Tag Archives: help

by

Experience

Friday I left for the Fourth of July, but not for fireworks. I went to help pack for a move. My family moved every 1-5 years through my childhood, and then I moved too. College, work, work, medical school, residency, first doctor job. Second job and I stuck: I have not moved for 25 years. Travel yes, move no. But like Martha, I am thinking about all those books! I am working on cutting them down to size and many fewer favorites.

Anyhow, I have quite a bit of experience packing and moving. When my family moved from upstate New York to Alexandria, Virginia, the movers stacked the plates with newsprint between. Every single plate in the pile broke. My mother was furious. She said the packers should have nested them on their sides, so they don’t break the one below. We shall see if my experience is useful or not.

I bubble wrapped this lamp and then packed it in a big box with more bubble wrap and a lot of t-shirts. Yes, I should take the shade of but it would have required a special tool that we didn’t have. Or a trip to a lamp store. There was not enough time. The moving truck comes Wednesday or Thursday. We were nearly done when I left to drive back to Grand Junction. Newsprint, bubble wrap, a pack for glasses and quite a few boxes. I hope it all makes it!

For the Ragtag Daily Prompt: pack.

by

Car situation

What did happen in my situation?

I am worried that a car will come around the corner and hit the car partway in the street. Plus, what if there is a medical situation? A heart attack, or drugs, or alcohol, or a seizure? I want help. I call 911. The dispatcher asks for the license plate and if I can see anyone inside. I give her the plate, but the car is fogged up, so I can’t see inside. This does make it more likely that someone is alive inside, but they could still be ill.

I wait, but I am anxious. I text my neighbor and ask if he will come back me up while I bang on the car. He comes out, but the police have just arrived. We wave and go back inside. I do peek out. There is a fairly young man and a dog, who get out of the car. He can walk without difficulty. They don’t move the car. The policeman leaves, then calls me. He says that the person is having an allergic reaction and is waiting to move his car until he can see. The car will be gone by the afternoon.

“Oh, thank you!” I say. “Can I take him coffee?”

“That would be nice.”

I go out and ask if he wants coffee. He does. I take him a cup and he leaves it on my steps. The car is gone later, so I hope he is much better. It’s lucky that he is on our side street rather than the faster main one. More chance of an accident there.

I did feel like a little old lady complaining about a strange car, but I was worrying about something medical more than a stranger. And with the possibility of alcohol or methamphetamines or opioids, I want help. We had an overdose death in our hospital parking lot within the last few years and our police have nalaxone to reverse opioids. I am very glad that it was not an overdose.

________________________________

For the Ragtag Daily Prompt: situation.

The photograph is my 1986 Honda Civic, not the car in the story.

by

Found

Barbie doctor is trying to interview the Get Real Girl about the origin of the missing part in front of her, but Elwha intervenes.

“Who, me?” says Elwha. “I am trying to help! I don’t eat Barbies or Get Real Girls!”

For the Ragtag Daily Prompt: missing part.

The funny bit is that I knew right where this missing part was: on a dresser upstairs. It’s the rest of the doll that has gone missing.

by

Avoid death by fentanyl

Some of the West Point Cadets overdosed on March 12, 2022 are still on ventilators. They took what they thought was cocaine. It was laced with fentanyl and they all nearly died.

Not only that, but two of the bystanders who did not use the drug, but did cardiopulmonary resuscitation, CPR, also succumbed. They stopped breathing because they got a heavy dose of fentanyl giving CPR.

Fentanyl is being laced into ANY illegal drug, and being 50 times stronger than morphine, it can kill you by making you stop breathing. Also, fake pills are made. Do not buy pills on the street. And I don’t care if it is your friend. Remember that when someone is really addicted, the addiction is running the show. They need the drug more than your friendship. People will lie, steal and sell drugs. Protect yourself:

Please read the website at

https://www.cdc.gov/stopoverdose/

If you or a family member uses illegal drugs, please get naloxone to have at home. If the shot is given in time, very soon after the person stops breathing, it can save their life.

Here: https://www.cdc.gov/stopoverdose/naloxone/index.html

If you give someone a dose of naloxone CALL AN AMBULANCE. Because it is short acting and the opioid may take back over. The person may need to be on naloxone iv! You must get them to an emergency room as fast as possible.

Our local Health Department was giving out naloxone shot kits in the last few years for free. Our local police carry naloxone. If you are on prescription opioids, you should be offered a prescription for naloxone and your family should be instructed on how to use it.

And teach your children well. I interviewed my patients for years on the age they started smoking. Most of my patients started at age nine. One woman said age seven. We have to start talking to children about drugs and risk and not smoking anything by third grade. That is the horrific reality.

And Bless the punk band The Offspring for reaching out to opioid overuse people and saying, “Get help. You can do it. Please do not die.”

The Opioid diaries live by the Offspring.

And they too are inimitable.

by

What I learned from my first doctor job

When I started my first job, I had a nurse and a receptionist within a bigger clinic, all primary care. Fresh out of residency. One month in I asked to meet with my nurse and the receptionist.

The receptionist brought the office manager. I was surprised, but ok.

I started the meeting. “I am having trouble keeping up with 18-20 patients with fat charts that I have never seen before, but I think I am getting a little better at it. What sort of complaints are you hearing and how can we make it smoother?”

The office manager and the receptionist exchanged a look. Then the office manager excused herself.

Weird, I thought.

The three of us talked about the patients and the flow and me trying to keep up. About one third were Spanish speaking only and I needed my nurse to translate. That tended to gum things up a bit, because she could not be rooming another patient or giving a child vaccinations.

I thanked them both and the meeting broke up.

Later I found that the office manager had been brought in because another doctor tended to manage by yelling and throwing things. And another doctor had tantrums. So the receptionist was afraid of me and had asked the office manager to stay. The moment they realized that it was collaborative and I was asking for feedback and help, the receptionist was fine without the office manager.

That was an interesting lesson on working with people. I had been very collaborative with the nurses and unit secretaries in residency. As a chief resident, I told my Family Practice residents to treat the nurses and unit secretaries and in fact everyone, like gold. “They know more than you do and if you take care of them, they will save your ass!” The unit secretaries would go out of their way to call me in residency. “Mr. Smith is not getting that ultrasound today.”

“Shit. Why not? What the hell?” I would go roaring off to radiology to see what the hold up was.

The unit secretaries did not help the arrogant residents who treated them like dirt.

I thought it takes a team. I can’t do my work without the nurse, the pharmacist, the unit secretary, the laundry, the cafeteria workers, the administration. It takes the whole team. I value all of them.

by

Oxygen testing

“If oxygen might help with chronic fatigue, as it has helped you,” a friend asks, “how do I get on oxygen?”

Complicated answer.

First of all, one of the things that is not clear, is what recovery looks like. I think I’ve had low grade chronic fatigue for the last 7 years compared to my “normal”. Now, will I get off oxygen? I don’t know. I am hoping for September but it may be that 7 years of low grade hypoxia means I have lung damage and no, I won’t get totally off oxygen.

They have apparently recently made the guidelines for oxygen more stringent. I sort of missed that update, even though I just recertified in Advanced Cardiac Life Support. You now have to have an oxygen saturation that goes to 87% or below. It used to be 88.

Now, you can test this at home with a pulse oximeter. In 2005 after the influenza, I held my saturations but my heart rate would go up to 135. Which means that I walked across the room very very slowly because a heart rate of 135 sustained does not feel good at all. Normal is 70-100 beats per minute. You can measure pulse with just a second hand, number of beats in a minute. For oxygen saturation, you need the pulse ox and it will measure both heart rate and oxygen saturation.

So: measure pulse and saturation at rest first. Write them down.
Then walk. I usually send patients up and down the hall three times then sit them down and watch the pulse ox. In some, the heart rate jumps up. If it’s over 100 and they are getting over pneumonia, I don’t want them back at work until it is staying under 100. Or if sitting they are at a pulse of 60 and then walking it’s 95, well, I think that person needs to convalesce for a while yet. They can test at home.

As the heart rate returns to the baseline, the oxygen level will often start to drop. Does it drop to 87? Describe the test to the doctor and make sure the respiratory technician does it that way and also they should do pulmonary function tests. Mine were not normal.

Now, what if the oxygen doesn’t drop to 87? We are not done yet. What does the person do for work or do they have a toddler? If they have a toddler do the same test carrying the toddler: they sit down, exhausted and grey and this time the oxygen level drops below 87. If they do not have a toddler, do the test with two bags of groceries. Or four bricks.

When I did the formal test, the respiratory therapist said, “Let’s have you put your things down so you don’t have to carry so much.”

“I’d rather not.” I said, “I want to be able to walk on the beach, so I need the two small oxygen tanks, my bird book, camera, binoculars and something to eat.”

“Oh, ok,” she said.

So I did the test with two full tanks of oxygen, small ones, and my bird book and etc. I dropped like a rock loaded. I think I would have dropped not loaded but perhaps not as definitively. Still hurts to carry anything, even one tank of oxygen.

We are making a mistake medically when we test people without having them carry the groceries, the toddler, the oxygen tank. My father’s concentrator is pre 2013. It weighs nearly 30 pounds. Now they make ones that weight 5 pounds. Huge massive difference.

Good luck.

by

Christmas for Children

For the Ragtag Daily Prompt: shop.

The main thing I am going to shop for today is a little tag that I got at my Sunrise Rotary yesterday. This is a gift request for a child, part of Christmas for Children, run by our local Kiwanis. Here: Port Townsend Kiwanis.

Applications for gifts for children are here: https://www.christmas4children.com/.

This year, Christmas for Children is not only handling Port Townsend requests, but Chimacum and Port Hadlock and Quilcene.

A friend just remarried and he says that they are comparing stuff. They have two of many many things! Kitchen items, house items. Maybe as a wedding gift we should all offer to go choose between two of the things and take one away to donate to someone in need! All those decisions!