Me

I had some issues with the local services.

Issue 1: So a car hit a telephone pole somewhere in the area, and we lost power for about an hour. That isn’t the bad part. The bad part is that the electrical surge that came along with it fried some electronics in the house. I wonder what a whole house surge protector costs. It seems like we are constantly losing electronics here because of power surges, although they are usually lightning related. It’s pretty much an annual event.

Issue #2: In preparing to move, we were getting rid of some bulk items. We called to have the garbage people come get them, then put them out on the curb for pickup day. No one showed, they remain out there. So we call the garbage folks on our bill, and they can find no record of our house. I ask “Well, if I stop paying my bill, who will call me?” They say, “You must be covered by our contractor” and transfer the call. Company two says, nope. We have no record of your house having an account. Call company number three. So we do. Company three says that they aren’t servicing our neighborhood. So back to the number on our bill. They say that company two is definitely the one, and transfer us to Company 2’s manager. Voice mail, leave a message. Total time on phone: 75 minutes.

You guessed it. No call back. So we call again the next day and play phone tag for another hour, getting nowhere. I snap a picture of the garbage truck while it was picking up our garbage, and it has the name of Company 2 on the side in foot tall letters. So we call them.

Company 2 drone: “Sure, I can place an order to get your bulk items. What is your address and the name of your neighborhood?” We give them, and she says: “That neighborhood isn’t in our reporting system. Do you have the correct name?”

We reply, “That is the only name. We have lived here for 15 years, and we are sure that’s the name.”

Drone: “Well, that one isn’t in the system, and I can’t put in the work order without one. The computer has a drop down menu with neighborhood names, and unless we put it in, it won’t let us go any farther.”

Can we speak to a manager?

Drone: “I can transfer you to their voicemail, and they will call you.”

I can’t drive it to the dump myself, because the closest dump is in a different county and won’t accept out of county drop offs. I think what I am going to do is load the items up over the weekend, and dump them in front of the garbage people’s business office and let them figure out what to do with it.

Issue #3: My storage locker had been costing me $68 a month. A new company bought out the Mom and Pop that was running it, consolidated it with three other facilities, and then doubled rates. That was back in November. When February came, they raised them again. Now it’s nearly $200 a month for storage. So I spent three days emptying that 10×10 storage unit into my garage. Now I can’t park in it, and I lost my little workshop I had set up in there. That’s OK, since we are moving in less than a year, and we are getting a larger garage in the new place. I will probably build a storage barn in the back of the new place. I can get a 10×16 that looks like the one below for about $4,900, delivered.

When I went in to tell them that I had moved out, I noticed that the security cameras were no longer hooked up, and I had noticed that the electric gate securing the property has been disconnected. So this place was bought out by a large company, the on site managers are gone, the security gate is gone, and the security cameras no longer work. And rates are now 285% higher than they were just four months ago. What the hell are those higher rates paying for? Don’t know, don’t care. I vacated the place.

Shooting at the range with one of my 80% homemade ARs. This one is a gorgeous rifle. Anyhow, this rando comes over and asks to see it. Not unusual, so I show it off. Then he asks me to sell it to him.

Uh, it’s a homemade rifle with no serial number. Not for sale.

He keeps trying to pressure me. I finally had to get firm with him.

My paranoid side says “Fed” or possibly “informant.”

As I said last month, we are searching for a new location to be closer to my wife’s job. I am also tired of things where I work:

• I was suspended without pay for a week because of a pending investigation when a delusional patient accused me of trying to kill him.
• An incident just after New Year’s day where a patient threatened violence.
• Three different incidents in January where patients either attacked or threatened to attack me.
• My hospital claims to want 4 to 1 nurse to patient ratios* in the ED. That is rare. Now it’s usually 6 to 1. On one recent shift, I had 5 patients, but 2 of them were on ventilators. One of the other three was a sepsis patient who went into cardiac arrest just after EMS brought him in. The work load there is just too high.

So I also want to change jobs. Career specialists say that you should change every 2 to 3 years, so I think now is a good time to do so. I think we are close to answers on both.

We found a builder that will build us a 5 bedroom, 4 bath, 2900 square foot house for less than $190 a square foot. The place is gorgeous. Here are a couple of pictures from the model:

Construction should take a bit. In the meantime, my wife’s job is moving in the fall, so if the house isn’t done by then, she will have a 45 minute commute. We are negotiating terms now.

On the job front, I just negotiated with a potential new employer. I spoke with people I know who work there, and they say it’s a good place. It looks good:

• Patient to nurse ratios in the ED of 3:1, with occasional jumps to 4:1. I confirmed with friends that they aren’t blowing smoke with this claim.
• Better neighborhood, so less of the violent psych and druggie patients.
• A $12 per hour raise over what I am making now
• Getting a $10,000 recruitment bonus for a 2 year contract doesn’t hurt (payable in 4 semi annual installments)

The downsides are twofold:

• Because this hospital is properly staffed, there are no shift bonuses for pulling extra shifts. Of course, my hospital stopped paying them in September, so no real loss.
• I can’t be PRN at the new place. I have to work full time for the time being. That’s OK, this will enable us to pay for this new house in 8 years and still keep the one we live in now as a rental.

The new hospital has sent the offer, and I have conditionally accepted for an August start date. (when the wife’s new job location starts) I should get the actual contract to look over some time in the next week. If it looks good, I will sign on. Hey, closer to the new place, less workload, and more money.

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Explanation of the importance of patient/nurse ratios:

For those who don’t know, each patient needs to be assessed at intervals, plus needs medications, tests, and other related things coordinated. For “routine” patients on a medical floor, a nurse can handle as many as 6 or 7 patients at a time. The more things that are wrong with the patient, the more time it takes to care for them, so task loading becomes an issue- a nurse can only do so much without increasing the risk that they will miss something important, or make a mistake because they are pressed for time and rushing high risk tasks like selecting and dosing medications. For this reason, the sicker the patients, the fewer that a single nurse can effectively handle.

Some patients are so sick that they take up all of your time. A patient on a ventilator is one of those. In general, having two patients on a ventilator is all a nurse can handle, because those patients are also usually receiving a list of medications that are high risk, and this combination means spending a lot of time with that patient. This is why the more acute the unit, the lower the ratios need to be. In the ED, patients in general shouldn’t be more than 4:1 to the nurses, unless you want to compromise patient safety by not monitoring the patients closely enough. For that reason, the ICU is usually 2:1, the “step down” unit is normally 3 or 4 to 1, and so on.

This is why the ED usually has a unit called “fast track” where patients are less sick with things like toothaches or broken fingers. In fast track, you will see ratios of 6:1 because the patients require far less of the nurse’s time. Fast track is usually a separate subunit within the ED, usually staffed with a nurse or two and a midlevel practitioner (a PA or a nurse practitioner), and the goal there is to clear out as many low acuity patients in as short a time as possible, thus leaving the sicker patients (who take up more time and resources) for the doctors and the nurses with lower ratios.

My wife’s job is moving. She will be working about 30 minutes farther away from the house than she is now. She wants to move closer to her new work location. I have been working on changing hospitals. If I want to do that, it would be easier if we move. If we move about 30 minutes south of where we are now, it would put us closer to my wife’s work and would make it easier for me to find a new hospital.

So we have been looking at houses. We had a few must haves, and some wants.

• We want a one story house.
• We need at least three bedrooms and three baths. This is so we have room to care for an aging parent if it comes to that, plus room for a guest.
• I would like natural gas service
• We would like a pool.
• We need more storage space. Either a bonus room, a large garage, or room to build a storage structure on the property.

So we began looking.

The first community we looked at wanted $400k for a 2000 square foot house. Hidden costs included a $45,000 bond. A bond is an invention here in Florida that requires each owner of a residential property to pay for roads, fire stations, and other infrastructure costs that are not part of the property. In other words, it is a cost of building a neighborhood that is passed on from the builder to the buyers of the homes. This raised the cost of the house to $455k, or about $225 a square foot.

The second and third builders did not have houses and floor plans that we liked. We went to a late lunch out in the country. While we were there, I happened to see a nearby community that looked interesting, so we headed out there. They had 2950 square foot home plan that they think we can get built with custom options for $525k, and no bond. That brings the cost to $178 a square foot. Admittedly, it’s at the upper limit of what we wanted to spend, but it’s a really nice house with a large kitchen. The best part is that it is within a 30 minute drive of 5 different hospitals, which gives me a lot of flexibility in changing hospitals. It’s one of those small Florida towns that only have a population of about 2,000 people, but still have stuff nearby.

The only real catch is the current lead time for construction is 12 months, meaning that we will be in late 2023 or early 2024 before we can move. We are looking at all of the numbers and facts, but we will likely be paying earnest money within a week or two. That means when the school year starts next fall, my wife will have to commute a bit. It also means that I can start looking for new work, expecting to start somewhere in July or August. There is a hospital that is only 15 minutes from the house we are looking at that is a good place to work and is offering a $10,000 bonus to work there. By all reports, the pay is good and I hear lots of good things about them. There are other hospitals that offer larger bonuses, but there is a reason for that.

So change is coming. It will be easier working where I am, knowing that my days there are numbered.

Speaking of expensive hobbies. One of the things that I do to stay busy is work on making my house a smart house. It all began about 8 years ago, when I installed a SmartThings hub. Our house is automated. I use our cell phones as presence sensors, and the house changes modes when we leave, come home, and go to bed.

My wife was very understanding, and has now come to love the automated features of the house. When we go to bed, the thermostat changes to make the house cooler, the lights turn off, and the smart locks on the doors all lock themselves. The landscaping lights change colors depending on the season. There is purple, gold, and green for Mardi Gras; Red, white and blue for Independence Day, that sort of thing. The hot water heater turns off when we go to bed or leave the house. It’s geeky, fun to do, and pretty bad ass.

But 8 years has gone by, and technology is evolving. I have always been bothered by the fact that SmartThings is a cloud based processor. I want local processing, and now that we are thinking about moving next fall, I have a chance to try it.

I am thinking of switching to Home Assistant. I just bought an Odroid N2+ processor and a 128 GB eMMC card to use as a server. Now I am going to learn how to program it and integrate it with all of the devices I am planning on using. So I will spend the next few months playing with it. I am planning on using smart switches that can control scenes as well as individual lights.

It’s good to have a tolerant wife.

Oddly enough, I posted the other day that I am thinking of changing to a different hospital and that same afternoon, I got two emails. The first was from my job, spelling out that all employees need to be aware that, should we decide to wear a shirt under our scrub top, it has to be white. We also have to wear white socks that cover our ankles. If we choose to wear a sweater or coat, it must be the same color as our assigned scrub color. This seems odd to me, since they can’t find shift coverage and are back to offering shift bonuses most days and are still understaffed.

We are a 50 bed ED, and we had 123 patients the other day. All of the rooms were filled, plus we had 50 patients on beds in the hallway and another 23 patients being treated in the waiting room. But our administration is worried about what color tshirt I wear under my scrubs.

The second email that I got was from a competing hospital chain. They are inviting a bunch of nurses to a free meal where cocktails will be served and we get the opportunity to meet the leadership team and learn about the advantages of coming to work for them.

Dude. Looks like I at least get a free meal out of the deal. I told my wife that I am not working that day, so I think I am going to go and at least hear the pitch.