Me

Nostalgic

I took the trouble to look up my patient from the other day. Less than 6 hours after I transferred her to the ICU, she passed away. Although I knew she was dying, I fought a battle for her to the best of my ability to keep her alive while simultaneously preparing her family for the inevitable. Even though her family weren’t yet ready to admit that she was about to die, I understood that I was buying time for them to come to terms with her death. They told me that she was “a fighter” and would pull through. I knew she wouldn’t, but I still did all that I could for her and for them.

I grew up in the late 70s and early 80s. I remember sitting in school and hearing the local church bells ring 53 times each day at noon, in honor of the hostages being held in Iran. I remember watching the rockets leave, carrying astronauts to the moon. My father worked with rockets and missiles, so I get to go to mroe than a few launches, including the launch of the Apollo-Soyuz mission. I grew up on bands that made some of the best music:

  • Journey
  • AC/DC
  • Dokken
  • Rush
  • Styx
  • Pink Floyd
  • Aerosmith
  • Dire Straits
  • Men at Work
  • Guns n’ Roses
  • Motley Crue
  • Van Halen

and though I didn’t realize it at the time, there were many other sounds and bands that I would come to appreciate more in later years, including Duran Duran. (It wasn’t cool to like them in the circle I ran with). I still sit and listen to the songs of the time, remembering my youth and the things that I saw. I had the distinct honor of serving in the military under President Ronald Reagan, and some of those songs take me back to my time in Europe listening to AFRN.

For those reasons, this article at Legal Insurrection really hit home for me. It does occasionally sadden me to have lived through some of the best times and the high water mark of the greatest nation in human history, only to see it destroyed. This nation isn’t perfect, but it has raised more people from poverty and has accomplished more great things than any other in human history. Watching it die is like watching someone that you love slowly die of cancer.

Like cancer, what is killing this nation came from within. I understand why some of the readers of this blog still think that it can be saved. I went through a period of believing that the old lady was a fighter. I know better now, and I am saddened at our loss, but also filled with resolve at doing what needs to be done as we venture out into an unknowable future.

By Divemedic, ago

Mowing the Grass

If you recall, I was out mowing the lawn on Sunday morning and had to use a filler post. I began mowing at around 8 am, and by the time 11 am rolled around, it was 95 degreesF outside with 60% humidity. That makes the heat index (or feels like temperature) a balmy 113 degF. That also makes the dewpoint 79 degF.

When I came in, my shirt was soaked through with sweat to the point that it was dripping water onto the floor. I have had enough with lawn mowing using a walk behind mower, especially in the summer. Something had to be made easier. I looked at Home Depot for a riding mower and was stunned to see that they cost between $3k and 5k for the cheapest ones. Holy cow. Not only that, but you have to store, maintain, and fuel the damned thing. Then you are still stuck outside using the mower to care for the grass.

Then I saw the Husqvarna Automower. Amazon had the cheapest one on sale for $699. I went a couple of models nicer, and got a model 430X. It cost a little bit less than the riding mower, but it mows the lawn for you. I temporarily placed the invisible fence wire using pegs, just so I could see how well it worked before making the install more permanent. It mows the lawn perfectly, cutting for a bit over 2 hours before returning for a recharge, then returns to finish the job. My lawn looks great, and now I don’t spend three hours a week mowing and another hour edging. All I have to do is use the edger for about an hour, and I am done. This will save me 3 hours a week during summer, and every other week during the rest of the year.

That’s more than 100 hours of leisure time a year that I won’t have to spend mowing the yard. Yeah, I know some people claim to like mowing, but I don’t, especially when it feels like 110 degreesF outside. Speaking of work, it’s now time for me to head to the salt mine to see what the idiots of my area are doing today.

By Divemedic, ago

So there I was…

I was working in Yellow the other day and triage sent me an 80 year old woman whose family brought her in because she had pressure sores on her bottom. She’s a paraplegic and had bleeding pressure sores on her hind end, because frankly, the family doesn’t turn her enough.

We get her into the bed, and the patient responds only to pain, her blood pressure is 86/42, her HR is 70 and V paced, her RR is 40. I called a medical alert. Less than a minute later, I had a doctor, two staff nurses, a charge nurse, a paramedic, and a technician. I asked the Dr for orders to give a liter of fluid, and it was granted. He told me to give a liter of saline, followed by a liter of ringer’s.

I started two IVs and drew blood cultures, a CBC, a CMP, a lactic acid, and a type and screen.

For my medical readers: Her labs came back with all sorts of critical results. Her hemoglobin was 4.3, lactic acid 3.8, troponin was 202.

By this time, she had almost liter onboard and her blood pressure was 76/48. I got the doctor to order 1 unit of emergent O+ blood, followed by two more units of type appropriate blood. The only problem was I had to discontinue the fluids because she was showing signs of fluid overload and congestive heart failure. Her SpO2 began dropping and I had to start oxygen.

It wasn’t long before she was on Levophed. I tried talking to the family about end of life and signing a DNR, but they insisted that she was “a fighter.” I spent the next 8 hours trying to keep her alive and stabilize her. I had two other patients who had to wait awhile because nearly all of my time was being taken by this patient. When she went to CT, I went with her, and the report came back showing all sorts of gas bubbles in her chest and abdomen from the large amount of sepsis. None of the surgeons would touch her because she was too sick. Simply put, she is dying. I was incredibly happy when the time came to transfer her up to the intensive care unit.

By Divemedic, ago

This Week in the ED

I had a few notable events happen in the ED this week.

  • A man was brought in by EMS who was gorked out of his mind and was under arrest by the local gendarmes. He was tweaking hard. Unsurprising to anyone who saw him, his urine tested positive for amphetamines. It seems that he used some meth, beat up his elderly roommate, stole the roommate’s gun, and walked around the neighborhood firing off shots. I spoke with the first cop to arrive, and he told me that he ordered the man to drop the gun, and was only going to tell him once. To treat him, all I could do was give him 2mg of IV Ativan every hour to keep him calm. Two days later, he was still in the PCU and still feeling the effects of the meth.
  • A woman came in with abdominal pain and symptoms that made me think she might have COVID. I tested her for it, and she did in fact have COVID. When the results of her abdominal CT came back, she had a large mass in the head of her pancreas that was consistent with cancer. There were also masses in her liver and lungs. The Dr and I had to tell her and her husband that she likely won’t live to see Christmas.
  • A 95 year old woman came in after driving her car through the front of a store. She got the gas and brake pedals confused. In her defense, when she learned to drive, there was no brake pedal. All you did was say “Woah.”
  • Had a 16 year old with mono, and another one who had spinal meningitis.
  • A 30 year old jumped out of the car he was riding in and attacked a motorist in an apparent case of road rage. The target of his ire put the car in drive and ran over his ass. He became my patient, and it took up more than two hours of my time getting IVs, X-rays, giving pain meds, and all of the other things needed to treat an idiot with a blood alcohol of over 300 and a pair of broken legs. He is going to need surgery.
  • We got a new director for the ED last month, and she announced that nothing would change. This week, she laid off 25 nurses. The very next day was my day off, and they called me at home to ask me to come in and work a 12 hour shift for overtime.

Posting has been and will be thin. I have a major project coming up that I need to work on.

By Divemedic, ago

Evidence Based Medicine

Light posting today. I am under a deadline to finish an evidence based project to evaluate one of our medication administration policies. I found an error in the way that we administer and document medicine, and I have been assigned the project of reviewing the evidence and submitting it to management so that the policy can be changed.

By Divemedic, ago

Good Questions

Some good questions to my security post of this morning, so let’s take a look:

  • I’m curious as to what you use as a training load equivalent?

I don’t for the higher powered 45 loads. How I address this, is nearly every pistol (as opposed to revolver) that I have is a S&W M&P: I have M&P40s, M&P9s, M&P45s, a Shield 380EZ, several Shield pluses, as well as Shields in 9mm, .380, .40S&W, and .45ACP. I also have a few Glock 19s and 19 clones, but I rarely shoot them and can’t remember ever carrying one.

Having the same models as carry pieces simplifies the manual of arms, makes repairs easy as they all look the same on the inside, and makes switching firearms and calibers smoother and easier. I know that full power loads don’t shoot the same, but it’s close enough for what I am doing here. I can still do A-zone shots quickly and effectively out to 15 or 20 yards with little effort, and that is all I am concerned with.

  • IDK if I’d go to a full size .45 tho, a single stack 9mm is very svelte, easy to carry, and similar capacity. A subcompact .40 a bit thicker, but smaller than the .45 and similar power/effect.
  • Open carry is legal in Florida on your own property. But wear a light cover garment anyway; they don’t need to know until it’s time for them to know, and you’re still “legal” if you step into the street.
  • It wouldn’t hurt to have a Glock 19-26 ish type pistol concealed appendix ish.

All handguns are a tradeoff. They have low power, not as much firepower as a long gun like an AR-10 or an AR-15, and not as much punch as say, a shotgun. We carry handguns because we aren’t sure whether or not we will need one, but it is useful to have one just in case. When I am at home, I have more freedom to carry a large handgun, hence the double stack .45.

One firearm on me at a time is all I need, especially when at home. All I need is something to bridge the gap that exists between me and a long gun. Remember, you carry a handgun in case you might be in a gun fight. If you KNOW you will be in a gun fight, endeavor to not be there. If that is impossible, bring a long gun, and bring a friend with a long gun, if possible.

When working on my property but outside, I just wear a baggy t-shirt and pull it over my OWB holster (a DeSantis Speed Scabbard that I used to use back when I was an IDPA competitor. A funny story about that below the divider)

When I am away from home, I avoid areas where I am likely to need a firearm, but just in case, I carry a pistol or revolver that is easy to carry and easy to conceal. Think a Smith and Wesson Shield, Shield plus, or J frame revolver. My EDC is usually a Shield plus (they hold 13 rounds of 9mm), or a J frame .38 loaded with wadcutters.

  • Have you made realistic plans for the “temporary” removal of your firearms after a “Good Shoot”?

I have caches of firearms. I have guns in safes. I’m not opening or revealing either to the cops.

I have a Tshirt that says “DeSantis, Concealment Perfected” on it that I bought some years ago. One of my wife’s coworkers saw me while I was wearing it out with her and some coworkers at an event. She told me that seeing DeSantis’ name on a shirt was a trigger for her because he was an evil fascist. I told her not to worry, that the shirt had absolutely nothing to do with the Governor, it was a brand of holsters that I liked carrying my pistols in, “and in fact I am carrying a handgun in one of their holsters now.”

She practically ran out of the venue and hasn’t spoken to my wife since. My wife says that she didn’t like the woman anyhow, but that saying what I said was hunting over bait, even if it was funny.

By Divemedic, ago

Security

A group of young men were seen in my neighborhood on at least three days last week. They were walking up to houses and knocking on the front doors. On the first day, if the homeowners answered, they would ask them a series of (in my opinion) intrusive questions, like how many people lived there, how much they made, how much they paid for the house, those sorts of thing. The second time they were seen, they were acting like they were selling solar systems, and when they came by yesterday, the same guys were selling home improvement supplies. Each time, the cops were called, but twice the guys were gone when the cops got here, and once the cops talked to them but they left- only to return the next day.

I was at work for the third day, and I told my wife not to open the door, and to tell them through the video doorbell that they were trespassing. She knows how to shoot, and I told her to then call the cops, and if the person tried to enter the house, to defend herself.

This is sketchy as hell. A bunch of us talk, and we have pictures of the three men involved, pictures of the two vehicles they were seen driving, and pictures of license plates. I will be keeping an eye out for those guys. Our neighbor’s husband works during weekdays, so I will keep watch over the house and wife while he is off at work.

I also pulled an outside the pants holster and mag holder out of the closet and will be wearing a larger firearm than my usual EDC whilst I am home. I will be open carrying an M&P 45, loaded with a 10 round mag filled with Speer Gold Dot G2 230grain +P hollow points while I am home (I got a great deal on a case of the GDHP last year from Lucky Gunner). Add a couple of spare mags to my belt, and I have 30 rounds of “you aren’t robbing MY fucking house without sustaining a sucking chest wound, asshole.”

Also available are shotguns, rifles, and other assorted mayhem should they give me a couple of seconds to get all of my shit in one sock.

I will keep an increased security lookout for the next few days.

Side note: The Speer G2 is a good looking load. 230 grains moving at 950 feet per second gives you 461 foot pounds of energy at close range. Expansion looks good. Check it out.

By Divemedic, ago

More Pay BS

Keeping up with my current problems at work, with them requiring us to perform training on our own time but not wanting to pay us. They are saying that any training hours claimed in excess of four hours in any two week pay period will not be approved. At the same time, we are REQUIRED to complete this training, or we will be taken off of the schedule and not permitted to work.

Here is a list of the training that I have been assigned over the next few pay periods:

May 5-18

  • Patient Experience Class- increasing customer satisfaction- 4 hours
  • Preceptor’s monthly TEAMS meeting (preceptors are required to attend 10 of these per year) 2 hours

May 19-June 1

  • Training- The Business of Healthcare, Lecture F, 4 hours
  • Preceptor monthly TEAMS meeting for June, 2 hours

June 2-15

  • Business of healthcare, lecture B, 4 hours
  • June Skills fair, 1 hour
  • Annual megacode simulation, 2 hours
  • Strokes, 2024 Refresher training, 6 course series (Due 24 June) 8 hours

June 16-29

  • Business of Healthcare, lecture E, 4 hours
  • Preceptor workshop, 4 hours
  • Quarterly HAZMAT Decon training, 4 hours

So as you can see, they are only willing to pay for four hours per two week pay period, but they assign you an average of 10 hours of training per pay period. Over the course of a year, that adds up to 240 hours of training, but they are willing pay us for less than half of it. That means I am being cheated out of about 130 hours of overtime each year, if not more. They are getting a month of free labor out of each nurse, each year. It adds up. If all of the nurses who work there are being similarly treated, and listening to the grumbling, they are, the hospital is saving almost $3 million a year by cheating the overtime rules.

By Divemedic, ago

For Example

I am sitting at home, taking a mandatory online training course on “preventing medication errors.” The class lasts from 0800-1200. Let’s see if I get approved to be paid for this course.

By Divemedic, ago