an hour or so.

Then I installed underground drainage lines to direct rain runoff from the gutters away from the house. I really like those, because they run about 30 feet away from the house to an automatic valve that opens when it’s raining.

Then I ran 4 zones of irrigation lines, planting 40 sprinkler heads so that everything within 35 feet of the house and pool gets irrigated, especially the plants we are putting around the pool.

Then the barrier lines for the robotic lawnmower went in around the edges of the back of the property. I don’t like mowing the backyard because it’s so large, so it was that or a riding mower. The cost was the same, only I don’t have to mow now.

Once those were in, I put edgers around the house to create a 2 foot barrier between the lawn and the house, so that the weedeater won’t damage the paint. Then the plants got put in, with some of them being large enough to keep nosy people from seeing us in the pool.

I also had to replace the tree in the front of the house, a 12 foot tall Crepe Myrtle.

After all of that was done, we put down 2200 pounds of mulch in all of the planter beds. We finally finished all of that today. Now we are waiting on sod.

I am paying a crew to come in and lay the sod, because that is hot, backbreaking labor, and it wasn’t that much more money than buying the sod and doing it ourselves.

While all of this was going on, I attended 3 days of classes, worked three days a week, and interviewed for two different jobs, as my contract with my current employer is ending soon, making me an at will employee.

All in all, it was a harder project than I thought, but it did save us quite a bit of money. It would have cost us about $10,000. All of that wound up costing about $4,000, with the biggest two expenses being 2,200 pounds of mulch and having 4 pallets of sod laid.

One of the things that makes the heat so dangerous here in Florida is the humidity. The dew point temperature is the temperature at which the air can no longer hold all of its water vapor, and some of the water vapor must condense into liquid water. At 100% relative humidity, the dew point temperature and the air temperature are the same, and clouds or fog can begin to form. While relative humidity is a relative measure of how humid it is, the dew point temperature is an absolute measure of how much water vapor is in the air (how humid it is). In very warm, humid conditions, the dew point temperature can reach 75 to 77 degrees F, but rarely exceeds 80 degrees.

The dewpoint for the afternoon that caused my heatstroke was between 71f and 74f. The temperature for that 4 hour period was between 91f and 94f. That results in a heat index of between 100f and 103f.

High dewpoints are dangerous because it is a limit on how well your sweat can evaporate and cool your body. Heat can build up to dangerous levels.

Combined with that, it was a bright, sunny day with almost no wind. The Navy actually has tables for permissible heat exposure. Under those conditions, Navy regulations say that acclimatized personnel shouldn’t perform heavy work for more than 15 minutes per hour. I far exceeded that for more than 4 continuous hours.

Even worse, I am now 35 years older than I was when I was in the Navy. I am also about 40 pounds heavier. All of that makes my susceptibility to heat stress more pronounced.

As I said, I know better. Let my experience in this case serve as a warning to others as we enter the hot summer months here in the South.

It’s been several days since my last post. There is a good reason for that. As my readers know, I am installing a pool in the backyard. It’s almost done, and I decided that this was the best time to install the landscape sprinklers. I rented a gas powered trencher and spent a day pushing that thing around the yard as it dug a few hundred feet of foot-deep trenching.

I thought the trencher would make the job easy, and it didn’t. It made the job easier and faster, but it was still a chore trying to maneuver that thing all over the yard. It was hot, and by hot, I mean 95f with dew points around 70f. That’s a heat index of about 102f. I drank four quart sized bottles of Gatoraid during the six hours I was working. When it was time to return the trencher, my wife came with me and we went to dinner afterwards.

At dinner, I began losing my words. It started when I tried to say “skin in the game” and what came out was entirely different. Then I couldn’t really hold a train of thought long enough to continue our conversation. When we tried to leave, I was walking like I was drunk. My wife drove us home. When I got home, I was feeling confused, my pulse was 125, and temperature was 101.9f. I asked her to take me to the ED.

When we got there, the staff thought the same thing that I did- they put me under the sepsis protocol. Another oddity was that my right ankle was swollen to twice its normal size and extremely painful. My vital signs were odd:

Pulse 120, respirations 28, Oxygen Saturation 98%, BP 145/110, temp 99.8f

They also tested my heart, did a CT scan of my brain, and a bunch of other tests. The results that were abnormal was my D-dimer, which was critically high at 1.02, as well as my creatinine levels and liver enzymes were elevated. It looked like my kidneys and liver were being damaged somehow.

For those who don’t know, d-dimer is a protein that is found in the blood of someone after the breakdown of widespread blood clots. Elevated D-dimer levels suggest increased fibrinolysis, which can be a sign of either clotting or bleeding.  Now they got really concerned that I had blood clots, which can cause swelling legs, strokes, heart attacks, and other problems. The decision was made to admit me at that point. I went back to CT for an angio scan.

All of the tests of my heart, brain, and other systems came back normal. That d-dimer still bothered everyone. Finally, the hospitalist came to see me the next morning with what we all agreed was the answer. The combination of fluid loss due to my large amount of sweating, as well as the elevated core temperature from strenuous outdoors work cause a severe case of heat stroke, which activates your body’s clotting mechanisms, causing widespread micro blood clots.

Studies have shown a correlation between elevated D-dimer levels and the severity of heatstroke, as well as with the development of complications like AKI (acute kidney injury). In patients with exertional heatstroke, high D-dimer levels are associated with an increased risk of acute kidney injury. This in turn causes hyperinflammation (hence, the swollen ankle).

The danger here is that I was on the verge of developing disseminated intravascular coagulation (DIC) and multiorgan failure, which would have killed me. I didn’t even feel bad while I was working, and I thought that drinking large amounts of fluids would keep me from being dehydrated. I was wrong. I lost 12 pounds in that six hour period when I was working. When you consider that I drank about 12 pounds of Gatoraid, that means I lost about 12 liters of sweat in those six hours. Sweating out 24 pounds of fluid in an afternoon is potentially deadly. I am fortunate to be alive.

In short, I had an extremely severe case of heat stroke, and it damned near killed me. I wound up being in the hospital for several days. It was stupid of me not to recognize the signs and symptoms, especially as a nurse, a paramedic, and as someone who has lived in the Florida heat nearly his entire life. I was supposed to work today. I called off. I still feel a bit weak and under the weather, and my ankle still hurts.

I passed my boards this morning. I can now add some more letters behind my name. Now to take a nap.

Came down with something. Didn’t know what it was, but didn’t feel well enough to go to work on Friday. Then my sense of smell disappeared.

COVID. Again. This is the fourth time I have caught it. I will be sleeping the day away. This couldn’t come at a worse time, I am taking my board exam in the morning. Hopefully, I will feel better tomorrow.

My own moral code is somewhat complicated. As all of you know, I am not a believer in any sort of deity. I guess that’s odd, being that I grew up in a Catholic household and was sent to a Christian private school for three years. My parents were hoping that the experience would help. It didn’t. All my experiences with organized religion did was make me believe that the people in the churches were mostly lying hypocrites. There is a joke I once heard that goes like this:

When I was a kid, I wanted to pray for a bike, but I know God doesn’t work like that. So I stole a bike and then prayed for forgiveness.

My experiences really turned me away from religion, but I also knew that I needed to develop my own moral and ethical code. That was when I discovered Robert A Heinlein. In more than a couple of his stories, his characters remarked on the importance of developing one for yourself, and that is exactly what I did.

I am free, no matter what rules surround me. If I find them tolerable, I tolerate them; if I find them too obnoxious, I break them. I am free because I know that I alone am morally responsible for everything I do.- RAH

In doing this, I looked at many different philosophies. For example, there are some cultures that don’t believe in owning property. To outsiders, they don’t believe that taking something that you want is stealing, since no one actually owns property. Still other cultures believe that objects belong to the maker. I discarded those and kept looking.

I think that it’s fair to say that most of my personal ethics and morals are a close parallel to Christian beliefs. So even though I don’t claim to believe in the spiritual and mythological parts of Christianity, I do align quite closely with its tenets on most things. I guess you can say that I am Christian adjacent. I guess, growing up on Heinlein novels, a lot of my outlook is close to his. Why did L. Ron Hubbard become the prophet for a religion, but RAH was not the founder of a political party? Puzzling.

Force and Violence

My first and most important one is that it is always morally wrong to initiate violence or force against another. That doesn’t mean that you have to wait for the other guy to throw the first punch- quite the contrary. Force to me doesn’t just mean that you are physically striking someone. I can use force against you in various ways- shouting in your ear with a megaphone, shining a laser in your eyes, or even sitting at the end of your driveway so that you cannot leave your house without running me over are all uses of force. Taking something of yours while daring you to do something about it is still force. I think this part of my philosophy came from that time when I was a child and my dad told me that I wasn’t allowed to start a fight. So I just forced the other kid to throw the first punch by being a royal asshole. Now that I am an adult, I know that there are more ways to start a fight than merely hitting someone, and I recognize it to be wrong.

Still, anyone who attempts to use force against me will have a fight on their hands. That fight might be a physical one, a legal one, or some other pushback.

Stealing and Fraud

We all trade our time in order to secure property. Whether we make the object, or trade our labor for money in order to buy the object, everything we own represents a slice of our limited lifetime. Stealing an object is no different than stealing time from another’s life or making them your slave. On the contrary, gift giving is indirectly giving someone some of your life, whether the gift is an object or your time, it still represents something.

It’s also wrong to use deception to take things from others. Lying to someone and telling them that this car has never had mechanical problems when you know damned well that it needs a new transmission is still stealing, it’s just stealing by fraud. It’s wrong.

I have no problem with charging all that the traffic will bear- an eager seller and a willing buyer is fine with me- as long as both are honest about what is being traded. I won’t sell you a broken car, you don’t pay me with a counterfeit bill.

Taxes and Charity

Taxes for the public good aren’t stealing as long as everyone gets the same benefit. So a tax that pays for police, courts, streets, or fire service can be a good thing, while a tax that takes money to hand out to people simply because they are poor is nothing more than theft.

“There is no worse tyranny than to force a man to pay for what he does not want merely because you think it would be good for him.”- RAH

Taxes are not levied for the benefit of the taxed.- Also RAH

Defending the Helpless

I also believe that we have a duty here in this life to defend those who are unable to defend themselves. I will always fight for what I think is right- even at great personal cost. In fact, the times in my life that got me in the most trouble were the times that I stood my ground and defended my principles.

There are plenty of things that I believe, and I suspect that many who claim to be Christians would find that our beliefs are actually quite closely aligned.

Limited Government:

I believe in a government that primarily focuses on internal police, courts, and external defense. Other matters should be handled by individuals and private organizations.

That we were slaves I had known all my life—and nothing could be done about it. True, we weren’t bought and sold—but as long as Authority held monopoly over what we had to have and what we could sell to buy it, we were slaves.- RAH

Individual Liberty:

I stand behind individual freedom, including freedom of speech, thought, and expression. Censorship and any attempt to control people’s knowledge or beliefs is wrong. That’s why I run this blog.

Distrust of Authority:

I have a great deal of skepticism towards authority, particularly government authority, but also authority of organized religion. How the pope can tell us we need to donate to the poor while he is taking a crap on a solid gold toilet just smacks of hypocrisy. It is far too easy for power to be abused. That is where the founders were so very wise in keeping government of limited power. That was destroyed from the Civil war on.

It is a truism that almost any sect, cult, or religion will legislate its creed into law if it acquires the political power to do so, and will follow it by suppressing opposition, subverting all education to seize early the minds of the young, and by killing, locking up, or driving underground all heretics.- RAH

Still, we need government. Why? Because true anarchy can’t exist, because someone with a yearning for power will always take it, by force if necessary. That’s why police morally exist- to protect the rights of those who are accused of crimes to receive a fair trial. The problem is that people don’t monitor their government to ensure that the powers aren’t being abused. Too much effort? No, it’s that people are good at wanting to use government power to force others to follow their own beliefs.

There must be a yearning deep in the human heart to stop other people from doing as they please.- RAH

Importance of Education and Critical Thinking:

Education and critical thinking are tools for individuals to resist tyranny and make informed decisions. However, education institutions can twist education to be a tool for ignorance, tyranny, and actually increase ignorance. That’s what we are seeing now. See my post tomorrow about Harvard.

I just do my absolute best to be worthy of being treated the way that I treat others. How would I feel if someone treated me or my loved ones the way that I am treating you? That doesn’t mean that I will be a doormat, and it doesn’t make me a Saint- after all, I sometimes fall short of my goal. I am far from perfect, even in meeting my own standards. We are all a work in progress.

I have committed transgressions against others, because I am not perfect. Some of the things that I did and said in my youth truly shame me when I think about them. I hope that those I hurt or offended through my faults have forgiven me. I am not that person any longer.

Does that make me Christian adjacent? I don’t know, but that’s my code. Parts of it, anyhow. It is what enables me to look myself in the eye in that mirror in the morning. I think that RAH and myself would have gotten along quite well.