Sunday, January 1, 2017

Are you a REAL nurse? Or are you just someone who was able to pass NCLEX?

As Ralph and I travel across the country, I have the opportunity to work with some of the best healthcare workers in the world. Their level of skill and compassion is second to none. Unfortunately I have to opportunity to work with some of the biggest slackers in the world as well.
One might ask what is the difference, or how can you tell. The most recent example we will illustrate below:
Scenario 1: 30 minutes before staff shift change we are called to the ER because EMS is inbound with a possible stroke. In preparation for their arrival, I ask lab to come to the ER and Xray to warm up the CT scanner. I tell the ER RN that if the patient is stable on arrival they will go straight to the scanner (which they will pass by on the way from the ambulance to the ER) and then to the ER. The reply from the "RN" was "they need to come to the ER first so I can triage them and get their history in the computer". Needless to say at this point Ralph woke up!
I met the EMS crew at the door, did a rapid assessment and to the scanner we went. When we exited the scanner and arrived in the ER the "RN" was nowhere to be found. The patient was in the ER with 3 members of the BLS EMS crew, a CNA and Ralph and I. Over the next few minutes an appropriate history was obtained, NIH Stroke Scale of 6 documented twice, a 12 lead EKG was obtained,  I started 2 large bore IVs, hI had reviewed the head CT and identified a subdural hematoma, and was talking to the tertiary hospital neurologist on the phone when the "RN" wandered back into the room. Her first words were "why didn't you come get me, I was just having a cup of coffee". I asked her to call the on call RN to assist us because we were going to fly the patient to a neurosurgeon. Her response was "night shift will be here in a few minutes, I don't want to bother the on call RN".
Well at this point it was all I could do to keep Ralph from "splainin" the facts of life to this supposed "RN". But, professionalism prevailed and I was able to keep him muzzled.
The night shift staff arrived and the day shift "RN" informed us that ******* is here I am outa here.
Scenario 2: A few weeks later, Ralph and I were called to the ER for a chest pain patient that had walked in. The ER nurse for the day was the night shift RN from the previous case. When I walked into the ER about 6 minutes after I was called I was handed a 12 lead EKG, the patient had 1 large bore IV and a second was being started, the patient had been given 325 mg aspirin that he chewed, and labs were drawn and in process. This patient eventually also flown to the above mentioned tertiary hospital with a diagnosis of Non STEMI MI, had been started on thrombolitics in our ER and, by EKG and symptoms, his infarct was resolving. The evolution of this case also overlapped shift change, and the oncoming night shift "RN" was, you guessed it, the day shift "RN" from the previous case. The day shift RN did not leave the ER until almost 3 hours after her shift had ended and she had seen the patient roll out the ER door with the flight crew, because this was HER patient.
Now the difference between the 2 scenarios, in mine and Ralph's opinion, is one of the above is a Registered Nurse, and one is someone who was able to pass NCLEX.
Ralph and I will let you debate which is which, and even more importantly, which you choose to be like.
Happy New Year!

Sunday, December 25, 2016

Happy Christmas Morning!

As Ralph and I sit here, away from home on a frigid ( 0 degrees F ) Christmas Morning watching the wind and snow through the window, we realize how much we have to be thankful for. We are warm and dry, have more food than we can eat, are healthy, and have a family at home that loves us.

Unfortunately, many of our acquaintances, friends, and neighbors can't say that:

My wife was out before 5 am this morning helping feed the homeless in Memphis, yet I have more than enough to eat.

Many people need warm clothes, yet I have dry boots, gloves, a hat,  and a warm winter coat.

There is someone, somewhere at this very second fighting for their last breath, yet I am healthy.

There are fire and EMS workers, at this very minute, exposed to the elements as they care for others. Yet I have a nice warm emergency room to practice my trade in.

There are emergency workers spending the day away from home with their "second family", yet I have the ability to FaceTime with mine.

Somewhere there is a soldier sitting in the sand, or maybe a wet ditch, standing constant vigil so I may enjoy the things I do and provide for my family. Yet so many things I seem to take for granted.

Somewhere there is a person that has no family, they may be in a strange land with no friends, yet Ralph and I have been befriended by many here and have several invites to visit this afternoon so we "won't be alone on Christmas".

As a christian, today is my celebration of the birth of Christ. Yet somewhere, someone is being persecuted because of their religious beliefs. And even more unfortunate, we may only have to look across the street to see it taking place.

So how do we change things, how do we make the world a better place? We do it just like we do everything else, one breath, one step at a time, and one smile at a time. But most importantly, we do it everyday and we don't just talk about it, we take action.

As we approach the new year, the time for resounding resolutions, let's focus on one thing:
Let's try to make everyday like Christmas. Be thankful for what we have, help those that have not, and most of all, "Let's be good to each other".

Merry Christmas from Scobey, MT

T and Ralph

Sunday, December 18, 2016

Good morning from frigid Scobey, MT!

Ralph and I are back on the road, healing the sick and observing life!

It has been two years since Ralph and I have shared with you, but life has a way of both getting in the way and changing your perspective on life. In my last posting, my plan was to blog more as I settled into an academic life. I was not going to work locums so I could be home with a blossoming teenage son.

Well, you guessed it, life sent in a 100 mph fast ball that totally changed both my plans and our family life. BG (our son) suffered a severe closed head injury 2 years ago and has suffered from post concussion syndrome since. Initially, he had a continuous debilitating headache that was uncontrollable with multiple medication therapies. Additionally, he had severe spatial vertigo so he was unable to walk without assistance. And if he attempted to read, after one to two minutes his headache became so severe he would vomit. We obviously could not leave him alone, so our family became home bound. Either Kat or myself stayed with BG continually, he was never alone. There was "no quick trip to get a gallon of milk". Kat and I rearranged our lives so we could care for BG.

This period was the most depressing, frustrating, maddening, and horrendous time in my life. Imagine your teenage son vibrant and active one day, and the next he is afraid to try and walk because he is afraid he will fall down. He doesn't want to go outside because his vertigo gets worse. He learns to compensate for the vertigo by crawling on the floor and sitting down to go up or down steps. He has a totally flat affect, he never laughs or smiles and he has no interest in doing things because he is afraid it will make his head hurt worse. Heck, a teenage boy that won't play video games? I am a healthcare provider, I take care of people, I "fix" people, yet I could not make my son better. Both Kat and I know people, we are respected in our local healthcare community, but we could not get appropriate help for our son.

There is a sports concussion program at one of the neurology groups in town. This program deals with concussions and the residual effects, BUT only if they occur during a "sporting event". It seems that the program is funded by research money, and BG didn't fit their research inclusion criteria. Now being the realist that I am, I know you can not truly imagine the emotions that that information produces, but try. What if that was your child? Well, I think you are getting the picture. The 6 ft 275 pound "papa bear's" redneck-country boy  personality moved expeditiously to the forefront! What do you mean "he doesn't meet your research criteria"? He is sick, you have the knowledge, information, and resources to potentially make him better, FIX HIM! Fortunately, this is one time Ralph's logic prevailed and I was neither arrested nor sued for inflicting severe bodily harm to the concussion program folks, even though I think it would have improved my state of mind (at least for a few minutes).

We finally found a program and facility in Atlanta, GA that provided information, resources, and support. Almost one year later BG's symptoms had improved enough for him to return to school, by the way, did I mention that he lost his entire freshman year of high school? He still has a continuous headache, that he rates daily as a 2-3/10. He occasionally has an increase in his headache that will put him in bed for a day or two, but he has learned to compensate and adapt remarkably well.

BG has returned to school and has made the honor roll his last two semesters. He has resumed most normal activities that teenagers participate in, including back to shooting competitive trap. He smiles, he laughs, and we have our BG back. We will help him deal with his headaches and pray that one day his head won't hurt (there is still that possibility).

Now that he is better, I have left the academic world and am back to doing what I love. Providing healthcare in rural and frontier areas!

Until next time,
Me and Ralph

Tuesday, November 11, 2014

The journey begins

As some of you know, I began a new journey into academia on November 3rd. I have assumed a full-time faculty position at The University of Tennessee Health Science Center College of Nursing in Memphis, Tennessee. I will be teaching in the Adult Gerontology-Acute Care Nurse Practitioner concentration. I will still be doing some “rental assignments” but will be staying closer to home due to my son’s health condition and trying to get him through high school.

Hopefully, I will have more time to post my ramblings and share some educational information with you on a more frequent basis. I will also continue to inform you of the “WTF” moments I observe in my everyday life.

As I sit here typing, a commercial comes across the radio taunting “free pancakes for our veterans today”. What does a “free pancake” have to do with acknowledging the sacrifices that have been made by those who have, and are currently, serving in our armed forces? Does this “marketing plan” not tend to shift the focus from the veterans to the “restaurant”?  Also, why do we just want to acknowledge the veterans today? Should we not be thankful and appreciative every day?

The very fact that I am able to blog is a direct result of the freedoms I have enjoyed for nearly six decades to rant, rave, ramble, and comment on my life, politics, and the general state of the world. I do not fear “political consequences” for my postings because my country men and women have sacrificed so I may experience these and many other freedoms.

Throughout my travels I have: given my seat on a flight to a soldier headed home from deployment and taken another flight, paid for a sailor’s cup of coffee, and thanked many service men and women for their service. Does this make me special, not at all, it makes me an American. So while we celebrate and honor our veterans with parades and accolades today, let’s continue doing it the other 363 ¼ days of the year!

To the Veterans and those that will become Veterans, know that you are in my daily prayers. For those that have served or are serving now, THANK YOU FOR YOUR SEREVICE! Because you choose to serve, my family and I sleep better at night.

Tuesday, October 28, 2014

Joint Injection Course in Memphis, TN November 8, 2014

I will be teaching a joint injection course in Memphis, TN November 8, 2014. There are only a few spots left, if you are interested sign up now at:

Hope to see you there!

12 Different Injection Approaches:
  • Glenohumeral joint injection
  • Subacromial bursa injection (2 approaches)
  • AC joint injection
  • Medial/Lateral Epicondyle injection (tennis/golfers elbow)
  • Trochanteric bursa injection
  • Knee joint injection (4 approaches)
  • Trigger Point injection- lumbar paraspinous muscles
  • Synovial fluid analysis
  • Viscosupplementation knee injection discussion
Plenty of Hands On Practice for each injection discussed included

Memphis, TN Injection Course
Date: 11/8/2014
Time: 8:00 AM - 5:00 PM
Where: Memphis, TN
Hyatt Place Memphis/Germantown
9161 Winchester Road
Germantown, TN 38138
NPs: This program is approved for a maximum of 8.5 contact hour(s) of continuing education (which includes 2.0 hours of pharmacology) by the American Academy of Nurse Practitioners.
PAs: This program has been reviewed and is approved for a maximum of 8.50 hours of AAPA Category 1 CME credit by the Physician Assistant Review Panel. Physician assistants should claim only those hours actually spent participating in the CME activity.
See Registration & Cancelation Policy.

Monday, October 27, 2014

Who the heck is Ralph?

Thanks to you wonderful cyber friends, this blog has had over 12,000 views. This means that someone must enjoy my ramblings and better than that, some of you are telling your friends about it. So as the readership grows and we have a new group of readers, it seems that a lot of folks want to know who Ralph is so I will try to explain.

Ralph is the “voice in my head”. He tends to live on my right shoulder so he can whisper in my right ear. When I can’t find him on my right shoulder, it is because he got tired of the scenery and is over on the left shoulder. Conveniently for him, there is an ear on each side so he can always “whisper in my ear”. Some of you are probably thinking about now that I am totally insane. The reality is that each and every one of us have a “Ralph”. I just choose to acknowledge his presence and existence. I first acknowledged Ralph many years ago as a paramedic. I learned that if Ralph was whispering that “something is WRONG!” there usually was, whether I had identified it or not. We have had quite an interesting relationship through the years, some days great while some days he is just a royal pain in the butt.

 Each of us usually have three things inside our heads. Obviously a brain, “that little voice” and a filter. How these three distinct entities interact can vary from person to person as well as from second to second in the individual. I will let some neurologist or psychiatrist attempt to explain the brain thing, but I will give you some insight into the filter and “THE VOICE”.

First, let’s look at the filter. The filter is present to keep the words that come out of our mouths and our physical actions from embarrassing us or worse, harming and maiming other human beings and ourselves. Unfortunately, filters do not always work. In order for them to work, one must first turn them on (sometimes I forget). Additionally, for the filter to work the input cannot be greater than output or the system overflows. And lastly, things like human emotion, alcohol, genetics, drugs (both recreational and therapeutic), and our friends can have a seriously detrimental effect on the functional capability of our filters.

Now on to “THE VOICE”

As stated above, each of us have a “voice in our head”. While yours may not have a name, it is definitely there. Some of you describe him/her (after all this is a gender neutral blog) as a “narrator”, some choose to ignore them, and some have yet to discover their existence. Ralph is a mixture of morals, ethics, life experience, situational stress, and occasionally all of the above mixed in a big pot that boils over totally exceeding the filter’s capabilities. Most of the time Ralph is mild mannered and serves as the voice of reason.

For instance, Ralph usually won’t let you say things that make your co-workers cry. However he may facilitate you explaining to them that their entire brain function is comparable to that of an amoeba. He has told folks that they were dumber than floor tile adhesive. The worst events occur when I forget to turn the filter on and Ralph is feeling “really frisky”. Ralph has been known to spend hours at a time sitting in an airport throwing fashion flags. On the other hand, Ralph and I have sat in the floor consoling a child whose doll has a broken arm. When a relative calls and asks for money, Ralph is the one who blurts out,” OH HELL NO!” I hope this sheds some light on Ralph.
Till next time!

Sunday, October 26, 2014

I did it, I did it!

Well it is official, Ralph and I have completed the Jurex PLNC certification course! We have made some great new friends and were able to extend our networking into a new arena. Elizabeth Randolph’s approach is to “keep it simple sister”, which does NOT insult mine or Ralph’s masculinity. Her explanations of the legal process, Latin terms, and ability to allow the students to realize how much they already know is amazing.

Here is a class picture (notice that I am surrounded by a sea of estrogen, but it is really good for mine and Ralph’s reputation):

Till next time!