Friday, March 16, 2018

Serendipitous Factoids 3


Here's the third installment of my ongoing series of posts called Serendipitous Factoids*
  • In 2010, the Philip Morris plant in Richmond that I drive past twice a day produced 146 BILLION cigarettes (a).  Those were only for domestic sale (Altria has plants overseas for “export”).  Some quick math: The population of the US in 2010 was 309 million people (b).  Subtract 35 million for kids up through 8th grade (who are less likely to have taken up regular smoking), this leaves 274 million people (c).  The rate of smoking is 15%, or 41.1 million people (d).  That’s 3,552 cigarettes per smoker annually, just shy of 10 a day.  From one company.  There are also cigarettes being produced by Brown & Williamson, Lorillard, RJ Reynolds and a couple of smaller companies, not to mention cigars, pipe tobacco and smokeless tobacco. E-cigarettes are a whole other topic.
  • ‘Manatee History Link’ is an anagram of my full name, as are 'Inky Rhino Stalemate', 'Skinny Aloha Emitter' and 'Horny Kitten Malaise'.  The name I usually go by can be anagrammed to ‘I Reset Mink’.  Serendipitous Factoids rearranges to 'Dissociated Pot Infuser.'  You can find all these - and more! - at the Internet Anagram Server (I, Rearrangement Servant): https://wordsmith.org/anagram/ 
  • Scottish grocers would stock selected single malts in their shops, often creating their own blends of single malts. Those blends evolved into modern blended whisky. George Ballantine (Ballantine’s), the Chivas Brothers (Chivas), William Teacher (Teacher’s) and Matthew Gloag (The Famous Grouse) were all grocers who developed their own whiskies.  So, too, was Johnnie Walker, a grocer in Kilmarnock, whose whisky blend would become the bestselling Scotch whisky in the world. https://www.forbes.com/sites/joemicallef/2018/02/01/gordon-macphail-scotch-whiskys-trailblazers/#68eb5a3a78e5


*Growing up I used to read a weekly column called, "Strictly Personal" by Sydney J. Harris.  I was especially fond of his recurring ''Things I Learned En Route to Looking Up Other Things.''  The tidbits he put into those columns filled my young head, or as my sister Diane called it, my "trivial brain."

I recalled Harris' work one day when I found myself down the rabbit hole of the internet, finding interesting fact after interesting fact, forgetting why I was surfing to start with.  I realized that I should emulate Harris and start keeping track of these things.  So I did, and here we are.


Previous Factoid editions:
Part 1
Part 2



Sunday, March 4, 2018

The Bahamian Medical System: A View from the Ward - or - Shelagh’s Big Break: Lessons Learned

Shelagh and I wish to thank you for caring enough to continue reading to the end of the first part, let alone this far!  We want to share with you some of our Lessons Learned...

  • Buy the travel insurance.  One misstep away from home could be financially ruinous without it.
  • Activate WhatsApp on your phone before you leave.  Here’s how their website describes it: “More than 1 billion people in over 180 countries use WhatsApp to stay in touch with friends and family, anytime and anywhere. WhatsApp is free and offers simple, secure, reliable messaging and calling, available on phones all over the world.”  Basically, it allows you to use your phone for voice and text over WiFi.  But, you have to be able to receive texts to activate it, which is why I recommend activating before departure.  The app is so ubiquitous outside the US that Bahamians were astonished or dumbfounded when they said, “Just use WhatsApp!” and I said I didn’t have it (you know when your dog doesn’t comprehend something and cocks its head? It was like that).
  • Passports.  Always take your passports.  If day-tripping to a Caribbean Island you are generally told you don’t need them.  This incident proves you do, indeed, need them.  If we hadn’t had them, the first parts of this story would be very different.  According to Adrian (who crossed himself, looked to the heavens and gave thanks, when I said we had them) I would have spent hour after hour at the US Embassy getting replacements, at a cost of about $500 each.  And if you don’t have a passport and are going day-tripping to the Caribbean, get one.  It’s easy, not inconvenient, and a helluva lot cheaper than not having one when you need it.
  • If traveling overseas, make sure your two-factor authentication on your e-mail system doesn’t rely on your cell phone receiving a phone call or text message.  When I had to print insurance documents that were e-mailed to me, I wasn’t able to login to my Gmail account from the hotel business center because my cellphone couldn’t receive Google’s texted security code.  I was fortunate to have my laptop with me (a recognized device) to temporarily disable the authentication so I could use the business center computers.
  • When you travel overseas to areas that clearly are not “first world” countries, remember that the people who prepare and serve your food, keep the hotel clean and generally make your life easy do not live in that comparative splendor, they only work there.  If you venture just two blocks outside the touristy areas you will see how they live.  Tip generously, even excessively.  You are travelling overseas so you can afford it and they could really use it.


The Bahamian Medical System: A View from the Ward - or - Shelagh’s Big Break: Part 5


We woke up to a bright and sunny Saturday morning, day 7 post-injury.  Shelagh reported she had a moderate amount of pain in the middle of the night and took some pain meds around 3am.  Knowing her pain tolerance and stoicism (cats take lessons in stoic from her) this was not a good thing.  But the pain meds worked and she slept comfortably until sunrise.

As we rose, the extent of Shelagh’s solar exposure became more apparent.  The tops of her legs were red, as was her nose.  It wasn’t painful, or so she said (see note on stoicism above), but she was positively delighted at having had the opportunity.

We went down for another fruit cup breakfast from Starbucks.  As we did, I saw the Dream coming in (yet again).  We went out to watch it dock, but it was windy and cool…much too cool for Shelagh (I’m well-insulated).  So we went inside to watch.  Seeing these huge liners dock is a thing of wonder.  The Dream, 1,115 feet long, 137 feet wide, weighing 129,700 tons, came slowly into the harbor, stopped, then rotated 180 degrees and backed in.  Seriously, it was awesome to watch.
Parking The Dream
The Disney Dream has just completed it's 180 degree pivot and is now backing into its berth.


A bit later, Shelagh’s nurse, Chris Stabile, came to our room to introduce himself and assess Shelagh’s baseline status.  He also laid out the game plan for the day.  The three of us were to rendezvous in the lobby to head for the airport in a couple of hours.

As Chris was giving Shelagh the clinical once-over, I looked out the window to see a sight that will be all too familiar to my EMS peeps…
New Providence EMS Medic Unit Posting at McEmbassy

At the appointed time, I took Shelagh down to the lobby, then went back up to our room to get the suitcases.  As I left Room 528 of The James Bond Hilton I took a last look around with a small feeling of sorrow.  That room was my refuge, a place of shelter and safety during a very turbulent week, and whose haven I could extend to Shelagh to protect her when she was discharged.

We met Chris in the lobby and waited for the ride he had arranged to get us to the airport.  When it showed up (a Cadillac Escalade :-o) we got Shelagh in and I returned the wheelchair that served her so well for the past two days to the hotel.  Like the room, it was like parting with a friend.

We checked in, got through security, then through US Customs and thanks to Chris (and, I guess, to Shelagh’s ankle) we got to the head of each line.  It was a breeze. 

Here’s another reason to get the travel insurance.  While Shelagh and I are adept at medical care and patient movement, getting through an airport and boarding/alighting an aircraft requires special attention and equipment.  Wheelchairs can get you through the terminal, even if it will cause extra time at security.  But getting on and off an aircraft when you cannot bear weight on one leg requires significant resources.  First, you have to make sure the gate attendant knows well in advance of boarding time about your needs.  Second, the flight crew needs to be told by the gate attendant about you.  Third, somebody has to show up to push you down the ramp, transfer you to what is called an ‘aisle chair’, a special wheelchair that will fit in the aisle of a passenger plane, and then help you transfer from the aisle chair to your seat.  Finally, let’s talk about trying to get through security on your own.  We had to cancel our return flights from Orlando and we would now be headed home from the Bahamas.  If you think you get run through the wringer at TSA normally, think about TSA’s Extra Deluxe Screening Process when you are an international traveler with a one-way ticket.  Being in the hands of a medical rescue service like On Call International makes all of that effortless because it’s arranged ahead of time.  And if you are too ill/injured to fly commercial, they will arrange an air ambulance.

Because we spent so little time getting into the airport we had time for a leisurely lunch – conch fritters for all three of us!  The three of us were first aboard – and last off – the Airbus A320 and had a comfortable and uneventful flight to Charlotte.

My Favorite Nurse and Her Escort Nurse
Departing Lynden Pindling International Airport 
Nassau, Bahamas

Charlotte to Richmond was a different story.  It was a long layover but the guys on the ramp weren’t prepared.  We were flying on a regional jet, a Bombardier CRJ-900.  It’s a small jet that seats about 45.  So small that you can’t use a jetway to access it, so you walk out onto the ramp and go up the airstair door.  Except in this situation, aisle chairs don’t go up airstairs safely and a portable ramp has to be used. 
Stock photo of an airstair door
It wasn’t in place when we reached the aircraft and had to be brought around by two people, one of whom had to be wrangled.  In the meantime, we sat out in temperatures that were somewhat above freezing, in the winds that are prevalent in the wide-open spaces of airfields, while wearing Caribbean cruise clothing.  It took a while to wheel the ramp around and get it set up.  The guy wheeling Shelagh in the aisle chair was kind enough to ask the flight crew for a blanket for her…after she asked him to…three times.
All this hardware for Shelagh?
Yes, and that's as it should be.
Anyway, we got aboard, got airborne and 47 minutes later were on the ground in RVA.  Chris took Shelagh in a hired Cadillac sedan (with a really careful driver) to Bon Secours St. Francis Hospital.  After I retrieved our luggage I drove my car and met them in the ED.  Wait.  That last sentence makes me sound like one of those crazies that drives their car INTO the hospital, so let me rephrase.  I drove to the hospital, parked my car and met them in the ED.  Once Shelagh was taken back to a bed from the triage area, Chris signed off.  We bade him farewell and thanked him for what he did for us.  Of course, we couldn’t thank him enough.

It was a very slow night at St. Francis so we were in and out in just under three hours.  In that time, Shelagh’s cast was removed, the wound and surgical incisions examined, labs were drawn, x-rays were taken, and a new, lighter cast applied.  We got home and got to bed 20 hours after we woke up.

To make a long story short (now that I’m well over 5,000 words into it), we are happy to be home and thankful for being in great continuing care. 


{Click here for Lessons Learned!}

The Bahamian Medical System: A View from the Ward - or - Shelagh’s Big Break: Part 4

We woke on Friday morning, now six days post-injury, rested, refreshed and happy as clams to be together again.

We had breakfast from Imperial’s and we ate nothin’ but Bahamian.  Shelagh had souse with Johnny cakes and I had a cheese on Johnny cake sandwich.  It was delicious!
If you want genuine Bahamian food, this is the place to go in Nassau.
But don't take my word for it, ask any of the locals who are the vast majority of the customers.

We spoke with On Call International who gave us our itinerary and told us Shelagh’s nurse, Chris, would be in touch with us later in the day to go over details.

After that, Shelagh took some pain meds (Tramadol. Write it down. Ask for it by name.) and then took a nap.  I blogged.

When Shelagh woke up it was near lunch time. So she got into the wheelchair and we trundled down to the hotel’s Starbucks.  We both got big fruit cups, while Shelagh got hot tea and I got iced coffee.  We took our tasty comestibles out onto the jetty at the end of the hotel’s beach.  As I trundled her wheelchair out towards the end of the jetty, I noted that if we were in one of the Lifetime Movie TV Network's movies, this would be the very beginning of the movie and I'd shove her off the end and into the water.  She noted she felt safe because I wasn't pretty enough to be one of LMT's villains.
The jetty (scene of the non-crime) is at center right

Once we finished, we took a moment from our busy sun tanning session to get a quick selfie.
This is from my selfie 'Blue Period'
After a while of watching the clouds blow by, boats coming and going from the Nassau harbor, and terns flying overhead, we went back inside to avoid sunburn.  We got in just in time.  We both got a good dose of Sol.  Shelagh looked dramatically better and healthier, wiping out the pallor caused by shock and then nearly a week in a windowless ward.

Our return to our room was followed by a packing session (Mirjana and I got everything packed on the Dream, but it wasn't necessarily packed in the right suitcase).  This was, in turn, followed by another run across the street to Imperial’s for take away dinner in our room.  Conch fritters and plantains.  After that, more Shark Tank reruns and off to slumberland.

{Click here for part 5!}

Friday, March 2, 2018

The Bahamian Medical System: A View from the Ward - or - Shelagh’s Big Break: Part 3


First thing the next morning, I walked to the hospital and found Shelagh in the second bed of a four-bed ward.  She was in great spirits and was comfortable.  Opiates will do that for you.  (Morphine sulfate. Write it down. Ask for it by name.)  She was receiving IV antibiotics, which is what is done for open fractures.  Bone infections are nasty things and need to be prevented with large doses of high-powered antibiotics.

The next couple of days were a lot of waiting.  On Call International, the travel assistance company that was part of our travel insurance, made contact with me (one of the many things the Dream’s crew did for me while I was packing, besides process our passports, was to open an account with them).  There was, of course, paperwork to be filled out, with sections for physician attestation.  We both prodded to get it filled out and sent in, but things operate on Island Time and they’d get around to it.

Two days after surgery Shelagh had follow-up x-rays (all was well) and had the cast removed to visualize the wound (it was healing well).  The next day a physiotherapist got her up and moving a bit.  The question of which would be better, crutches or a walker, was not clearly answered at the time (it did get answered the next day: walker).

That was it as far as excitement goes.  Lots of lying about and healing.  The ward had a TV that was playing Lifetime Movie TV 24/7.  Shelagh and the young girl in the bed next to her watched enough of it that, even with no sound, they figured out the formula.  While everybody was attractive, the heroes and the villains were the really good looking ones, the guy with the red hair and a beard must own the company because he’s got a part in all the movies, and there was always a car chase.

As I headed to the hospital on Tuesday, I realized that you know you’ve been ashore for a while when your ship comes back.
Huc accedit per Somnium!
Latin for 'Here comes the Dream!'
And this entire caption comes from lots of time on my hands.

My route from the PMH main entrance to Shelagh’s ward took me past the Labor and Delivery unit.  Walking out of the hospital one day I heard a woman giving birth who wasn’t a student of the Lamaze Method, but clearly studied the Le Mans Method – she was screaming like a Ferrari.

Visiting hours at PMH are old-fashioned and draconian, as are the nursing sisters who enforce them.  Hours for the wards at PMH are noon to 1pm, and 6pm to 8pm.  I got away with excessive visitation on Sunday, and again on Monday morning, but after that I was persona non grata outside those hours.  

I used my down time to visit all the nearby tourist traps (and spent less than $15 for a pocket knife and a Bahamian flag fridge magnet), nap and draft my blog posts.  I couldn’t bring myself to doing anything more than that while my Sweetie was stuck in that ward.  Hell, I felt guilty about all the sun I was getting walking to and from PMH twice a day that she wasn't getting.

Speaking of opiates, they are freely available over-the-counter in the Bahamas.  Just be sure to complete your recreational activities therapeutic course instead of trying to bring leftovers back with you.
Codeine: Morphine's kid sister
Suddenly on Wednesday afternoon, four days post-injury, the doctors started making noises about discharge.  To back up the talk, all the paperwork suddenly got filled out.  By Thursday morning it was clear that discharge was going to happen.  At noon, her physician came in and told her to get dressed since the discharge orders were written.

Since transportation to CONUS (military term for ‘continental US’) was still pending I had to get her to the hotel.  I called John Knowles from RH Curry, the port agents, to ask if he had a recommendation for a reliable taxi.  With Shelagh being non-weight bearing on her left leg and a bit wobbly on her right, having been bedridden for five days, we didn’t want to just chance it with the next guy in line at the taxi stand.  John was kind enough to come to the hospital and give us a lift in his minivan. 

The hotel lent us a wheelchair, which I really appreciated because I wasn’t looking forward to lugging Shelagh around the room, down to dinner and back upstairs again.

We had a conch dinner that I ran and brought back from Imperial’s, a restaurant that is right across the street from the hotel (where else?).  Conch was, after all, one of the two reasons we came ashore.  We managed to take that off our list without further incident.

I got Shelagh tucked in, we watched a bit of Shark Tank on TV, and then she had the best night’s sleep since we left the Dream (which, by the way, has outrageously comfortable beds).


{Click here for Part 4!}

The Bahamian Medical System: A View from the Ward - or - Shelagh’s Big Break: Part 2

After I caught my breath at the hotel I headed out for Princess Margaret Hospital (PMH).  It’s a 20-minute walk from the British Colonial Hilton.  The first half of the walk is through the port-associated tourist traps.  The second half, not so much.  But in the daylight I wasn’t concerned about it.

As I started my walk, I saw the BTC telephone store across the street from the hotel that Adrian told me about (lots of things are apparently across the street from the British Colonial).  There I could get a sim card for my phone since it wasn’t working in the Bahamas and keep everybody in touch.  Or I could get a cheap phone.  Or I could do what I wound up doing: staring at the door of the closed store.  I missed it by about 20 minutes and now would have to wait until Monday morning for it to open (this was Saturday).  Communicating with the boys and my boss would have to be through old school e-mail until then.

When I returned to PMH’s A&E (that’s Accident and Emergency, the term used in the Queen’s English for what is called the ED or ER in ‘murica) I found Shelagh in the same place but with a different wardrobe.  She was wearing a hospital gown, which isn’t any different from those in the US – designed for easy access and to maximize patient humiliation.  The pants she was wearing when she fell couldn’t be taken off normally because of her injury and the splinting, and they had to be cut off.  They were her favorite capris.  She was heartbroken.  She was also saddened because she had a new pair of white sandals that were super comfy for her and the left one was pretty bloodied.  I told her not to worry, I knew how to get blood off of things.  Not only did I work in EMS at places that had white uniform shirts, but I also worked at a blood bank as a phlebotomist back when we had to launder our own white lab coats.  The best trick I learned was that running large volumes of cold water over the stain with some gentle friction works like a charm.  And even the next day when I got around to trying to clean her sandal, it worked.  So there’s your stain removal tip of the day, free of charge.

Just as I caught sight of Shelagh in her bed, I was told to follow as she was being taken to x-ray.  She had already been seen by an orthopedic surgeon and surgery was going to happen right away (yay!), but they needed to see what exactly they were dealing with (really good idea there, doc).  When we got there, I sat in the waiting area just outside the x-ray room she was taken into.  This allowed me to be a knowing but very unwilling audience to what I knew I was about to hear.  I had an ankle sprain about 30 years ago and knew they would manipulate her foot to get clear views of the bottom ends of the leg bones.  It was excruciating for me with a moderate sprain and I knew it would be much, much worse for her.  Listening to her undergoing the necessary torture was shattering.

Her fractures prior to surgery. 
In order to get a good view of the bottom of the tibia and fibula her foot had to be pulled down.

Once the films were obtained and deemed to be of sufficient quality (thank God because she didn’t have to go through that again), she was taken to the OR, or ‘Operating Theatre’ in the vernacular.  I was plopped in the surgery waiting room.  It was spacious, well-appointed and more modern than the rest of the hospital.  I was pleasantly surprised by how soft and comfortable the chairs were.  I was also pleased that I was the only one there.  I wasn’t in the mood for crowds and noise.

After a while a lady who worked in registration came in and said we still needed to do some paperwork, or as they say in American healthcare, we still needed to do some paperwork.  We took care of that and the lady asked if I needed dinner.  I said that I did and she kindly escorted me to the cafeteria.  This was truly kind of her because I was just beginning to notice that there was absolutely no directional signage in the hospital.  The various areas were marked at the entrances to those areas, such as ‘Radiology’ and ‘Accident and Emergency’ but no indications anywhere as to how to get from one to the other.  When we got to the cafeteria, she even walked me through the process, which was also very kind because it was not anything I was going to figure out.  Even in retrospect, I’m not sure how money from my pocket turned into food in my hand.  And then to top off her kindness, she made sure I could get back to the waiting room.  My regret is that I never got the name of this angel.

What I wound up with was stewed lamb chops on a bed of rice with mixed peas and green beans.  The peas and beans were blah, but the lamb was good.  Not gourmet, mind you – this was a hospital, after all – but something I would recommend to anyone having no choice but to eat at the PMH cafeteria.

The waiting room, as I mentioned earlier, was all mine.  But it was also oppressive because of one thing: CNN.  There was a TV on the wall that had CNN on, at a volume that wasn’t too loud, but was difficult to ignore.  And it wasn’t a case of my having anything against CNN (I have long since loathed all the US news networks), it’s just that they had on nothing but a long line of talking heads going on and on and on and on about a top secret document that they had never seen, and for that matter, may not even actually exist.  But boy, could those people make up complete BS and state it authoritatively, sometimes even forcefully, in order to fill up the entire evening with things that weren’t news.

Around 2 hours after Shelagh went into the pre-op area, the PACU Sister (nurse) came into the room.  She said, “Mr. Erskine?” and I leapt to my feet since she was going to tell me that it was over and everything was OK.  Well, I didn’t leap because rapidly exiting those comfy chairs was the same as leaping from a La-Z-Boy…it just doesn’t happen, regardless of one’s athleticism.  So I stood up as quickly as possible and she told me that Shelagh had just gone into the theatre because she got bumped a couple of times for emergencies.

{sigh😒}

The hell of it is that I can’t even pretend to be upset about this because researching and improving the triage of injured patients has been part of my job for the better part of the past two decades.  I’m going to have to figure out a “Hey! That’s my Sweetie!” exception.  (Cam, let’s talk about this.)

I did take advantage of the Sister’s presence to ask if there was a remote anywhere for the TV.  She dug through some desks and found it.  Hallelujah!  I went up just one channel, landed on the BBC and they were reporting actual news.  They spoke of the Olympics, the confusing multilateral civil war in Syria, wearable technology, storms battering Sri Lanka and SE India, the growing shortage of Egyptian penguin milk and any number of things that, if not relevant to me, were at least important to someone.  

For the next couple of hours I alternately played games on my phone, dozed in the comfy chairs, got terrified by how low my battery charge was dropping while in a foreign hospital and a 20 minute walk from my chargers in the hotel, playing some more games anyway, and watching the BBC’s report on the issues revolving around why British nurses trained at the Royal Victoria Hospital don’t get Abbott and Costello’s ‘Who’s on First’ sketch.

(OK, that last one is actually a reference to an incident that occurred once while Shelagh and I were driving through West Virginia.  Ask either one of us and we’ll be happy to share this one with you.)

Finally, the Sister came in and told me she was out and doing fine.  The surgery was a success.  I wound up speaking with the anesthesiologist, who told me all went well from his perspective, both induction and emergence, as well as an orthopedic surgery resident who said that the fracture itself wasn’t severe but still required some screws and plating.

I got to go in to PACU to see her a little bit later and she looked as well as somebody emerging from anesthesia can look - pale, pasty, shivering, not pretty and pretty shocking if you've never seen it before.  She smiled when she saw me and we spoke briefly.  She was in no pain, had a cast and she could wiggle her toes.
After ORIF (open reduction, internal fixation), showing plate, screws, skin staples and cast.

The Sister took me back out to the waiting room, told me which one of the wards could find her in in the morning and then asked how I was getting back to the hotel.  “I’ll walk.  It’s only 20 minutes from here,” I said.  The look of consternation that overtook her face told me immediately that that was the wrong answer. 😳  It was approaching 11pm and those not touristy areas were not a place for tourists after dark.

Just then Dr. Kumar, an anesthesiologist (not the one I spoke with) walked through on his way home.  The Sister asked him if he could give me a ride, which he was more than happy to do.  A few minutes later I was back in my room.  It was 11 o’clock and we had packed a lot of adventure into the preceding 13 hours.

{Click here for Part 3!}