Even more to learn!

12/27/2012

Even more to learn!

     Some of you are wondering why I blogged about the CHAP program. The health aides are people I interact with on a daily basis. As the “first call” provider for the ER, I am also the medical control for 22 village clinics and about thirty community health aides. The aides are very well trained, their CHAMs (Community Health Aide Manuals) are very detailed, but unfortunately they can not cover everything. This is the point in the process where I come in.

     Every week day, the CHAPs are contacted for “radio traffic”. The term “radio traffic” is a throwback to the days before Alaska had a statewide telephone system and all communications with the village clinics was by two-way radio. Today it is actually a phone call. Because of the frequent outages of land based phones and power outages there are three different phone systems available in each clinic. A dedicated IT line (like in the city where you only dial 4 digits to connect to an extension), a land based telephone line provided by the local telephone provider, and a satellite phone.

     Each village clinic has a basic stock of common medications: amoxicillin, Augmentin, Levaquin, Bactroban ointment, Tylenol III, etc. Their CHAM provides diagnosis/appropriate medication guidelines that the aides are required to follow. About now this is beginning to sound like a real “no brainer”.  Could one of these “magic manuals” make your life as a provider easier?  Several of you are already writing me an email wanting me to get you a copy of these “magic manuals”. Your “Ralph” is asking you, “what could be easier?” He has it all figured out, the scenario goes something like this:

Patient presents with bilateral ear pain.

Physical exam reveals bilateral otitis media.

CHAM tells you to prescribe amoxicillin.

     Ralph figures all you need is a CHAM and a street corner. As usual, Ralph did not read all the way to the end of the “otitis section”. What if you patient is allergic to penicillin (you know the real anaphylactic kind), CHAM tells you to contact me (your medical control). What if the TM is perforated, the CHAM tells you to call me. What if, as for the past several weeks, the weather has prevented village supply deliveries which include the medications to restock the clinics, and the clinic has no amoxicillin?  You guessed it, the CHAM tells you to call me.





     While we are playing “what if”, let’s make it really fun.

      The CHA calls in on the phone with this patient presentation:

62 yo female in the clinic with her family members complaining of increasing weakness over the past several weeks. Denies cough, SOB, fever/chills, NVD, swelling, recent changes in medications, no recent sick contacts.

Pertinent  PMH: chronic anemia

PE:

General: Well developed elderly female, NAD, ambulatory with assistance from her family, no staggers, speaking in clear-complete sentences.

V/S: B/P 88/62, P 64, R 20, T 91.8 (recheck of temp in other ear 92.1)

HEENT: PERRLA, EOMS intact, TM pearly gray bilaterally, no redness or pus in the throat, moves head around and shows no stiffness in the neck, no stridor, thyroid not palpable

Lungs: BBS clear and equal, no retractions or accessory muscle use

Cardiac: RRR, no extra heart sounds, no murmurs

Abdomen: good BS

Ext: no edema CRT <3 sec

Neuro: CAOX4, no motor changes, thoughts appropriate and complete

Hgb in clinic today = 8.2 (you quickly reviewed the patient’s previous labs and find this is their norm)

So now the big question is WWRD (what will Ralph do)?

Remember, you have a patient 232 miles away in a remote village. There are no roads; rivers are frozen; only transport is by airplane.

Now to make it interesting, I am going to let you think about this a while. You are the one sitting here at the desk. You have the telephone you are talking on; you have a Polycom system, and EHR access.

What questions are you going to ask?

What differentials are you formulating?

Does the patient need to come to Dillingham?

If you think you can treat the patient there, what are you going to do?

If you think the patient needs to come to Dillingham, how are they going to come?

Your options for transport are:

1)      In matters of life and limb = Emergent MEDEVAC by fixed wing aircraft by the Hospital (flight crew would include pilot, co-pilot, two RNs, and yourself) The cost of aircraft operations for this flight is about $4200.00, plus team members salaries and expendable supplies.

2)      In other matters = Transport to Dillingham via commercial airline. (Cost of patient’s ticket and companions’ ticket, about $215.00.

     Post your ideas in the comment section. I think it will be an interesting challenge; at least it is for me.

    

CHAP is not something cowboys wear!

The Community Health Aide Program (CHAP) consists of a network of approximately 550 Community Health Aides/Practitioners (CHA/Ps) in over 170 rural Alaska villages. CHA/Ps work within the guidelines of the 2006 Alaska Community Health Aide/Practitioner Manual in assessing and referring members of their communities who seek medical care and consultation.  Alaska CHA/Ps are the frontline of healthcare in their communities.

About the Alaska CHAP Program

The Community Health Aide Program (CHAP) was developed in the 1960s in response to a number of health concerns, including: the tuberculosis epidemic, high infant mortality and high rates of injury in rural Alaska. In 1968, CHAP received formal recognition and congressional funding. The long history of cooperation and coordination between federal and state governments as well as Native tribal health organizations has facilitated improved health status in rural Alaska.  

CHAP now consists of a network of approximately 550 Community Health Aides/Practitioners (CHA/Ps) in more than 170 rural Alaska villages. CHA/Ps work within the guidelines of the 2006 Alaska Community Health Aide/Practitioner Manual, which outlines assessment and treatment protocols. There is an established referral relationship which includes midlevel providers, physicians, regional hospitals and the Alaska Native Medical Center. In addition, providers such as public health nurses, physicians and dentists make visits to villages to see clients in collaboration with the CHA/Ps.

The Alaska Area Native Health Service (AANHS) has the responsibility of providing medical and health related services to Indian Health Service beneficiaries residing in Alaska. These services are provided by tribal organizations within the Alaska Native Health Care System. The village based CHA/Ps are a vital link in the delivery system.

CHAs are selected by their communities to receive training. Training centers are located in Anchorage, Bethel, Nome and Sitka. There are four sessions of CHA training, each of which lasts three to four weeks. Between sessions, CHAs work in their clinics completing a skills list and practicum. After successfully completing the four-session training curriculum and a clinical skills preceptorship and examination, the CHA qualifies as a Community Health Practitioner (CHP). CHA/Ps at any level of training may obtain certification by the Community Health Aide Program Certification Board (CHAPCB).

The CHAP model is currently being to develop programs in the areas of dental care, behavioral health and elder care.

http://www.akchap.org/html/home-page.html

Some pictures from Kanakanak Hospital

I will be posting a hodge-podge of photos as I go along. The native crafts are indescribably beautiful and intricate.

So much to learn!

12/17/2012   

 Well I made it here and survived my first two days, which were “orientation”. As usual, orientation at a new facility consists of filling in the blanks on seemingly thousands of pages of paperwork, getting an abbreviated tour of the facility, meeting the department heads, and genuinely feeling overwhelmed. I complete my orientation knowing that over the next few days  I will feel lost and confused as I get settled in here in Dillingham.

     I will experience several episodes of Ralph induced frustration that will probably go something like this:

Me: I need to get a medication from the pharmacy.

Ralph: Are you sure there is a pharmacy here?

Me: Well yes I know there is a pharmacy here; after all it is a hospital.

Ralph: Ok big boy, where is it then, you are so “intelligent”? (And yes I hear the snickering in his voice)

Me: I went past it on day one of my orientation, it is on a long hallway, and is next door to the lab.

Ralph: CONGRATULATIONS! You have just remembered that the pharmacy location is in the building…… I was afraid you thought it was in the middle of the parking lot.

Me: I wonder if anyone would notice colored magic marker arrows on the walls with directions for next time.

And so the saga continues for another 10 minutes, as I eventually patrol every hallway in the facility, I find the pharmacy (and as you probably guessed, it was very close to where I started my adventure). But you can bet that I know its exact location for next time!

By the end of day one, I not only knew where the pharmacy was, but I eventually found, the lab (remember it is next door to the pharmacy), the housing office (where I got my linen from on day one, wow found it two times in less than a week), medical supply, the medical staff office (where my desk is located and the location of daily rounds, and I was on time for rounds…. well only a little late the first day), the cafeteria, and several restrooms.  To you this may not seem like much of an accomplishment, but remember, I have to learn the service locations and their capabilities at several new facilities every year.

Throughout all my exploration, the entire staff here is friendly and very willing to point lost souls like myself in the correct direction.

I made it to Anchorage, now what?

     When I landed in Anchorage, I had been instructed to see the gate agent who would direct me to my connecting flight to Dillingham. Guess what; when I got to the gate desk there was no one there. I looked around the other gates and they too were unmanned. So I did the next best thing, I went to the departure board to see where my next flight would depart from. As I scanned the postings, I could not find my next flight. This is also about the time Ralph woke up from his nap. I believe his words were “you’re screwed, it is 35 minutes toil your next flight departs, you don’t have a ticket and you have no clue where to go or what to do”. My response to Ralph I can’t post here, after all this is a PG blog.

     Having never been to the Anchorage airport, I truly had no idea where to go. I found a sign that said ticketing and off I go. I eventually found an airport worker who was very helpful informing me that 1) I needed to go to the Penair ticketing desk to get my ticket 2) I was not the only person who this had happened to, in fact it is a daily occurrence, and 3) if I intended to make my flight I needed to move my butt. As I dashed off in the direction of the Penair ticketing desk I heard my name over the public address system informing me that I was needed at the departure gate immediately if I intended to have a seat on this flight. I found the ticketing desk and informed the agent that I was the person being paged and I needed a ticket and directions to the gate. They handed me my ticket and pointed toeward the gate that, thankfully, was within sight.

     As I announced my presence to the gate agent, she explained the urgency of my page. The airport in Dillingham had been closed for 2 days due to severe icing and Penair had added two additional flights this evening in an effort to get everyone that had been delayed to Dillingham. Needless to say, I understood why seating was at a premium. I boarded the Saab turbo prop and folded myself into the seat and enjoyed a very uneventful flight to Dillingham.

     On my arrival at Dillingham, I had been flying and running through airports for about seventeen hours. Having finally arrived at my destination, I mistakenly presumed (I defer from using the word assume due to its hidden implication) my adventure was over. Boy was I wrong.

     Through email, I had been instructed by my contact in Dillingham to take a cab to the hospital and report to the emergency room for the key to my lodging and further instructions/directions. Being the professional that I am, on my entry to the terminal in Dillingham, I contacted the local cab company. As I was waiting on my cab (as instructed), I was chatting with a fellow passenger who was waiting on his ride. A couple of ladies walked past that obviously knew the person I was speaking with and even politely said hello to me. After the ladies got in their car and were pulling out of the parking lot, my new friend inquired where I was going. I informed him that I was going to the hospital. His next comment came a a great surprise to me. He said “you should have just ridden with Sue (not her real name) she works at the hospital”. In fact, Sue was my contact person at the hospital who had told me to take a cab. Now I was really confused. About this time my cab arrived and for a fiver it took me to the hospital.

     When I arrived at the ER, as previously instructed, I presented myself and received looks from the staff like I had a bugger on the end of my nose. They knew nothing about my arrival, had no keys, nor any instructions for me. As they attempted to help me with this confusing situation, the DON, who happened to be in-house, graciously asked me if I had eaten. When I replied no, but if I could get some milk, I would make a protein shake and go to bed. Needless to say by this time I was beyond tired. My new “bestest” friend that had offered to feed me, looked high and low and was only able to find chocolate milk, which really sux when you want to make a vanilla protein shake.

     After several calls by the gracious staff, it was determined that the reason I had no keys was because someone had been sent to the airport to pick me up. Since the airport had been closed for two days and three flights coming in instead of one, and they had one person arriving on each flight, the plan had changed during the day. As I was traveling, there was no way they could have contacted me to let me know. My contact person did have a recent photo of me that was submitted in my credentialing packet, told me the next day “because you were so calm and not frazzled I didn’t recognize you”.

     After a brief time, I received my keys and was taken to my very nice apartment. It is a townhouse layout with two bedrooms and a bath upstairs and kitchen, living room, and dining room downstairs. I got in and carried my luggage upstairs, noticing that there was no linen on the bed or in the bathroom. I unpacked and went looking for sheets to put on the bed. You guessed it, there weren’t any, nor were there any towels. There is also a telephone upstairs and one down stairs, neither of which had a dial tone. I did find a blanket nicely folded on the sofa. I also found several rolls of paper towels in a kitchen cabinet.

     If there had been a hidden camera in the apartment, I probably would have won the $100,000.00 prize. I was so tired and exhausted, I took a shower and dried off with paper towels (I always carry a bar of Dial soap) after which, I laid the blanket on top of the bed and made myself the filling in the taco. I awoke the next morning at 3:30 am (which was 6:30 am according to my internal clock) refreshed and ready for new challenges.

     Now before you ask, the folks here did not have a vendetta against me. They actually are some of the nicest, down to earth folks I have met in my travels. I was the “victim” of an unusual set of circumstances. My contact person and everyone here have been so apologetic and actually look like little whipped puppies about my experience that I don’t even tease them about it. This facility has an enormous amount of personnel moving in and out on a daily basis and some things just happen. I am actually glad that it happened to me rather than someone who could not laugh about it.

    

Alaska here I come! 12/12/12

     The day is finally here to start my Alaska adventure. While I have been to many places in the lower 48, this is my first trip to Alaska. I “think” I know what I am getting into, but until I am actually there I have no way of knowing if I am truly prepared. Did I pack the correct clothes? Is there anything I need that I won’t be able to get in Dillingham? How will the native people receive me? And the questions from “Ralph” (that little pesky voice living inside my head) come fast and endlessly.

      Now for those of you that travel, you already know that there is no “travel fairy” that waves a magic wand and everything about your trip is hunky dory. I have prepared myself over the years to expect the unexpected and pride myself in the fact that I am fairly self-sufficient and can deal with most travel related issues while still smiling. However, Ralph is constantly trying to instill doubt and frustration in my life. I am determined that Ralph will never win, but he is occasionally able to temporarily gain a slight advantage.

     I awoke this morning at 3 am. I put the coffee on, brushed my teeth, and at 3:30 am I woke the “princess”. As I have mentioned before, I have the “bestest” wife in the world (who else would get up at this ungodly hour to take me to the airport?). While she dresses and prepares her 2 (yes two) cups of coffee (one for going to the airport and one for the return trip), I put my bags in the truck and start the engine so the cab will be warm when I, er she, gets in. I remove the heavy frost from the windshield and      return to the kitchen where I inform her “your chariot awaits”. Unfortunately, she did not find this statement nearly as humorous as I did at “oh my god thirty” in the morning.

     We arrived at the airport about 4:15 am (for my 6 am flight), I unloaded my bags, had a prolonged “good bye, hurry your ass back home hug and kiss” and she departed as I entered the Memphis airport terminal. As I crossed the threshold of air travel, the comedy of errors began and I realized this was going to be a LONG day.

     I was unable to check in online because my flight had “too many legs”. My itinerary was: Memphis to Atlanta; Atlanta to Seattle; Seattle to Anchorage: and Anchorage to Dillingham. Now in my “prepared” state I know that the airline recommends that you arrive for domestic flights 90 minutes prior to departure, it even says it on the ticket. With my inability to check in online I allowed myself a few extra minutes to check in and get my boarding pass. Now I should have suspected something when the TSA check point was unmanned and had heavy steel gates pulled across the entrance with a sign advising that they would open at 4:30 am. Great, I have fifteen minutes to get checked in before I go through TSA screening. Funny thing Delta doesn’t tell you is that their ticket agents don’t even show up at the ticket counter in Memphis until 4:45 am. About this time I tell Ralph to be quiet as I wait in line with about 20 other passengers that did not know Delta ticket agents got to sleep in. There was a “very unhelpful” Delta lady in a red jacket that walked up to the line I was standing in and told us that we should be checking in at the kiosk. I and several others informed her we had tried, and the kiosk told us we had to see an agent. With this information firmly grasped in her little mind, she smilingly informed us that we would have to wait to see a ticket agent. Thanks a lot lady in red!

     At exactly 4:45 am, the gentleman in the blue Delta jacket finally got his computer turned on and the line began to inch forward. When it was finally my turn, the gentleman informed me that he could only ticket me to Anchorage; I would have to get my ticket for the last leg when I got there. Seems like we have a plan and can go forward, Ralph has gone back to sleep and all is well. The time is now 5:20 am. The TSA screening process was uneventful and I got to my gate just as the last of the first class passengers was entering the jet way. I boarded without difficulty and was ready for a day of flying. As we departed the gate, the pilot informed us that we would be slightly delayed for take off due to the fact that we were in the de-icing line. I silently chuckled to myself at the irony of this. I am leaving the “warm” south headed to Alaska, and before I can take off the plane needs to be de-iced.

     The timing of this trip before the holidays meant that there were quite a few families traveling and a multitude of fairly fresh babies probably on their way to see grandma for the first time. Throughout the first three legs, the children were well behaved, unlike the gentleman I will refer to as “Richard Cranium” on the Atlanta to Seattle leg who apparently is a legend in his own mind. “Richard” refused to sit in his assigned seat because there was a mother with a little one in her lap in the next seat. His exact words were: “I refuse to sit by that sniveling brat all the way to Seattle!” About half way through his tantrum, Ralph woke up and encouraged me to politely step over to “Richard” and (as Ralph so eloquently put it) “knock him on his humpty dumpty ass”. This would have given me a great feeling of chivalry and satisfaction, but probably resulted in my incarceration and very large fines. I did do the next best thing and inform the flight attendant that I would be glad to exchange seats with “Richard”. She thanked me and quickly allowed us to swap seats. The young mother was visibly upset but the infant in question was soundly sleeping in his mother’s arms. I assured her that I had no problem with her or her child, advised her to forget about “Richard” and enjoy the flight. The child was an angel throughout the flight, and even let me hold him while his mother made a trip to the lavatory without vocally objecting.

     Now at the time that our friend “Richard” was showing his ass and I offered to swap seats, no one had filled the seat next to mine. Shortly after exchanging seats, a very large elderly lady “squozed” herself into the seat beside “Richard”. Several times during the trip to Seattle, she could be heard throughout the aircraft snoring loudly and smacking her lips. Now who says there is no such thing as karma?

     I arrived in Anchorage without further incident and all was well until I disembarked the plane. I’ll tell you about that in the next blog.

Don't you know it is cold in Alaska?

     After today, I have 4 more days at home before I leave for an eight week assignment in Alaska. I am scurrying around attempting to complete all my "honey do" tasks prior to my departure. My last major project is completing the back yard fence so my wife and son will not have to brave the elements while I am gone to walk the dogs (this is pretty high up on my list, if you don't believe it just ask my wife). My progress is halted due to several days of rain, thunder, and lightning. But on the bright side the forecast for Monday is clear, but the high temperature will be around forty.

     Over the past few days, I have had several friends "remind me" that it is cold in Alaska. The most recent reminder came this morning from a friend in North Dakota by way of an IM. These reminders make me chuckle (especially when coming from North Dakota). I appreciate their good intentions, but most of them don't know "where" in Alaska I will be and know nothing about the climate. They seem to forget that this is "not my first rodeo".

     Now I consider myself a fairly well educated individual, after all I have completed a doctorial program and earned the right to put Dr. in front of my name and most of the alphabet after my name. I am reasonably computer literate (just don't ask me about programing or what ever is on the inside of the thing) and have access to the internet. Before I accept an assignment, I research the area and the facility thoroughly. I currently reside in the Memphis, TN area. I lived for two years (2010 & 2011) in North Dakota, and have traveled extensively through out the United States. I am very familiar with the terms "cold, "wet", "humid", "torrential rain", "dry", "blizzard", and "hot".  Let me share with you what I have discovered about my Alaska assignment.

     My first reference for a new place is City-Data (www.city-data.com). Here I can find information on the climate, cost of living, housing, government, tourism, and yes even the number of registered sex offenders. Let's look at a comparison between Dillingham, AK, and Oakes, ND.

     Dillingham, AK:
Population in 2010: 2,329. Population change since 2000: -5.6%

Estimated median household income in 2009: $76,481 (it was $51,458 in 2000)

Median gross rent in 2009: $976

Mar. 2012 cost of living index in Dillingham: 110.5 (more than average, U.S. average is 100)

According to our research there were 18 registered sex offenders living in Dillingham, Alaska in July 2011
The ratio of number of residents in Dillingham to the number of sex offenders is 129 to 1.
Average climate in Dillingham, Alaska

Based on data reported by over 4,000 weather stations

     Oakes, ND:

Population in 2010: 1,856. Population change since 2000: -6.2%

Estimated median household income in 2009: $36,772 (it was $30,263 in 2000)

Median gross rent in 2009: $473

Mar. 2012 cost of living index in Oakes: 81.1 (low, U.S. average is 100)

According to our research there was one registered sex offender living in Oakes, North Dakota in July 2011
The ratio of number of residents in Oakes to the number of sex offenders is 1856 to 1

Average climate in Oakes, North Dakota

Based on data reported by over 4,000 weather stations

     As you can see, Dillingham's temperature extremes are not as hot nor as cold as Oakes, ND.

     I also search for local newspapers, radio stations, and city web pages for the area I am investigating. This research allows me to properly pack and gives me an idea of opportunities for adventure while on an assignment. There are many other great sites with information on cities and areas, these are some that I use.

     And for my friends in North Dakota, "don't ya'll know that it is cold there?"

All I need is some Rolaids!

     Many times in the emergency room I have nurses that "think" they know what is wrong with a patient. Too often I hear comments like, "why don't you just discharge them (the patient), they were just here yesterday with the same complaint!" I look at these patients with the approach, "what did they miss yesterday?"  Some times their "thinking" is correct, unfortunately many times it is not. As the provider, I can not afford to "think", I have to "prove" my diagnosis. If I miss a life threatening or debilitating injury it is my fault. If the nurse "thinks" wrong, it really does not matter because the ultimate responsibility is mine. I make this statement as preface to a case study. This case had a positive outcome, but hopefully you will see how it could have been a disaster.

     The patient is a 67 yo caucasian male that presents ambulatory to the ER accompanied by his wife. They had eaten at a local restaurant about 40 minutes prior to coming to the ER. About 15 minutes after eating the patient developed "heartburn" and belched a few times. He denies any chest pain (other than his
"heartburn"), shortness of breath, sweating, nausea, diarrhea or other complaint. He has had no recent fever, chills, cough, or other symptoms of illness. He reports having "frequent indigestion". He advises that he only came to the ER because so his wife would leave him alone, he has Tums at home.

     He had a complete physical exam 6 weeks ago that included labs, EKG, and hemocult (all results were with in normal limits and there were no EKG changes). He takes a multivitamin, fish oil, and a baby aspirin daily. He is an only child, father died at 93 from "natural causes" and mother died at 88 from complications of a hip fracture repair.

     General appearance: CAOX4, NAD, speaking in clear complete sentences, ambulatory with out assistance.
     Initial vital signs were: BP 132/80, HR 72, RR 18, SaO2 98% on RA
     Lungs: BBS clear and equal with adequate air exchange
     Cardiac: S1, S2 RRR, no murmurs, rubs, gallops, or extra heart sounds
     Extremities: No edema

     After my initial assessment, I ordered EKG, portable chest X-ray, CBC, CMP, Troponin, 3-81mg ASA chewed, and an INT.

     Pertinent labs: WBC 13.1, Troponin I 0.00, electrolytes WNL   

     The EKG showed:

    

     The patient was having an inferior MI (STEMI). Marked ST elevation in Lead II, III, and AVF.

     While he was in out ER, he received IV morphine for pain control (nitroglycerin use in inferior MIs has a tendency to cause marked HYPOTENSION), 5000 unit heparin IV bolus followed by a heparin drip (all dosages were weight based per the hospital heparin protocol), and after consultation with the receiving cardiologist TNKase. He was transferred emergently to a tertiary facility where he underwent cardiac catherization. The cath revealed a 100% occlusion of his right coronary artery. He received angioplasty and stenting which resulted in total re-profusion.

     This is an example of why we treat everyone like they have the worst case scenario, then do everything we can to prove they really did just need "Rolaids". 

Somebody loan me some fashion flags, QUICK!

     I want to first clarify the fact that I am NOT the poster boy for GQ. I am old, wrinkled (all of which I have earned), and prefer the t-shirt/shorts/flip flop look any day to "getting dressed up". However, I do enjoy watching people which does result in my abundant dispersion of "fashion flags".

    Every time I take an assignment, it means getting on a airplane. If I get on an airplane to go to an assignment, that means I must get on an airplane to get back home. Unfortunately, this means two adventures through the TSA screening process. While you are in the TSA line it is easy to tell who travels frequently, who has never flown, and who thinks there are there to impress someone.

     When I fly, I attempt to make myself TSA friendly. I wear Merrills, usually wear jeans and a golf shirt, don't wear a belt, check my pockets several times, and place my watch/ring/wallet in my computer bag before I enter the line. I check the TSA site (http://www.tsa.gov/) frequently for any changes or updates in carry on regulations. And yes I put my liquids in a one quart bag. This does not mean that I am immune to the "random" hand and shoe swabs for explosive residue, an occasional "pat down", or having my bags "sniffed" by Fido.

     Last Friday I was standing in the TSA line at 6:15 am. A female (I think) entered the line wearing dangling metal ear rings that touched her shoulders, thigh high boots (with no zippers), a tank top with metal stars covering the front, a jacket with rhinestones everywhere, belt buckle that Tuff Hedeman (3 time world champion rodeo star) would be proud of, and a large bag on her shoulder who's contents rivaled Opie Taylor pockets was about 4 persons ahead of me. The "aroma" she was emitting validated my thought that she used the $3.99 a gallon "fly spray" available at Rite-Aid, and had applied several gallons. I really could not begin to estimate her age because of the amount of make up she was wearing., If the quantity of make up she had was Bondo, it would supply a body shop for several repairs.

     As this "lady" approached the tub line, she removed her jacket and attempted to remove her boots. After struggling for several minutes, she finally asked an elderly (really old) gentleman in line behind her for help. This action would have definitely won the $100,000.00 prize. As she pushed tubs on the floor and sat down on the stainless steel table, her assistant dutifully began to tug and pull on her boot. Lets sum up this action with the words: slip, fall backwards, and busted his ass more than once. A female TSA officer finally came to her rescue and jerked them puppies off with an apparent vendetta which resulted in another "busted butt" (as the "lady" slipped off the table) and a group "laugh out loud". When the TSA officer advised her that her shirt would set off the scanner, the "lady" replied in a very loud voice, "well I don't know what you expect me to do about it, I can't take it off, I don't have on a bra". Other than being entirely too much information, the mental image that this created required an immediate application of mental bleach. When the "lady" attempted to send her bag through the scanner, it came back way faster than it went in. The TSA officer removed two bottles of water, a tray of cinnamon rolls (you know, the aluminum ones at the grocery store with eight in them), several candy bars, and a can of hair spray.

     Fortunately for me, there were 2 screening lines open and I was a participant in the other line. As I cleared the scanner without a hitch and retrieved my items, I could not keep myself from looking over my shoulder to see what was happening. The "lady" was being escorted from the line area by several TSA officers, two of Memphis's finest, and my old friend "Fido" and his handler. Boots in hand, toe socks on her feet, and screaming at the top of her lungs "I didn't do anything to deserve this abuse, I will have your jobs you ba#%*&@s".

     Needless to say I was out of fashion flags before I ever boarded the plane. At least I was entertained.