Me

Working a tough shift this week because I get home just in time to go to bed and get up to do it again. Makes posting tough. I’m working with pediatric patients this week. My last shift looked like this:

• a 14 year old with developmental delays who admitted to being sexually active. Her mother knew and was OK with it. She was my sickest patient of the day.
• an entire family (2 adults, 3 kids aged 9 months to 8 years) who came in with body lice because they are homeless
• a 15 year old and her mother who came in with bed bugs from the long stay motel they are living in
• A 3 year old who fell out of bed and broke her collarbone.
• A 17 year old who had a bruise across his abdomen from a dirtbike accident
• a 16 year old with chest pain that gets worse when he breathes in
• plus a parade of sniffles, fevers, and sneezes that cause screaming children, which are the reason why I don’t like working pediatrics, but it’s my turn. I think I had around 25 or 30 patients overall, but I lost count. Most were easy- in and out in about 90 minutes or so.

One of the things that makes pediatrics hard is that all of the medication dosages are weight based. Because of that, it’s easy for people to screw up. Last night, 5 minutes before my quitting time, a Doctor ordered medication and discharge orders for a child. The dose appeared to be too large. I sat down and did the math. This is what my day was like:

The Drug Reference says that the dose is supposed to be 20-50 milligrams per kilogram of body weight per day, divided into three doses. The ordered dose was 1080 milligrams to be administered to a 5 year old child who weighed 27 kilograms. It required calls to the pharmacist, messages to the doctor, cancelling the original order, getting a new order, administering the medication, returning the excess to the pharmacy, processing the discharge, and I finally got off work, 30 minutes past my scheduled time.

Nursing.

The tenants who have been renting from us since before COVID just informed us that they have bought a house and will be moving out. So now we begin planning for new tenants. There is some work that needs to be completed. The kitchen counters need to be replaced, pest control, painting, landscaping updates, and other maintenance items need get taken care of.

They haven’t given us a date for the move out yet, but wanted to give us a heads up. They were guessing that they will be moving out a month or two early. Depending on how early, I may or may not hold them to the early termination clause in the lease. We will almost certainly work something out, because they have been there for nearly four years and have always been on time with the rent. (The only time they were late was my fault, so I don’t count that one. I screwed up the electronic billing.)

The flip side is that we have been renewing the lease for about 10 percent less than market because I wanted to encourage the current renters to stay. We will adjust the price so that we are getting close to market, which means a 10% increase in rent. I hope that the place won’t be empty for more than a month or two.

I was giving a deposition a few years ago when I sued my mortgage holder, SunTrust bank. I had gone through a Chapter 7 bankruptcy and it had been discharged. There was a court order, so they weren’t allowed to do anything to collect the debt. All they were permitted to do was foreclose on the house.

Here is the problem- it turned out that they were NOT the mortgage holder. They had lied to the bankruptcy court. They tried all sorts of tactics- they forged a note. They lied to the court. None of that worked, and they were unable to foreclose on the house. So they resorted to sending collection agents to my house, and calling me repeatedly on the phone. I wound up suing them 5 times in 4 years and collecting more than $40,000 in damages. They still kept it up, with a collector calling me a deadbeat who doesn’t pay his bills, so I sued them again.

So that’s how we wound up in the deposition. I brought my attorney. One part of the deposition went like this:

Divemedic: I have a tape of your client’s collectors harassing me on the phone and calling me a deadbeat

SunTrust Lawyer: Did you ever think, even once, that if you paid your bills, the calls and visits would stop?

DM: Are you telling me that you and your client are knowingly violating the orders of the Federal Bankruptcy court to collect this debt in violation of Federal Law?

STL (to the court reporter): Stop recording this. This is off the record. (To my attorney): You need to remind your client that I am an officer of the court, and he needs to be civil, or we will ask for contempt charges.

My Lawyer: (to me) You heard her. You have to be civil.

DM: (to my lawyer) This is still off the record, right?

My Lawyer: Yes.

DM (To STL): Kiss my ass.

The SunTrust lawyer came unglued and ended the deposition at that point. On the way out, my lawyer told me that my comment was the funniest thing he ever heard at a deposition. We wound up settling the lawsuit for five figures, but I can’t comment on how much because of an NDA. That was almost ten years ago, and I still laugh about it.

I am on night shift for the next 10 weeks. Getting used to this is a bear. If any of you have noticed my posting quality dropping off, that’s why. They have me on the 4 pm to 4 am shift. The extra $6 an hour in shift differential is nice, but it’s been awhile since I worked nights and is taking some getting used to. I’m just getting to bed while the wife is getting up to go to work. I worked on Labor day, which gets some good bonus money. Time and a half, plus the $6 an hour for shift differential. Still, tired.

Since I have been dragging, I didn’t get a lot of time for researching the news today, so instead I will tell you what’s up in emergency medicine. This week, we saw some interesting stuff. Here are some of my more notable patients:

• A guy complaining of abdominal pain and constipation. He had a large blood clot in the main vein that runs from the digestive system to the liver (Portal Vein). It was 85 percent blocked. Because he was so big and the clot so large, he got the largest loading dose of Heparin I’ve ever given- 10,000 units.
• A man who came in with groin pain. We had to let him know that he has testicular cancer.
• A woman with congestive heart failure. She damned near died when her lungs rapidly filled with fluid. She was joking with me and fine. I left the room and 10 minutes later, she was gasping for air and needed BiPAP, a nitroglycerine drip, and Lasix. At one point, I thought she was going to code.
• A guy who did code. Wasn’t my patient, but a code is all hands on deck. He used the bedside commode, passed about 1 liter of blood, then went into cardiac arrest.
• A woman who stabbed herself 10 times because “I was sad.” She remembers feeling sad, and said the next thing she remembers is seeing the knife on the floor and being covered in blood.
• A woman who took some penicillin and had an anaphylactic reaction to it.
• A woman that had been trapped in a burning vehicle who had a hoarse voice and a cough.
• Interestingly enough, I didn’t have any COVID patients this week, but other nurses did.

We have been mostly at 3:1 nurse:patient ratios until 9pm when the mid shifters leave, then we go to 4:1. That means I see anywhere from 10 to 15 patients per day. One thing that gets me is how grown adults who are covered in tattoos can be afraid of needles. I’m talking people in their 30s, 40s, and 50s who cringe, and even cry when you start an IV on them. Three of my patients in one night were actually SCREAMING at the top of their lungs because I started an IV on them. In one case, a woman’s heart rate went from 90 to 150 while I was getting her IV.

Anyhow, since my work week is done, I now have 5 days off in a row. That means I have work to do around the house.

When I got to work yesterday, we had a significantly larger number of COVID positive patients in the ED than usual. Usually, we will see somewhere around 2 or 3 percent of our patients testing positive for COVID. Yesterday, it was hovering around 12 percent.

One of my patients was a 20 month old who came in because she had what her father reported as a seizure, the third one in the past three months. Apparently, no one before had tested her for drugs. I asked the Doctor for a urine drug screen because the entire family smelled like weed. Her urine came back positive for Cannabis, Fentanyl, and Methamphetamine. When we called DCF, they weren’t surprised. Apparently, this family is well known to them. Go figure. Because of having to wait around for DCF, I wound up working 14 hours yesterday.

My patients yesterday? Two homeless people demanding to be admitted (I guess looking to ride out the storm in comfort). A couple of broken feet from falls, a dude with chest pain that he got while clearing debris ahead of the storm, two drug seekers trying to score some pain meds, a 20 year old with nausea, and a woman in heart failure, you know the usual. We were 4 to 1 yesterday, which is better than my old hospital. I think I treated 15 patients overall.

I retired from the Fire Department back in 2011. After a brief journey to grad school where I majored in Physician Assistant Studies, I left because I couldn’t handle the leftist professors telling stories about how Ronald Reagan deliberately engineered AIDS as an attack on women and gays. You can read about this nutcase here. I highly recommend reading it. It’s enlightening. Anyhow, the liberal indoctrination and constant bullshit made me want to leave, so I did.

My first job when I got back put me in a position of working for a boss that was deliberately keeping people sick so that he could make more money. He insisted that we falsify documentation and lie on paperwork. He told me “We are making money, the nursing home is making money, and the patient doesn’t even remember his own name. We all win here, so don’t rock the boat. You want to keep your job, don’t you?”

I didn’t. I wound up being shown the door because I had ethics.

I took a couple of years and enjoyed retirement. That was when I met my wife. She told me that we could do so much more than what we had. We could travel. If only I got a part time job, we could use the money to travel. I was bored sitting around the house, so I got a job teaching just three classes a day. We used the money I made to see the world. We have been to 14 countries and 48 states. During the seven years I was teaching, I went from part time to full time, and realized that teaching wasn’t for me.

Then COVID came along. I went back to health care. That’s how I came to be unretired.

As I rapidly approach my seventh decade, I realize that I can’t work as a bedside healthcare worker forever. I can’t wrestle with meth heads forever. It’s time to start thinking about what comes next. My new employer will pay for my classes and books, so I have decided to get my Masters degree. There are two real choices: Nursing Management, or Nursing Education.

I have already gone down the road of education- I was a high school science teacher, I have also had jobs teaching Paramedic, ACLS, PALS, and other classes. I also don’t have a very high opinion of nurse educators, so I don’t want to do that.

That leaves Nursing Management. If you’re gonna be in the band, it’s better to wave the stick than to carry the big drum. That requires a couple of undergrad prerequisite courses that my previous degrees didn’t cover. Classes begin this week.