Me

Adding Skills Can Hurt Sometimes

Now that I have completed my latest degree, our move, and my rental has tenants again, I now find myself in possession of spare time. I decided to fill some of that time by taking up Brazilian Jiu-jitsu. The gym that I joined lets you attend unlimited sessions for $200 per month, with an extra $100 if you want to add Muay Thai. The two together are what comprises MMA. There is no contract, it is a simple month to month deal.

For now, I signed up for the BJJ, with the intention of adding the Muay Thai at a later date. There are two types of classes: one group practices with the intent of competition, the other with the intent of self defense. Different approaches. There are different classes at different times each day, so you can go every day, if you so choose.

I have only gone to a couple of classes so far. The classes in the middle of the day are small, with the instructor and just three or four students. They last 90 minutes, and we spend most of the class mastering a move and the counter for it. We end each class by sparring in 5 minute rounds. (Called ‘rolling’ in BJJ). The rules for rolling are simple:

  • No striking. That includes knees, feet, hands.
  • No gouging of eyes, or grabbing the throat.
  • No genital strikes.
  • Nothing that is intended to injure or disable your opponent. This isn’t a street fight, its practice.

It makes the fight purely one of strength, endurance, and skill. Skill is a HUGE part, and a good fight is like a chess match. Move, countermove. The more skill the two fighters have, the faster and more complicated the ordeal.

Today, I was matched up with a 20 something year old who had more experience with MMA, but was about 70 pounds lighter than I am. I am very flexible and I weigh over 200 pounds, so I have advantages there. He was younger and more skilled, so there were his advantages. It turns out that his biggest advantage was endurance.

He made first contact, and I managed to throw him to the mat and land on him before he could react. I had him pinned and kept my base wide, so he couldn’t reverse or throw me off. He tried several joint locks and throws, but I was stronger than he was and kept him pinned for the next 3 and a half minutes. Then he managed to reverse before pinning me to the mat and I had to tap out. He was surprised that I was strong and flexible enough to get out of most of the holds he tried to use. In the end, he just outlasted me because my endurance ran out.

It was a lot of fun, but was very tiring. I was completely out of breath by the end of the five minutes.

By the time I got home, the right side of my chest hurts every time I move. It hurts to breathe, to bend over, and it’s even somewhat uncomfortable to type this post.

I really hope I didn’t break a rib. Even if I am still hurting, I will still go tomorrow. Today’s biggest lesson was that I need to do more cardio. I am going to work on that.

By Divemedic, ago

Finals Are Over

I have been offline for a couple of days because I just took the final exam for my last class to get (yet another) Bachelor’s Degree. This time, it was a Bachelor of Science in Nursing. When I went to campus to take those exams, I carried a can of pepper spray and an expandable baton on my person and a firearm locked in my truck. Why? Because of the behavior in the video that JKB over at GFZ posted. Watch the video on the right:

As I posted in the comments there, Florida law says:

A person is justified in using or threatening to use force, except deadly force, against another when and to the extent that the person reasonably believes that such conduct is necessary to defend himself or herself or another against the other’s imminent use of unlawful force. A person who uses or threatens to use force in accordance with this subsection does not have a duty to retreat before using or threatening to use such force.

Assault doesn’t include a physical touch:

An “assault” is an intentional, unlawful threat by word or act to do violence to the person of another, coupled with an apparent ability to do so, and doing some act which creates a well-founded fear in such other person that such violence is imminent.

What is battery? While assault is defined as the threat to cause physical bodily harm, battery is the actual act of doing so. it is the crime of battery if you touch another person against his or her will or deliberately cause an injury to another person, however temporary or minor that injury may be. From the state statute:

The offense of battery occurs when a person:
1. Actually and intentionally touches or strikes another person against the will of the other; or
2. Intentionally causes bodily harm to another person.

Under section 784.03 of the Florida Statutes, indirect contact, such as throwing an object, can constitute battery if the indirect contact was intentionally caused by the accused and was against the other person’s will. Even spitting can constitute a battery. Mohansingh v. State, 824 So.2d 1053 (Fla. 5th DCA 2002) For that reason, I believe that shining a strobe in someone’s eye is either battery (the strobe is causing pain and disorientation), or assault (shining the light is intended to temporarily blind the victim and make it impossible for that victim to detect or defend against an attack).

Note that the law requires intent to touch, strike, or cause injury. That is referred to as mens rea.

All the law requires for nonlethal self defense is that you be in a place where you lawfully can be, and are the recipient of someone else’s imminent delivery of unlawful force. So:

  1. Are you where you can lawfully be? Yes. I am a student here to take an exam.
  2. Is the other person threatening to imminently use, or are they using unlawful force?
  3. Would a reasonable person believe that the attacker intended to touch, strike, or injure you in any way?
  4. Would a reasonable person believe that the person was about to (or was already attempting to) carry out that intent?

This meets the absolute lowest threshold for self defense. The real issue here is that you probably will get arrested, and it will cost you some money to defend yourself in court. Make sure that you have good CCW insurance, so it will pay for your legal defense.

I want you to note that there are perhaps half a dozen people that are assaulting him. That means the attackers will likely gang up on you, and that will likely mean that someone will be shot by the end of the fight.

Think about where this is headed.

By Divemedic, ago

Stories From the ED

A young adult woman comes to the ED, having been brought there by her mother for having abnormal behavior. Displaying many of the classic signs of mental illness, she is obviously having a mental health crisis. The mother even said that she woke up in the middle of the night with her daughter standing over her with a large knife in her hand. The doctor considered her to be a threat to her own or someone else’s safety, and subsequently signed the Baker Act paperwork.

As I always do, I am explaining to the young lady that she is being held on an involuntary 72 hour psychiatric hold. I am trying to explain the rules to her- she can’t wear her own clothes, can’t have any of her possessions with her, she will be searched, and she can’t go home.

As I am doing that, the mother keeps hovering and trying to talk to her. The girl keeps trying to negotiate and delay: begging her mother to take her home, asking to go to the bathroom, and looking over my shoulder at the exit, obviously planning an escape. The mother keeps insisting that the girl can’t change clothes with me in the room, needs to be permitted to use the bathroom without a male present, kept blathering on about the woman’s rights, and said that she wanted to “take it all back” and sign her daughter out. I explained that it doesn’t work like that. Legally, once the doctor signs that order, the only person who can cancel it is a psychologist, and that is after the patient is examined by that psychologist. The doctor who signed the order can’t even rescind it.

After over an hour of trying to deal with this, I finally told the mother that she needed to be quiet for a minute so I could do my job. She replied with: “Wow! You’re rude.” I called security to come over so we would have someone that is wearing a body camera there for backup. Then I told the mother: “This is how it’s going to be: Your daughter, my patient, needs to be supervised and has to be within sight of a staff member at all times for her own safety. She doesn’t get to decide who or how that is going to happen, as that is all done according to state law and hospital policy. She is going to take her clothes off and put on these paper clothes voluntarily, or I am going to cut her clothes off and dress her by force. If she resists, I will sedate her. If you continue to impede my ability to provide patient care, I will have you removed. This isn’t a debate, it isn’t a negotiation, and this isn’t a courtroom. That’s how it’s going to be. You can either let me do my job in caring for your daughter and I will allow you to stay, or you can keep getting in the way and I will ask you to leave.”

The patient continued to argue and resist, so I gave her 10mg of Haldol after which we got her dressed in the paper gown, and put her down for her nappy nap. I put a hospital employee in her room as a safety sitter. Mom filed a complaint, and when the charge nurse came over to talk to me about it, she said, “I was waiting for you to have enough of that. You were more patient than I would have been.”

By Divemedic, ago

Work Pharmacy

I work for a hospital, and I think all of my readers know that. With that being the case, our employee insurance requires us to use the hospital’s mail in pharmacy to fill all prescriptions. That pharmacy is run by corporate, and they suck royal donkey balls.

I am a diabetic and have been taking Mounjaro for the past year. In order to get the drug, you need to get approval. To get that approval, you need to prove that you have tried other remedies for at least a year, and that those remedies failed. I met that requirement, as I have been a diabetic for over 15 years, have taken those other medications, and they no longer work. So it was approved, but it took weeks.

This pharmacy sends prescriptions 90 days at a time. When it is time to refill that prescription, it’s always a hassle. You would think that a pharmacy owned by a hospital would be decent, but it isn’t. I suspect that this is because they are trying to control costs at the expense of their employees. Let me explain:

Now, every time I go to refill, there is always an issue. They claim that they are out of Mounjaro, and try to convince me to switch to being an insulin dependent diabetic. I know how fragile diabetics are once they go on insulin, so I always have to fight them on it. The first time, they blamed it on a supply shortage caused by people using it as a weight loss drug. So this time, I ordered the refill a month ago.

It wasn’t filled because they had an issue with my credit card over the $25 copay. I corrected that, and now they are saying that the medication is out of stock. I just took my last dose, and my next one is due in six days. Since it must be shipped to me, it has to ship by Friday. Any bets on whether or not they make it? Assholes.

It’s complete bullshit. My last hospital required us to use the in hospital lab for all of our lab work, and I suspected that they were doing that so the bosses could see your medical history.

If you have a problem with modern healthcare, it shouldn’t be with the actual workers. The administrative bean counters are the problem.

By Divemedic, ago

Part Time

This post over at GFZ reminded me of a story that happened to me 15 or 20 years ago, while I was still a street medic. I was partnered with another medic, a female who like to seem like she was jaded, but really wanted to believe the best in everyone.

There was a prostitute who had diabetes that we would run on every month or so. The call would usually follow the same path. Her “customers” would call 911 every time she would pass out at “work” and we would check her blood sugar to find that it was low. We would start an IV, give her some glucose, then she would wake up and refuse to go to the hospital. We did this for several years.

Then we didn’t see her for awhile. After not seeing her for 6 months or so, we got a call to a local convenience store and there she was. My partner says to her: “Hey Dianne! We haven’t seen you in a while. How have you been?”

Dianne replied: “Things are great. I got me a man, now. We have a good job, and moved to Orlando.”

Partner: “Good for you! So what brings you here to town today?”

Dianne: “Well, my husband says that now that we are married, we have plenty of money, so I only have to work part time.”

By Divemedic, ago

Complaint

I recently had a complaint made against me at work, which is a rare occurrence. This was a 50 year old woman with a history of diabetes who came in because she had an open wound on her ass. We were admitting her because it was a diabetic sore. When you admit a patient, it takes a couple of hours to secure them a bed and send them upstairs.

She had an A1C of 12.6, meaning that her AVERAGE blood sugar level is 315. At that level, your blood gets thicker, meaning that it can’t perfuse as well, and as a result she had already had one leg amputated. She just isn’t managing her diabetes.

After six hours in the ED, we managed to get her blood sugar down to “only” 177, and had been refusing to feed her because her sugar when she came in was over 400. When I told her she couldn’t eat, she said she would fix that, and took some of her insulin when I wasn’t looking, which caused her blood sugar to drop into the 40’s. Then we had to give her an ampule of dextrose, and it really complicated her care.

She was upset with me that we were sending her upstairs without “fixing the problem” that she came in for. I told her that her problem was caused by her not managing her diabetes, and that continuing to eat sugary foods and not taking her medication would mean losing other body parts, and would eventually kill her. This wound was not something we could “fix” in the ED, and would require a stay in the hospital with specialized wound care nurses working on the wound, and with her constantly trying to eat sweets, it likely would never completely heal.

So she complained about me for being rude. My boss agreed with me, and told me that sometimes people don’t want to hear the truth that they need to hear.

By Divemedic, ago

Builders

We called the builder to complain that the sink in the upstairs bathroom had no hot water, only cold. The bathtub that is right next to the sink has hot water, though. So after a couple of weeks, a plumber shows up. He runs the water in the sink for a couple of minutes, then declares that the sink is piped incorrectly. He says that he will have to cut into the drywall to get at the pipes and will need the boss’ permission to do it. He says he will be back.

An hour later, he returned with a second plumber. They said that they would be cutting into the drywall to repipe the sink. I have a complete set of photos of what the house looks like without drywall in place. I show them where the pipes are, and they cut a 2′ square hole in the kitchen ceiling. In the wrong spot. They are mystified when they wind up under the upstairs air conditioning plenum.

I again point out to them that they are in the wrong spot. This time, they cut where I tell them the pipes are. There is the hot water pipe, and they tell me that the pipe was mislabeled during construction. They then cut a third hole so they can tap off of the bathtub’s hot water.

The sink upstairs still doesn’t have hot water at that point. They keep trying to figure it out. At this point, they have been at it for over 4 hours. There are three giant holes in my kitchen ceiling. There is insulation raining down all over the kitchen. My house is in a shambles. We can’t use the kitchen.

I asked them if they checked to see if the faucet is bad. They looked at me like I was a moron, so I continued: “What if there was some construction debris in the pipe, and it made its way to the faucet’s hot water valve, clogging the valve.” They asked how I would figure that out. I replied: turn off the cold water valve under the sink. If the faucet still works, it’s piped wrong. If the sink doesn’t work, it’s the faucet.

It was the faucet.

They plumbers apologized profusely and said that their boss would call me to figure out how to repair my ceiling. This is what it looks like.

I understand that mistakes happen, so I call the builder. He tells me that it’s a warranty issue, says he will put in a work order, and according to the warranty documents that I agreed to at closing, they have up to 15 business days to repair it. They will, he tells me, get to it “when they get to it.”

I tell him that he needs to do a better job of reading the warranty. A warranty item is described as a “defect in materials or workmanship that occurred during construction of the home.” This didn’t happen during construction. It happened because his subcontractors were incompetent morons. This means that it is a claim for their insurance, and they have exactly one week to get it fixed. If it isn’t, I am going to hire someone to fix it myself, then I will sue them to collect my costs.

I can’t use my kitchen. There is drywall dust everywhere. We are finding blown in insulation all over the house, because when the plumbers tried to clean the insulation that had fallen from the ceiling, the shop vac they used just blew it everywhere. That cardboard patch that is duct taped to the ceiling in the picture below? It fell off 15 minutes after they left.

Now every time we open a door or the air conditioner comes on, insulation falls from the holes. Bugs crawl in at night. So I got some pieces of cardboard and attached them to the ceiling using staples from my nail gun. These are essentially holes that open my house to the outside.

I am more than a bit pissed off about this. If it isn’t fixed by Monday, I will start calling my own drywall guys and an attorney. This is complete and utter bullshit. I’m not nearly as mad about the plumbers fucking up as I am about the attitude of the warranty supervisor. You handle things like this by saying “I am so sorry this happened. Let me tell you what we are going to do to fix this. It will be a priority item for us, and I will see how quickly I can get someone out to help you. In the meantime, one of us will be over right away to secure your home from the elements.”

What you don’t say is “I don’t control the drywall company’s schedule. I will put in a work order and they will get to it when they get to it.”

In the meantime, posting may or may not be sporadic as I deal with this and still have to go to work to pay the mortgage on my now trashed house.

By Divemedic, ago

Six Courses

My wife and I have been together for a decade. She decided to take us to dinner as a celebration. We went to a six course meal, which I had never done before. The meal was prix fixe, and consisted of six courses, each paired with a wine selection by a professional sommelier. Each course was small, which was a good thing, since there were six of them.

We arrived at the appointed time and were served a welcome cocktail while we waited for the other diners. The cocktail was simple syrup, mint leaves, and champagne. It was intended to be a light, refreshing palate cleanser.

We sat down at the appointed time and were served our first course. It was the appetizer course. Scallop Carpaccio paired with an Italian Pinot Grigio. The scallops were sliced thinner than a sheet of paper. It was fairly good. This is the plate:

The soup course was second, and it was a Smoked Tomato Soup that had been cooked for six hours. It was paired with a white wine from Napa Valley that was pretty good.

The third course was the salad course. It was made from butter poached lobster, hearts of palm, pineapples, and cilantro with a vanilla dressing. The wine pairing was a Sauvignon Blanc from New Zealand.

The fourth course was the fish course. It was a roasted branzino with zucchini, peppers, lemon, and a pesto. It was hands down the tastiest course of the night. If it had not been such a fancy restaurant, I would have been tempted to lick the plate. This course was paired with a Chardonnay from California.

The fifth course was the beef course. A grilled filet mignon with truffled potato puree, asparagus, and bordelaise sauce. It was delicious, but I have to admit that I was getting pretty full at this point. This course was paired with a Cabernet from Napa Valley.

The last (dessert) course was a chocolate sphere that they poured hot caramel over, revealing a peanut butter ganache, chocolate mousse, and a caramel gelato. It was good, but I was so full at this point, I only ate about a third of the dessert. It was paired with a Salted Caramel Espresso Martini. The martini was so good that I had two of them.

The meal was superb, but I have to admit that I ate so much that I didn’t eat at all the following day. I had two of the martinis, and that turned out to be a mistake. First, there was so much alcohol served with this meal, that I was pretty drunk after the three hour dinner experience. Second, I woke up in the middle of the night to pee, and my heart was racing at about 120 beats per minute. I am guessing the espresso had something to do with it.

We had a great night, and this meal was an appropriate celebration of ten years together.

By Divemedic, ago

Finally Rented

It took 5 weeks to get my rental home repaired from the damage done by the previous tenants. The total repair bill came to over $9,000, and I still need to replace the flooring in the entire house because their dog ruined it in spots by peeing on it.

Anyhow, we listed it 28 days ago, and our new tenants signed the lease to move in soon. That’s one project off my plate.

Now I have to work on selling our old house. It’s always something, and I am always busy.

By Divemedic, ago

At Work

At work this week, a couple of noteworthy patients.

The first was a woman who brought in her year old baby because the baby had a purple spot on her tongue and about a dozen red spots on her body, just isolated 1mm red dots. The baby’s tongue looked just like this:

This is called purpura, and the ones on the skin are called petechiae. It can be genetic, or can be triggered by a virus that causes the immune system to misbehave and attack the patient’s blood. So I went to go tell the doctor, who ordered a blood test. Sure enough, the baby’s platelet count was 3,000. It should be between 150,000 to 450,000.

The disease is called thrombocytopenia. It can be caused by a number of different things, this will require more testing. No matter what, it isn’t going to be good news. We transferred the baby to a children’s hospital.

The second one was a fine example of how people abuse the system. A woman came in telling me that she had called in sick to work so her and her boyfriend could spend the day smoking weed. She had no medical complaints, but wanted a doctor’s note for work so she wouldn’t get fired for calling in again.

We ( the nurses and doctors) were offended, but the doctor wrote her note. Why? Because payment rates for the hospital for all patients are set by satisfaction scores, according to Obamacare.

On the business front, we began showing the rental finally. There have been two people by to look at it, but no one has put in an application yet.

By Divemedic, ago