My gag reflex

One of the newbies sat across from me in the "doctors' pod" (where we and the doctors run to in order to escape from patients in the ER) with wide eyes from the edge of his chair. "So was the ankle lac bad," he asked me.

At times we pick up little golden nuggets about what's going on in another room from overhearing the staff gossiping about it. The ankle laceration had been deemed "decent" by a nurse. Anyone would quickly learn that "decent" to an ER nurse means bad to the general public. And now it was time to play "Make the Newbie's Eye's Bug Out".
"The lac itself wasn't that large, but it's deep and cut half way through his achilles," I said to him. His eyes took on a jealous appearance. He had hoped his doctor would sign up for that case, but the doctor I was with that day works really fast and beat him to it.

Also, there's a path newbies take while maturing into more seasoned workers. At first there's ooh'ing and ahh'ing over lacerations requiring a few sutures (and come hell or high water, they will be in the room to watch the doctor put in the two sutures) with bordom, or being overwhelmed, with non-trauma patients. As they progress, they become bored with the small lacerations and stay in the doctor's pod to chit chat as the doc sew thereby only ooh'ing and ahh'ing over lacerations requiring 15 sutures or more. They gain an increased interest in diagnosing things such as appendicitis as they learn about what different studies are testing for. Finally, they become bored with any lacerations, and semi-bored with missing extremities, avulsions, almost any blatantly obvious trauma, and have gained the ability to have a clue as to what and why things are ordered on the medicine patients, what exam findings may indicate and, should it be a common or fairly obvious diagnosis, be able to tell the doctor what they think it'd be with surprising accuracy. I've stuck my toe into the seasoned pool but what I saw with the achilles lac sort of tickled me. Seeing anatomy like you see in books is always fascinating.

With my own foot, I showed him where the lac was and the approximate size. "He was mowing in sandals and a piece of metal flew out and sliced him. Dr. M had him flex is foot and half of that tendon tried to come out the wound."
The scribe's jaw flopped open and he scooted back in his chair. "No way! That's freaking cool!" Eyes bugged out. I won.
I've seen that tendon before, but the lac was lower and the tendon was intact. This was over a larger part of the tendon and I had marveled at how large that tendon was.
Anyway, the point is, it didn't illicit a gag reflex. What happened next did.

The doctor and I went to finish up an exam on a late twenties woman with lower abdominal pain. Ladies, if you go to the ER with low abdominal pain, 99% of the time someone will be rooting around in your goods.
The woman had denied any vaginal discharge, vaginal itching, any problems with her genitals.
As the doctor did the pelvic exam, I was positioned behind and off to the doctor's right side with a good view.
She had vaginal discharge. Copious amounts. How she missed that, I couldn't tell you. The doctor was thinking the same thing. "You haven't noticed any discharge," the doctor asked the patient just to confirm.
"No, nuh-uh," she denied with as much dignanty a person could have with feet propped in stirrups, laying down, and tools shoved into her woo-hoo.
"Well, you have some..." the doctor paused and had to steady the speculum while he withdrew it.

Here is a pic (stolen with pride) of one to help you understand how nasty this was:


That curved portion acted as a bowl and was full of yellowish/white vaginal fluids which almost poured onto the doctor when he pulled it out.
No, she hadn't noticed the buckets and buckets of discharge her vagina was leaking.
"Whoa," the doctor said, moving so bodily fluids wouldn't pour onto his shoes.
I swallowed just to keep things moving in the right direction with hopes that the momentum would help. It sure felt like things were trying to reverse.
*shudders*
Do you think the doctor, once he found out that I thought it was gross, would go easy on me? Nope. Every so often, he'd grab my arm with a mischievous smile and drag me with him, "Come on. We gotta go tell (so and so)."
Ugh.

Futility

"These patients used to just die naturally, but now it might be doctors, hospital ethics committees or courts that decide if and when to let them. The more science discovers, especially about the brain, the harder it can get to make that decision."

Link to the article.

I've seen many cases where it seems obvious the person should be allowed to die, but family won't allow it. It can be heart breaking to see the condition these people are in--feeding tubes, nearly comatose, wetting themselves, defecating into a bag, laying on bed sores (I recently saw a real bed sore...a "decubitus ulcer". Click to see a picture-I warn you it's gross and on a person's behind.) It's something I hope to never experience personally.
Though I'm young, I really should write down what I'd want done and what I wouldn't.

***

Unfortunate ad placements

Here's the link for your viewing pleasure.

***

First intubation

I hadn't been paying attention to the EMS radio. While the doctor examined an early twenties male with a genital problem, I was somewhat reclined in a chair behind the doctor's desk, flipping through lab reports. Bed eight had low sodium, ten was perfectly healthy, and eleven was pregnant. I tossed the reports into their cubby holes and glared at the printer who wasn't giving up the cardiac enzymes we needed to admit the patient in two.

"Type-B!"

I sat up. It sounded like the doctor so I peaked around the shelf which separated the doctors from everyone else effectively hiding doctors from patients. Blinkie lights flashed in the ambulance entry and with my sharply honed detective skills, I figured they brought in something critical.

I pushed my way past a few big bruiser of fire fighters and found an isolated corner with a view. Drats, the patient looked young. I wasn't sure if he was old enough to drive yet. The paramedics had him on a NRB mask and dried blood covered his forearm to his hand.
I remembered seeing the red shirt when I entered the room. It must have been him. The red shirts are paramedic students. It's almost like wearing a sign, "Caution, dangerous student!" He stuck out like a sore thumb. I was lucky and had to wear a navy blue shirt when I was a student.
Gaining a general impression of the patient, he looked to be perfect for starting a first IV on. He was so gorked, he barely responded to pain so, with the excitement of lights and sirens, the student got to have at him. And it looked like it was multiple times.

The doc gave the patient a firm sternal rub, then pinched his abdomen and twisted. The patient sucked in some air, moved one arm slightly, but that was about it. "He needs a tube," the doc stated, his tone leaving no room for argument. He gave him a few more pinches. Nodding, he added, "He's getting a tube."
"What's his GCS," a charting nurse asked. GCS refers to Glasgow Coma Scale and is a way to objectively determine your conscious state, the best score being a 15.
The doctor cocked his head. "Well, he doesn't open his eyes, so that's a one. He's non verbal, so that's another one. He withdrawls from pain...so...is that six? Yeah, six. Yep, that's a tube." He waved a circle in the air as a sign to move'em out into a more critical room.
"So what's the story," I asked one of the responding paramedics as he peeled off his gloves.
"His parents are out of town. He called his dad and said he took 300 pills. His dad called 911," the paramedic said and shook his head. With a laugh, he added, "He took the time to count them."
"It was a forced entry," a serious police officer began, stepping towards me. "We knocked, but there was no response, so we barged in and found him unresponsive with this." The officer pointed to a large ziplock bag full of bottles ranging from Advil to some serious antidepressants. I glanced at them, memorized the more important medications like the tricyclics, and handed the bag to the nurse with an apologetic look. She'd have to write down each medication, count the pills, and calculate how many were missing. That can make you hate everyone out there who's ever tried to overdose and was serious about it.
The doctor had listened into the conversation while the patient was pushed into a more critical room. "Has anyone spoken to the parents?"
The paramedic shook his head. "They know we were bringing him here."
The officer placed a piece of paper in the docs hand. "Here's the number." The doc handed it to me, I handed it to the charge nurse.
Another paramedic approached us with the red shirt in tow. He pulled up on his belt loops and asked, "We got a student with us doc. Do you mind if he tries to tube him?"
The doc smiled. He enjoyed teaching students. "Sure. Just don't break his teeth or otherwise f*ck up."
The student, wide eyed and looking slightly pale, nodded. The doc clapped his shoulder and led him behind the patient. The student filled his lungs with air for support and walked along side the doc while nervously pulling on gloves. The doc gave him a few last minute tips and told him, "Don't worry if you can't get it because I'm right there." The student located a face shield and had all of the proper protective equipment on, like a good student.

Nine pairs of eyes watched this first timer intubate this kid. His hands shook. The gloves were beginning to become transparent from sweat. He positioned the patient's head. "Wait until the medication kicks in," the doc told the student who was ready to intubate now, right now. The doc tested the patient's jaw and gave the nod.

It went smoothly, or as smoothly as it can for a first time. No teeth were broken. It took the student three tries with positioning the blade, and two for positioning the tube. It was like threading a needle, but he made it look easy for a first timer. I couldn't help but smile seeing his hands shake. I know the feeling all too well of having the patient's care in your hands. After a while, you get smooth and it begins to become closer to second nature. Before that, a text book runs through your head and your heart threatens to break your rib cage open as it bolts from your chest, screaming into the night.
The doc listened to the patient's chest for air moving into his lungs and not into his stomach. He gave the student a complimentary nod. One of the seasoned medics shook the student's hand and pat him on the back. "Nice job," he told him. The student proudly smiled. He was that much closer to being a real live paramedic.

I presented the list of some of the more critical meds to the doctor and learned a neat trick the ER docs use. "He may have taken some Tricyclics," I proudly presented.
The doctor read over my list and spoke to the team. "Lets get that EKG. Then give him two of bicarb and get a repeat EKG." He looked at me and grinned, "Now, why would I do that?"
I shrugged. EKGs are still a mystery to me. I know how to get the rate and I know how to identify "tombstones" or a-fib, usually, but other than that it's a piece of art doodle graph paper to me.
"I'll look at the QRS complex on the before and see if the bicarb shortens it. You see, tricyclics inhibit the sodium channels. He could start out with a width within normal limits, but if it drastically shortens after the bicarb, then the bicarb has overwhelmed the tricyclics."
"So you're ruling out Tricyclics by using an EKG and bicarb."
"Exactly. If he hasn't taken much," the doctor said while accepting an EKG, "it won't change much. And he could seize before the lab could get us a tox report." As I pondered that, the doctor said, "He'll be okay. He'll be fine," and gave the patient a reassuring pat on the leg that he wouldn't feel.
Hopefully by now, the kid is doing well. He probably is. By the end of the shift, he was starting to fight the tube and causing the ventilator produce funny sounds. He's no stranger to this game. This wasn't the first time for him.

***

Headache

Acetaminophen, aspirin, and caffeine equals a slightly spacey but pain free employee about to go to work. It's the off brand OTC migraine pain reliever formula. I would kiss the feet and write love songs to the makers of this fine cocktail.

***

Scared clean?

You could hear the coffee maker gurgle on this side of the ER amongst the beeps of monitors happily watching their patients and employees talking between themselves about their weekends. The smell of fresh coffee wafted through the air which is always a welcomed smell. At times you only smelled urine and alcohol. Make no mistake though, that pleasant smelling coffee could burn a hole in your stomach the moment it slides down your throat. Even with this information, our nares were enjoying the break from offensive odors.
It was nice and calm, which is rare AND odd. We get a little suspicious when it's quiet and calm. That is why we were able to relax when Mr. V became upset and started yelling, disrupting the unnatural silence of the ER.
"What the hell do you mean," he growled with a reddening face. "I'm gonna sue your ass for not treating me! You fuckers don't know your ass with both hands!" He was so upset, he messed up the insult he venomously spat at Dr. A.
But Dr. A stood ramrod straight with a passive look on his face. Mr. V, a slim forty something year old male with silver temples that stood out against his black hair, was a frequent flier and had been marked as a possible narcotics abuser. Dr. A was on the end of this verbal assault for telling him he would not be receiving any narcotic drugs. Mr. V already had received a "pain letter" from our department which basically tells the patient "no more narcotics". I looked at his chart. Mr. V claims he's allergic to all pain meds except for Dilaudid.
Yeah right.

He was also in for abdominal pain which can be a tricky area of the body. Many drug abusers know to use this complaint because of it. We usually CT scan them which, as they may not know, the contrast is hell on the kidneys not to mention the awful amount of radiation their belly will absorb--the equivalent of 500 x-rays in one single scan.
He was in two weeks ago for the same thing...and two weeks before that...and two weeks before that. Every two weeks or so, for the past few months, Mr. V has been in for abdominal pain and we've been unable to determine the cause. His loud outburst to our refusal to provide narcotics is only further evidence he's abusing.
And to think there are people in the waiting room with real emergencies, waiting, because Mr. V wants his Dilaudid.

We knew of his potential outbursts, yet somehow he was in a room with a view. Only curtains surrounded him which let the entire department hear his outbursts. Dr. A took his verbal beating without even flinching. This was typical drug abuser verbal diarrhea. He's heard it all before. Once Mr. V took a breath, Dr. A stated, "Say what you want, but I'm not giving you any narcotics. You can have Tylenol..."
"Fuck your Tylenol. I want my lawyer," Mr. V carried on, waving his arms like mad. Dr. A turned and rolled his eyes while Mr. V continued, not caring that Dr. A was walking away from him.

We met Mr. C in the hall as he was being transfered to the cath lab for treatment of his recent heart attack. He looked at little pale, but smiled and waved as the tech pushed his bed. Then his hand dropped. It was an unnatural drop and the monitor screamed for attention at the same time. Mr. C was in v-fib.

In two large strides, Dr. A was at his side. "Lets go," he yelled to no one in particular. He raised a giant fist while paddles were readied and slammed it into Mr. C's chest with a sickening impact. The monitor didn't change after the precordial thump. As readied paddles were handed to Dr. A, he announced the voltage, "Clear," and shocked Mr. C back to life right there in the hallway for everyone to see. Everyone smiled since most codes don't end with a live victim. Even though we were out in the open, there was only one witness.
I looked down the hall and saw Mr. V craning his neck to see. He sat wide-eyed and silent, staring at the bed where Mr. C now started to comfort the area where Dr. A had hit him.

Mr. V silently eloped from our department. We haven't seen him for months. Maybe he's going to another department for drugs? Maybe he's dead. Perhaps what he saw jolted him badly enough to realize what he was doing. Hopefully so, but probably not.

***

Never Poke a Big Cat

Really, don't poke them with straws, poles or sticks. Especially not sticks. They take offense to that.

Grand Rounds 3.39

Grand Rounds is up with an original and enjoyable presentation.

***

Strange Instructions

I dare you to beat this.

One of the choices for pre-typed discharge instructions on our fancy archaic computer system is...




*drum roll*



Kegel Exercises

















[snicker]

***

Upsetting the cook

First of all, does anyone see the humor in this? (If not, just place your money on the table and leave.)

Put on your imagery hats and imagine the suspicious look I cast towards this display. What is Walmart saying, exactly? What are they doing? Wouldn't this be similar to shooting themselves in the foot by possibly aiding in the prevention of increasing their customer base?

They've labeled it "Back to college savings". Where are the notebooks? I ask again, WHERE ARE THE NOTEBOOKS!

Some poor parent in denial about their precious baby growing up is in for a rude awakening when they see this display.





I upset the cafeteria cook. I'm sure I commit blog e-self mutilation by telling this story. I don't have much material as of right now.

Part of my job is to get food. I do it well, if I may boast. It was said that I would ascend the stairs towards the hospital cafeteria for sustenance (never skip an opportunity to say or type "sustenance"). Our cafeteria isn't so bad. It's decent. It's as good as the food I prepared when first learning to cook--edible but without getting those pesky cravings for more.
I stood in a long line to wait for the grill. It was almost noon so it was busier than I was used to. Typically, I wouldn't get to go to lunch until two or three. It depends on the doctor. A few are never to go hungry or else. Luckily, the ER is always stocked with graham crackers should there be an emergency.
A semi-happy older gentleman stood behind the sneeze guard and raised his brows to question what I wanted. "Turkey melt. Can I get tomatoes grilled into it?"
He turned to face the grill. "You can have whatever you want on it. White or wheat?"
Drats, not something the doctor went over. I made the executive decision and chose white. I waited as he finished a cheese burger, stretching to my toes to see how those looked to turn out. A little greasy for my tastes.
Next up was the sandwich sans tomatoes. "Uh," I stuck my index finger in the air. "I wanted tomatoes grilled into it." I went for a pleasantest of pleasant smiles.
Not pleasant enough.
His semi-happy expression disappeared and he frowned before widening his eyes as if to say, "Are you serious?"
I stared at him. He stared right back at me. He was hoping I'd simply wave my hand and tell him to never mind. That I'd simply settle for the cold ungrilled tomatoes from the salad bar. I was specifically told to forget those existed. I refused to budge and held my silly smile in place though inside I was beginning to falter.
He lost the shortest staring contest ever and reluctantly turned to fix the sandwich. I was victorious. I silently celebrated as I'm typically a doormat and avoid confrontations at all costs.
My New Year's resolution was to replace the doormat with an aggressive boot scraper. It's a small change, but should you decide to walk on me, it'd be a little uncomfortable. I admit I'm still too weak to stand up to the toughest of opponents.
Despite my victory, I will avoid him until I am satisfied our incident is forgotten.

***

Monty Python meets Star Trek

This is good stuff.

1957 Belvedere Unearthed

It's back above the ground after fifty years under the Tulsa, OK soil. Sadly, she isn't exactly in pristine condition like everyone hoped. Neat story though. And I hope they can polish her up. Here's another link about the actual unveiling. They can still read the signatures on the white wall tires!
They were such beautiful cars. They certainly don't make them like they used to.

This isn't the only famous Belvedere. Some may remember Christine. It was my favorite:






The recently unearthed Belvedere in her present condition:





I've seen worse that were restored. *



*After looking at more pictures, um...it's pretty much toast.

***

Grand Rounds 3.38

Grand Rounds is up.

I'm still astounded that I received an honorable mention. It's made my day!

Grand Rounds 3.38

***

Null and void-critical thinking skills

The employee's back was to me while I spat on my finger and rubbed the moisture over indented numbers on that blasted belt. I had been tasked with the mission to find a replacement belt for the lawn mower.
"Do you have the model number of the mower," was the first question asked of me after approaching his desk.
I stabbed a finger towards an orange mower. "It looks like that one." I looked at a similar orange rig which looked nicer than what I drive to work every day. "Or maybe that one." I could hear the employee's eyes roll in his head. I thrust the belt into his hands. "Here is the belt off of it." I looked at him like he was to work some magic. It must have been a convincing look since he turned around. His big shoulders moved up and down with a sigh as he marched towards the rows and rows and rows and rows of belts. I found the same color orange as was on the mower wrapped around each new perfect and unfrayed belt. I'll bet it's one of these, I silently mused. I'm brilliant, you know.

So many numbers, I realized while tucking a loose strand of hair behind my ear. I glanced over the labels while thinking on my lip. There were primary drive belts, secondary drive belts, mower belts, first mower belts, second mower belts. I felt my eyes crying for relief of all the labels. It's no wonder the thing sits broken in the garage. It's too complicated!

I watched the large, probably high school football star, orange vest clad employee scratch his head. "You don't know the model number?"
I think he was trying to rub it in.
"No, but I'll bet we can compare this belt to the others and find the correct belt." He looked at me as if I'd gone insane, as if he might point out the rows and rows and rows of belts displayed before us and scream, "For God's sake, woman! We have enough belt to wrap the globe three times!".
I had a brilliant idea requiring that we eliminate the belts which were definitely not for my mower. I remembered the deck was 48" upon seeing a clue on the packages. "The deck is 48 inches," I said to Ugg when I noticed the belts were grouped by deck size. This eliminated 90% of the belts.
Ugg cocked a brow at me and continued to look over my belt. "I can't read these numbers." Was he ignoring me? He looked at me again. In an effort to prove how frustrating of a customer I was being, he shoved the belt back at me, "Can you?" I heard "princess" in that tone.

Lifting a stubborn chin, I carefully looked it over, not before noticing he was perusing labels for belts made to fit deck sizes other than the one I specified. I couldn't read the numbers. So, I moistened my finger...with spit...and ran it over the numbers. They were a little more clear, but still not legible. More spit meant more numbers. "Ah-ha! It ends in an 8," I said with the maturity of an eight year old. All that was left to complete my transition was a good hearty "neener-neener".
Both of us jerked our heads to read over the teeny tiny printed numbers on the packaging for the belts. Seeing that nothing matched, he took my belt from me and looked again. Then, he began browsing through the wrong sized decks. Again.

"It's a 48" deck," I said loudly enough. He wasn't listening. Common sense would dictate that he stick to the belts which matched my deck size. Common sense would also dictate that I bring the model number of my mower.
I watched him ignore me a moment before shoving belts aside to pick one the same color as mine. He seemed to sneer when I found a length which didn't match.

We finally did find a match. Did you know the number on the belt doesn't match any of the numbers on the package of a new belt? You have to look at the hard to read numbers printed directly on the belt to find a match. Ugg and I each learned a lesson that day. Ugg learned that you're more likely to hit gold if you stick to the right deck size. I learned to bring in my model number. Of course, I have yet to put the belt on. That is the real test.

***

Scribal Attention

Talk of scribes on the internet have rung the Scribal tree and have been tickling my ears.

(The tree pictured to the left is a "Tribal" tree. But instead of "Tribal", I'm using "Scribal". Ha! I slay myself!)


The news article link.

"Doctors struggling to keep pace with the growing volume of patients who pass through Tri-City Medical Center's emergency room are getting help from an unlikely source: college students.

The Oceanside hospital has hired undergraduate pre-med students and recent graduates as “scribes” to document physician notes and orders in the emergency room – work that doctors usually do themselves..."

Is Movin' Meat fancying scribes?

"I would be interested to hear whether any ED docs out there have used scribes in their practices.

Our group is always looking to improve efficiency, and there are a number of folks who are downright evangelical about using scribes. They certainly sound good, but I take that information with a grain of salt, coming as it does from the true believers..."

GruntDoc seems to love scribes:

"Frankly I love our scribes, and there are a number of benefits for the docs..."

It's such a good experience for premeds. If you get the opportunity and are able, by all means, go for it.

***

"You're sure?"

Upon hearing the news, a perfectly manicured hand raised to her mouth to hide her trembling lip. Despite the fact that she was wearing a hospital gown and hooked to a monitor, she still looked elegant and strong.
"That's why I'm dizzy and have been falling? Because of..." she gave one sob and couldn't say the words "brain cancer". The doctor nodded. "But," she let her hand drop to her lap and gave a shake of her head. As her eyes studied the tile floor, she murmured, "I thought I had beaten it."
She had metastatic breast cancer and it had traveled to her brain.
She swallowed hard and tried to hold onto one last other, better, diagnosis, "But the CT from this morning said it was a stroke." As devastating as stroke can be, it would be better diagnosis than what she had. She was grasping for anything. I could see it in her eyes--dear God, not more chemo.
The doctor breathed in and cleared his throat. "Your doctor and the radiologist were not completely sure that it was a stroke, which is why Dr. S__ asked you to come in. From the MRI, the radiologist is confident that it's cancer." The report had read "multiple" lesions.
Her husband stood when tears filled her eyes and she began to crumble. He looked weak and beaten by the news himself, but he still put his hand on her shoulder to give her every last ounce of strength he had. I saw tears forming in his eyes just before he buried his nose into her curly blond hair. He wrapped his arms around her tightly. Her hand raised to hold his arm. There was no telling how much longer they'd be able to hold onto each other.
"The neurosurgeon is coming down to see you. He should be here shortly. If you need anything, let me know," the doctor said to the huddled couple who nodded. He peeled back the curtain enough for us to leave.
Once out of earshot, he asked me, "Where to next?"
"Room seven," I said while handing him the chart. He looked at the chart while rubbing disinfectant on his hands out of habit. Room seven was a nine year old male sexual assault victim. He took the chart and began walking while thumbing through it. "Lets go."

***

Grand Rounds

Grand Rounds is up over at ImpactED Nurse. There's plenty of good reading.

***

New Header

Folks, that right there, at the top of the page, is a spectacular logo/header thingie. It doesn't get much better than that.

Unless you use pay-for-it software.


This pleases me.

***

Rules of Shadowing an ER Physician

...by Type-B Premed.



I need to rant about a few premed students who have circulated through the ER for a "learning experience". I sincerely hope I don't come off as arrogant. I simply think there are a few things premeds need to understand about shadowing.

The most important rule is that the staff, the ER, and the patients do not exist for you to learn about medicine or for you to "see something cool". Patient care comes before your questions and curiosity. This means you do not take the chart away from those who need it so that you can look at it in hopes you will understand anything. If you do not have a grasp of medical terminology, the abbreviations, the significance and normal ranges of vitals, you aren't going to get anything out of reading the chart anyway. You will hold up patient care which is against the rules.

Do not interrupt medical conversations between the doctor and doctor, doctor and nurse, doctor and scribe, or doctor and patient (or their family) for your questions. Remember, patient care comes first. Make a list during the conversation and ask after the conversation is over.

Do not knock staff over to catch up with the doctor. The hallways are long so you probably have time to go around that nurse to catch up.

It is more important that staff be in the room than you. If there is no room, do not shove people aside and stand by the crash cart. Should you choose to stand by the crash cart you may get an elbow to the face, knocked to the floor, etc. That is, if the nurse doesn't drop kick you out of the room.

Stay light on your feet. If you get to be in the room during a code, be able to move out of the way. Do not make someone ask you to move. If you see someone coming towards you, move. Shoulder checks from techs are worse than one from your favorite professional linebacker.

Don't interrupt while the doctor is trying to think. If you catch the doctor looking over some images, or musing over lab values, be quiet for a little while. I promise you won't explode. Give them five minutes to look or think it over. Trust me, an ER physician isn't going to take too long, so it can wait. Let them think.

Realize there is a point where a doctor's patience will run out. Don't ask about every single little detail. There's an amazing amount of information on Google. You can look up the minor things. You will prevent irritating people to the point they avoid showing you anything "cool" for fear of the 100 questions you're going to ask about it.

If someone needs to look up an image or labs on a computer you're on, "just a sec" is not the appropriate response. Remember, the chairs roll. We will move you. Or, if you start this up, more accurately it will be "remove" and you won't be welcomed back.

Do not ever, EVER state anything like "nurses don't know anything". Nurses know more than you think. Once they find out you think they're stupid, you will be destroyed, end of story. Your entire fantasy will end. Using an opinion like "nurses don't know anything" will not be a good conversation starter with the doctor. I can't say for other specialties, but most ER docs will look down on you for such thoughts. A nurse can make a huge difference in the outcome of a patient. And you pissing off one of their patient's nurse will make them hate you.


Just be courteous. Leave the ego at the door. A premed shadowing is lower on the totem pole than housekeeping because you can only hinder patient care and can't do anything to help (regardless of what you think). You are a shadow. Shadows do not get in the way. Don't ask the first thing that pops out of your mouth. Chances are it's a question that Google, which the computers in the ER have access to, can answer. A good physician will use resources available to them. Start practicing.

Bottom line-Don't be annoying.
If you're confident that you're not annoying, you probably are.

***

Dueling Banjos

The ability to play Dueling Banjos is like the holy grail to me. For a week, I have been working on this song until my poor little fingers are raw. My two dogs wish to make it stop.

I'm playing the guitar part. Nobody is playing the banjo part. I can sincerely, honestly say that it is difficult to duel with...




...nobody.

I am sad.

***

Should America be embarrassed?

President Bush accidentally started to say the British Queen was alive and kicking back in 1776. Mickey Rooney also kissed her hand which is a serious faux paux.
(for those who have had their nose in a book for the last few weeks for finals or MCAT, the Queen of Britain came to see us)

The media is going crazy with this-

From Hotline On Call:

Now, the general protocol is that you don't touch the queen. And Mr. Rooney ... gave her a smackaroo on the back of her hand. And everybody is saying that this is a breach of protocol, it's a no-no, it's a disgrace.

From the Mangalorean:

When youve just made it sound like the Queen is more than 200 years old, there may be a few ways of recovering from the gaffe.

But turning to her and giving her a sly wink is probably not included in any book of royal etiquette. Thats what happened on Monday after George Bush mangled his greeting to the Queen on her state visit to the US.

And from This is London:

It is hoped that gaffe-prone President Bush will manage to host the state visit without any hiccups.

He hasn't been so successful in the past, however. He once admitted to the Queen he was the black sheep of his family and then turned to her and asked "Who's yours?"

The encounter came at the White House in 1991 when his father was in power. The Queen, wisely, did not reply.

From the above, it seems the media is more offended by things than the actual queen. As it turns out, the Queen has a sense of humor! and hasn't turned her nose up at such gaffes.

Now, I have a question. I'm an admitted social retard. I'm curious as to how far you're supposed to go with brushing up on your etiquette when you invite someone to dinner? You want to respect the other person, but should that other person visiting expect to run into different customs?
Once upon a time, my brother was dating a vegetarian who ate meat. She would eat chicken and fish. I invited them both over for dinner and knowing about her special diet, I prepared a meal she could eat. Am I willing to not ever discuss a good tasty T-bone steak in front of her? Nope.
I guess it's a good thing it didn't last.

How far are we supposed to go in changing our customs for another? I'm not sure if I should be embarrassed for us, because we're well known for a lack of knowledge of other cultures, or if I should roll my eyes at the media. I'm leaning towards rolling my eyes.

***

Learning at another's expense?

I'm not a real live certified medical student, so it's not like I can say the learning experience is critical to my education. It's not yet written in stone that I'm going to be a doctor.
I generally try to learn under the patient's radar. I try not to stare, make faces, or otherwise do anything to make the patient feel like I haven't seen their problem before. I fake a disinterest, so to speak, so they don't feel like they're a freak, spectacle, or that something really bad might be wrong with them. I try not to take more than a glance at whatever may have come out of their body while trying to learn what I can. But there are some instances where this approach just won't work.

For this post, I chose a picture of a teddy bear only because if I had one I would have given it to her. She looked like she needed something to hold. She had just had a miscarriage. She was extremely distraught and all alone. Her abdominal pain wasn't nearly as bad as her emotional pain. Without a doubt, she had wanted this baby. She already cleared her first trimester when she began bleeding. She sought medical care at another ER and was told her cervix was closed, go home. She came to this ER complaining of pain and bleeding which had worsened. She said she passed her baby and had it in a bag.

She looked away and hid her face with a sob as the doctor searched through the plastic bag. It was simply too painful for her. The sudden stop of plastic crinkling as the doctor peered at her baby caused a small whimper to escape her lips. Her tiny baby, the size of a thumb, was in the bag and on display.

I wanted to sneak a look, and badly. I was terribly interested. I cast a glance at the patient who's shoulders slouched forward, her face in her hands. I had never seen a fetus. I wanted to see. But she was so sad and distraught. I couldn't. I felt like it wasn't worth the added pain it may cause her to have someone else looking at her now dead child.

Maybe it's a feeling I need to get over. Maybe I should have looked. As of now, I simply do not feel that, as an undergrad not yet admitted to a medical school, a patient's anxiety should come before my morbid curiosity.

***

A funny

Perhaps I'm in a weird mood, but I found this amusing. I found it here.

White cloud vs Black cloud

Allow me to express my current frustration. As a premed, I want to see some cool and disgusting stuff while in the ER. Unfortunately, I have that thing over there, on the left-that white cloud-following me around and hovering over my head. And it's a big'un!

That thing is responsible for all of the gastroenteritis, URIs, and mild bronchitis that have come through the ER instead of limbs hanging on by a thread, CPR cases, MIs, or even a freaking appendicitis for crying out loud! That thing keeps me from seeing the cool cases and that thing will even engulf our village shit magnet's black cloud.

On my first day on an ambulance, two people died. One was dead on arrival. Another died from a wreck (I was on scene and had a different patient). The department I trained with labeled me as a black cloud. They didn't see the white one lurking in the distance ready to gobble it up. It ate that black cloud by my next shift and I had to do extra clinicals because nobody was calling 911.
The first time with a fire department as a real live EMT, it was a mass casualty incident where we had to start triage. One patient we didn't touch. He was dead. Nobody's neck and back can bend like that. No pulse and he was blue. We had to work on the people we could actually save. Exciting stuff! But guess what? The black cloud died and the white cloud replaced it.

My first day in the ER as a volunteer, they had a critical LOC. After that, all of the cool stuff happened either before or after I was there.
My first day in the ER as a working stiff, the first day in training when I do nothing but watch, we had a CPR case. Weee! After that, nothing. Even when I'm with the village shit magnet, my cloud beats his black cloud into submission.

And then, I went to a local trauma I center to tickle my fancy. ALL of the bad stuff goes there. I was told I'll see people cut in half, dangling limbs, etc. Oh I was excited!
You know what? I didn't see a single trauma case. I vented to one of the doctors back at my home village ER. He said, "You didn't see any trauma? Huh. That's weird."

[Huffs and folds arms while pouting]

***

Rant from an ER doctor

This rant does not come from Mr. Baldwin, but from an ER doctor who wishes to tell drug seekers a thing or two to make things easier.

Link

***

When commercials were funny

I nearly forgot about Terry Tate the Office Linebacker. Tears of joy and laughter is what this brings to my face.
Enjoy!

Link-if you need it

***

Shoddy Electronics + ED = no good

I approached this shiny new computerized system with an open mind. I spend a chunk of time searching for charts. Another chunk of time is spent checking for labs and radiology reports. And a third chunk of time is spent documenting these labs and radiology reports. The computers were supposed to make it easier.
For the most part, it has made it easier. Navigating the windows takes time. After a consult, all I'd need to do is maybe flip a sheet over and I was ready to write down the consult information. With things being computerized, I have to go into the patient chart (you can only have a few charts open at a time due to memory restraints by the computer), go into the assessment portion, go into the note tablet, go into note text, scroll down to the area for consults, click inside the window, and possibly be ready to type. That slows things down since our computers aren't exactly speedy. I rely on my memory and multitasking skills more than I do with old school paper. I wish there were a short cut to the notes where I spend most of my time. Generally consults aren't full of a lot of information, but if I could get there more quickly, my mind could be a little more lazy...which it likes.

Here comes my gripe. We really need a tech guy available 24/7. The ED doesn't stop for anything...even computer problems. However, computer techs work 9-5 as I have learned. And nobody calls the tech guy about problems during the day when it can be taken care of. This means that by the time the night shift comes in, the problem is worse and the night people have to deal with it.

This computerized system is to prevent us from every having to write on anything. We're supposed to be completely paperless, aside from EKGs and discharge instructions. While in an exam room, right when the doc and I walk in, my computer kicks me off of the system. I think of a four letter word and try to listen to the patient's story while arguing with the computer. I never could get it back up and had to jot things down on my emergency piece of paper I carry with me for such instances. We leave the exam room and as the doc leaves to tell the nurse something, I try and argue with the computer some more. I finally get it back up about the time the doc comes back.
"Ready," he asks as he looked at the screen. He saw all of the error messages I was getting when we had left the room.
"Yep," I said to him. We go into another room. I set the computer down to begin typing and I'm kicked out again. I don't even mess with it and go to my piece of paper. As we leave, the doc dictates the exam to me. I went to one of the desk tops to put everything in and the laptop has the patient charts locked up, but I can't get to them on the lap top either. By now, I'm gritting my teeth.
I shut down the lap top. I still can't get in. I turn the lap top back on and fuss with it a while. I get it to log completely out of the system, without drop kicking it, and quickly catch up on the immediate things. I can go back later and put in all of the negatives.
I find another lap top since the one I had is being so fussy. Well, it didn't help things. I find yet another lap top and it won't even start up. "Has anyone had computer problems," I ask to no one specifically.
"They've been crashing all day," someone responded.
My doc asked, "Has anyone called tech support?"
Silence.

After the seventh time of being denied documenting while in the exam room, I decide to call tech support. I check to see if the doc is going to see anyone, and he isn't. I place the call and learn they don't have anyone at this hour to come and look at things. It was only 3 in the morning...pft! And the computer people I know personally are night owls.

That was an irritating shift.

We know the face of a killer

We know the face of a killer, but not those he murdered. The VT victims simply have the name and face of "32" while we know the killers name, his face, his personality, and his thoughts.
I think this is very wrong to give him so much time and call the victims the "32". So, please wander here and take a moment to see who these students were.

***

Healing

My heart is with those who have lost someone they love.
I hope time moves fast to heal the wounds.
I hope the pain quickly subsides.
I hope the tears soon dry from your weeping eyes.

Take comfort these precious souls are free to fly.
Their new journey gives no reason to cry.
They feel no pain,
They have no wounds,
They are now perfect in every way.
For them, it is a new day.

I cannot imagine the pain and the anger those touched by this tragedy must feel. I offer my deepest, sincerest condolences.

***

Scribe abuse

I must be "in" with the group in the ED. Somehow I've earned the right to the tribal greeting-a swift punch to the shoulder. I mean, what the hell?

Actually, I'm down with a little physical abuse. I have two brothers. One's a little bigger than me. Another is a lot bigger than me. The powers that be made sure I can hold my own. I'm also not an uptight nitwit who can't take a joke or a noogie. Don't give me a noogie.

You'd think some of these people would have the courtesy to turn their big pimp daddy rings around first! Brass knuckles aren't fair.


On another note, I must be maturing in the health care field quite nicely. Regular strength coffee is starting to taste like water.

***

Here's some good reading for now

The Onion is always a good place for a laugh. Someone has met a few of our patients or has been spying in the ED. Careful, because there's a few adult words.
Following is an excerpt from an article that I stole a link to, err...found:

"They jabbed his arm up with penicillin to clear it up, but next morning, he got all swollen and looked funny, so I had to bring him back in, and that's when the nurse say he must be allergic. Now he have to be given special antibiotics twice a day, like I got time to f*ck* around with medicine."

*censored for your pleasure

**Edit: You wanted a link to the full article or something? Geez!

***

Don't tell ME medicine sucks!

There has been an influx of whiny baby premeds who are incredibly appalled by some of the honest answers some doctors give them when asked about practicing medicine. There are doctors who hate their jobs, who feel they wasted their lives spending 8 years in higher education followed by 3+ years of training (sometimes 7+ years).
Yes, some of them hate their jobs.
I've spoken to doctors who tell me, "Run. Run as fast as you can. Run and do not ever look back." Finally, someone isn't going to blow smoke up my ass is how I consider it. I seize the opportunity to learn the ugly side of practicing medicine. A ranting doctor will be at full disclosure. That's good for me.

Unless you fell off the turnip truck yesterday, you know all jobs come with an ugly side. I have several memories packed away, a recent one involving a family run business. I figured the office would be full of love. I quickly figured out that family run business office dynamics are beyond hope of recovery. You can't complain about the slacker manager to the big cheese because that's his son. Everything the slacker son messes up becomes your fault. You can't demand that witch of a woman be removed because that's the boss's wife. You suck it up and take it. It's poison to the soul if you don't learn how to deal with it.

It's your personal responsibility to find out as much as you can about the ugly that goes on and determine if it's something you are willing to handle. I'd bet doctor's who tell premeds to hit the MCAT door running didn't realize exactly what they were stepping into when they were a skippy happy little premed. Some of them have been around to remember when practicing medicine was about getting people well instead of about covering your ass should the person sue you. What do you think will happen in 30 years? A large population of doctors may be government employees. A premed who hasn't done their research is likely to end up telling other premeds to escape the disaster of a profession.

What do you want these doctors to do? Paint a beautiful pastel picture and tell you how perfect practicing medicine is? That you haven't wasted your time in pre-req courses? That you didn't bull your way through a standardized test for nothing?
Would you rather wait until you're $200K in debt and years older to find out you've been wearing rose colored glasses? That you've been had?
Or do you want to listen to ALL of the opinions of those who practice and look at a portrait with true colors before deciding to purchase it? Seriously, do premeds envision themselves zapping every patient back to life, receiving pats on the back? Saving the life of someone every time they go out to dinner? Do premeds think all of their attendings will just love their personality and a patient wouldn't dare sue them?

Why is it so offensive to premeds to hear that medicine may not be all it's cracked up to be? Every job has it's perks. Every job has it's pool of crap you must wade through. Medicine looks to have a deep pool of it. I think it even has sticky properties as well.

Look at a career for what it is. Don't be offended with a doctor who tells you what you don't want to hear. Can you reach into the hind end of a patient and pull out fist fulls of feces? Can you handle being abused during medical school and residency only to struggle to keep the lights on in your new office?

Medicine is a career that will be far more offensive than someone warning you against a career you have your dreamy little eyes set on. No, I'm not a doctor, but I play one on TV. And I didn't fall off the turnip truck yesterday.

***

Change of Shift

Change of Shift is up and in a clever poem written by code blog.

***

What was up with last night?

"Lunar Syndrome" is what I've chosen to name it. Last night was a new moon. Typically a full moon is what brings the strangeness about.

There were patients who's chest pain radiated into the new gray hair on their head, abdominal pains which caused a shooting pain in their throat to their toe and caused knots in their shoe strings, and then the psych visits. Oh man, the psych visits...

One patient drank too much and OD'ed on Tylenol. So that reading this blog is not a complete waste of your time, courtesy of emedicine, why taking a bunch of Tylenol is bad:

"In acute overdose or when the maximum daily dose is exceeded over a prolonged period, the normal conjugative pathways of metabolism become saturated. Excess APAP is then oxidatively metabolized in the liver via the mixed function oxidase P450 system to a toxic metabolite, N-acetyl-p-benzoquinone-imine (NAPQI). NAPQI has an extremely short half-life and is rapidly conjugated with glutathione, a sulfhydryl donor, and is renally excreted. Under conditions of excessive NAPQI formation or reduced glutathione stores, NAPQI covalently binds to vital proteins and the lipid bilayer of hepatocyte membranes. The result is hepatocellular death and centrilobular liver necrosis."

"The antidote for APAP poisoning is N-acetylcysteine (NAC). NAC is theorized to work through a number of protective mechanisms. NAC is a precursor of glutathione and increases glutathione availability to bind to NAPQI."

A PA student was pimped on this nugget of information last night. He was saved by a pelvic exam. It may be the only pelvic he will ever be glad to do.

The patient didn't want to drink some charcoal. So, it was up her nose with a rubber hose. The NG tube would make sure charcoal would get into that thrashing little body of hers.

Another patient threatened to hit the doctor. She was warned it would be a bad idea. She got admitted. But she wouldn't be admitted until the morning, per the MD on call.

Yet another patient had to be restrained to his bed. He was an AMS brought by ambulance. He attempted to pull out his IV numerous times. He enjoyed exposing himself. Before being restrained, he was running into other exam rooms and scaring patients who were in for Cardiac-Obs. But he was a kind and helpful soul. He tracked down his nurse after peeling off his EKG leads and handed them back to her. I guess he didn't want to leave them on the floor.

Despite what room 10 wanted you to think, a blood pressure of 345 is impossible. Blood pressure cuffs don't measure that high. She informed us that her doctor told her to check it every two hours. [insert cow pattie]
One doctor asked, "And what was she to do with this...data?"

That doctor had an ex-psychiatrist. She had a history of "cyclical depression". Don't befriend her. It's dangerous. One of her friends died recently of a brain abscess. Another friend died of some sort of cancer. And another friend...well, I'll spare you from it.

We also had an anti-racist racist who was in the process of reporting two doctors to the board for basically not feeding her drug seeking habit.

A crazy night...literally.

***

Hill O' Fire

Occasionally I get the itch, the nerve, the desire, the fortitude, the COURAGE to dare myself to take on an obstacle and overcome it. **

**Note to all: This usually happens when I have a serious lapse in judgment.

Lurking in my neighborhood is a hill. It is an innocent hill to motorists. It's a friendly piece of state property to those walking their dogs.
But to a cyclist, or a rollerblader, it is pure evil.
To traverse this hellishly steep monstrosity while safely avoiding those motorists who have glued their cellphones to their ear, you must remain to the side. To a cyclist, this means many bumps, rocks and potholes you must negotiate while climbing this steep grade...while geared down to the "Flinstone's" gear (you know, the one you pedal your heart out yet you don't move fast enough to even balance?). To a rollerblader, this means considering the many bumps, rocks, potholes, and little bitty teensy valleys in the asphalt which would gleefully stop you in your tracks, pitch you backward, and send you plunging down that villainous bitch at break-neck speeds...literally. I mountain bike, so potholes and rocks hardly test me anymore. Hills I don't like so much, but that's because I'm out of shape. They make me breathe hard.

As I drove home one day, coasting down The Hill in my truck, I had a thought. This usually spells trouble, but I conveniently forgot that minor detail. I thought, "Wouldn't it be a good workout to rollerblade up that hill?" My rollerblades have been collecting dust in the closet.
Of course, my somewhat more intelligent personality said, "No."
The other said, "Narly kickass idea!"

It took a few days for the Spicoli personality to persuade the intelligent one this was a splendid idea. Yesterday it finally won the argument and I gathered my rollerblades from my closet and dusted them off. While doing so, my intelligent personality said, "We will wear a helmet." Yes ma'am.
I attached the cranial protection device to my head by way of tangled straps and buckles, then stepped outside. My husband was tinkering around in the garage. He looked up, looked at what I carried, and rolled his eyes with doubt. Oh yee with little faith, I would conquer that hill.
I sat down and began shoving my feet into the ski boot apparatus type rollerblades. I noticed a shadow standing over me soon after and looked up. He was there to hassle me.
Pretending blasé, I said to him, "If I'm not back in thirty minutes, come find me," and completed the task of affixing the rollerblades to my feet. I used the bumper of the truck to pull myself upright. I was like a child standing for the first time--wobbly, arms straight out to the sides, but I was independent. I just needed to adjust a strap or two.
My husband thought that was the perfect time to softly lay a hand on my helmet, as I was bent over, and wish me luck with a gentle push to roll me backwards. My arms flailed and a screeched a protest. After regaining my balance, I glared at him. He was nearly doubled over with laughter. Hmph!
With an assertive push with my right leg, I lifted my chin and off I went. To the hill we go! To conquer it!

[Cue "Eye of the Tiger" music]

The first part of it wasn't so bad. I was in better shape than I realized. But then The Hill turned up the heat. She wouldn't go down so easily! I huffed and puffed my way up that hill, cursing its very existence, cursing whatever soul put me up to this feat! My heart felt like it would break my ribs as it thundered away valorously. My lungs worked to feed oxygen to my blood. They began spasming. My legs commenced to protest, burning deep inside the muscle. She was the Hill O' Fire!
Soon, my rollerblades were no longer gliding up the hill, but rather to the side, like skis striving uphill. I was no longer rollerblading, but taking baby lunges up this hill. Crack after crack in the asphalt slowed me down. Rocks picked apart my line, sucking the efficiency out of each ungraceful glide.


[Turn down the volume of "Eye of the Tiger"]


My God my lungs hurt. Only a crazy person would torture themselves.
I could see light. I could hear angels! And then I realized it was THE light! Oh God I had killed myself! And I hadn't finished my taxes! My husband will be pissed!


[Turn off "Eye of the Tiger" music]


As suddenly as The Hill had unleashed her savagery upon me, she eased her stony unforgiving grip clenched tightly around my chest. The poison in my burning legs began to dissipate. I reached the top, inhaling and exhaling as hard and as fast as physically possible. I set my hands on my hips and turned to look. I wobbled a bit and flailed my arms to regain balance before I finished scanning the obstacle I had conquered.
I had succeeded! I wanted to pump my fist in the air and scream at the top of my exhausted lungs! Only my arms felt too heavy, and my scream would have been but a pathetic whimper. No matter because I felt like a superhero!

That is, until the ten year old boy pedaled by on his bike, waved with a smile, hardly breathing any differently than if he were playing video games.

I slumped my shoulders and rolled down the hill silently. I used to be the exact same way as that young boy. I could ride my bike for hours without notice. He'll be old and out of shape, just like me, one day. In fact, statistics show it will happen sooner to him than it did me.

Today I pay for my stupidity in pain. I feel like I drag my legs behind me with every step. Clearly the bicycle doesn't work the back of your legs as well. I was going to do some resistance training today. That'll wait until tomorrow.


Look at that idiot at the bottom of the picture I posted above, gliding effortlessly up that hill like a fool. Feh.

***

Beer for all patients!

It was a backwards night. Nothing unusual there.

Patients who came to the ER for "vomicking" x's 2 hours, or those with an abrasion on their right buttocks, were going to die-judging by their Oscar winning performances.

Those with some ETOH coursing through their veins were worse off visually, but also worse actors, less dramatic and quite happy. One hobo looking patient (white beard with cigar stains around his lips) had a few beers and decided it was a good time to cut some limbs off of trees.
And off of himself.
Meh, it was merely a finger tip amputation, but through the bone. He joked about how sad he was that it was his "trigger finger". The doc asked, "Did you bring your finger?" He responded with a sigh as he looked around the room, "Oh...it's around here somewhere." When asked if he needed some pain meds, he responded with a gravely, "Naahh."

A woman decided to demonstrate how dangerous a second story window was to drunk people. She was going to show a friend, or family member, how someone could fall out of it.
And she did.
She said she felt fine, just a little sore. She came to the ER to make sure she was okay, prompted by friends and family. No neuro deficits at all on exam and just a contusion on her back. A c-spine revealed a nasty C2 fracture with shifting.
"Room 23's x-ray is back," I told the doctor when I saw it was completed. It had been a slow night and we had been discussing social differences between men and women.
The doctor scooted forward as I brought up the x-ray. The lateral view showed nothing. I don't know the technical term for the anterior view where the patient opens their mouth, but that one prompted an "Oh shit" from two doctors. Later, he explained that her head was in danger of literally falling off. I wisely assumed that would be bad (I'm a genius, you know, but I don't like to flaunt it).

Anyway, beer would be good for all patients complaining of pain. It makes them happy and fun to talk to. It takes their pain away. Those who have indulged to the point of euphoria, or teetering on the edge of passing out, I get to examine (sometimes and under the close supervision of the doctor). And I doubt anyone would be allergic.
The problem is that the ER staff likes to be happy and pain free as well.

***

Being cool can bite you

I think I know why some doctors seem too serious. We've all met the type who would break should you bend them. You know, the type who seem they might benefit from an enema or two? I think I've seen the reason behind it.

Work is much more fun when you're surrounded by others who are having a good time and enjoying their jobs. You get some laughs in which always makes the day go by faster. People like you and are willing to do favors for you, but it comes at a price.

When you're fun to work with, everyone relaxes. They kid around with you and make jokes. When you ask them to do something, you get a smartass comment and your request is put on the back burner if the department jerk has put in a request.

General surgery was paged for one of our patients and we hadn't heard back. They were paged again. Sometimes getting surgeons in is like pulling teeth. Usually they're good. Occasionally there's one oncall who isn't the best at answering pages. It's not like our department is full of incredibly injured, incredibly ill patients because there's a nationally recognized trauma I center basically down the street. We do get gunshot wounds dropped off at our door step and some interesting walk ins though. So occasionally, we really do need pages answered quickly. This one was in regards to a walk-in who suffered a crush injury to his left side. Externally, he had a red mark. He was tender over his LUQ. CT scan showed a spleen consistent with a crush injury.

The patient seemed okay, relatively. On the initial examination, his color was good and he had only moderate tenderness. He was willing to sit up and talking alright. Oddly throughout the night, his pulse began dropping. He started at 65 bpm. The last time we looked at him, he was at 39 bpm. I thought it odd since an internal bleed usually causes the heart rate to increase. We had blood ready should he need it.

I had overheard the nurses telling the doctor about his heart rate and declining general appearance. Later on in the night, when I had time, I decided to cruise by to see...out of curiosity. I peeked in covertly. He looked pale. His tattoos over his biceps stood out vividly against his pasty flesh. He seemed ridged in his bed from pain. His eyes were closed and his brow drawn over his nose. I found the doctor and said, "I wonder if you should recheck one. He looks fairly pale and uncomfortable."

The doctor agrees to and in we go. Upon recheck, the patient is much more tender, pain radiating into his arm, and doesn't want to move at all. He wasn't terribly excited about talking. The doctor asked me to page surgery again which I take care of. Upon returning, I met the doctor at the door who looked a little concerned and confirmed with me that surgery had been paged.

Here's where being fun to work with began to bite him. Five minutes later, the doctor checks with the clerk to see if surgery was paged.
"I paged him five minutes ago," she said with a teasing smile.
"Page them again," he said dryly.
"I already left a message. I'll try in a few minutes with sugar on top," she teased him and returned to shuffling some files on her desk.
The doctor stared straight at her, almost glaring, and said, "We have a guy in room one bleeding to death." His tone caused her head to jerk up and regard him with wide eyes. "Page surgery again. Now."
She looked hurt, but jumped on it. She has taken more severe tones from others without being hurt. The rest of the night she remained subdued.
Before entering another exam room, he grumbled to me, "They think I give orders to feel important."

I was once told it's a rare trait for someone to be able to have fun but instantly jump to being serious and get things done when needed. I'm wondering how many doctors purposely look like sticks in the mud simply because they need things done.

***

Varmints

<----- An icky creepy crawly just like that had crawled inside a woman's ear! I thought cockroaches in the ear were one of those things the veteran docs told the newbies about as a trick, seeing the way they smile when telling their cockroach story. Surely a cockroach nestling inside of an ear is a made up story. Nobody could let one get inside of their ear. That's just disgusting and nobody would have it!

It was just the other day I was asking, eyes wide with curiosity, "You really look inside and are sometimes greeted by twitching antennae?" "Oh yeah!" The doctor silently reminisced about things he had extracted from ear canals with a distant look in his eyes and a smile on his face. "Usually, hopefully, they're dead. Sometimes you have a live one looking right back at you...and magnified." I shuddered in my scrubs which earned a chuckle from him. Not one week later, after joking about it, a chief complaint of "Bug in ear" popped up onto the screen. Awww right, I mused with excitement (things have been dull lately). Sometimes when we scribes get excited about something, the doctor will sign up for it. I think it's more to see if they can gross us out than out of the goodness of their hearts. Anyway, the doctor signed up for it.
We passed by one of our other patients who suffered a laceration over her eyebrow. The plastic surgeon was kind enough to come in the wee hours of the morning and sew her face up. But, we had to do a double take. The surgeon had her entire face scrubbed down with iodine. She looked like sunless tanner gone wrong. Terribly wrong. I snorted a giggle and continued on.

When you have a bug in your ear, they try and flush it out first. But this one wasn't giving up so easily. He was dead and that ear canal was his grave. He wasn't excited about being exhumed.
So the doctor went in after it with a pair of alligator forceps. The corner of his mouth lifted which signaled to me he had a hold of it. Moments later, he pulled out a one inch long dead cockroach.
He proudly presented his find to the patient, but she turned her head away in disgust. I would have asked to have my ear amputated.
I wonder what would have happened had it still been alive? Does it get caged? Thrown into a bowl? Flicked onto the ground and stomped on by the tech?

So, now I have officially seen a bug in the ear. I'm considering ear plugs at night.

***

This broken healthcare system

Who's fault is it? Where do we get the money to fix it? How much money do we need to fix it? Why is it broken?
Unfortunately, the questions are in the correct order we are asking them in. First, we point fingers. Then, we assume it will take money to fix. Thirdly, we half-ass figure out how much money it will take. Lastly, we try and learn why something was broken in the first place.
The questions should be, and in this order:
1.) Why is it broken
2.) How do we fix the broken part
3.) Will this fix require new parts (ex: money)

Our current society is the most impulsive, irresponsible society that has ever lived. I don't think anyone will disagree with me there. We live in absence of common sense requiring labels to warn us against drinking household cleaners, eating fiberglass, or bathing with toasters. Instead of common sense, we simply need a good lawyer to sue manufactures of these goods for all they have. Our lack of accepting consequences for our irresponsibility is costing us dearly.
We don't handle our money wisely because we don't have to. MSN reports that "personal bankruptcies have doubled in the past decade". That the average household carries "$8,000 in credit card debt". Here's the mind boggling truth: "About 43% of American families spend more than they earn each year"! 43% spend MORE than they earn each year! Holy shit!
Creditcards.com reports for the first time since the great depression, we are, on average, dipping below 0% in personal savings.
You ask, "Since the great depression? You mean, that era when people fought over bread crumbs? The era caused partially by soring consumer debt ? When things were...[gulp]...disastrous?"
Yes! Since the great depression!

"Seven out of 10 low and middle income households reported using their credit cards as a financial safety net, i.e. to pay for car repairs, rent or housing repairs and medical expenses, rather than relying on savings in 2005" -creditcards.com

Households are spending, on average, $1,164 in interest payments alone. That amount of money would cover my medical expenses for the next three years. That includes lab work I need to have done every year, doctor visits, and an occasional sick visit.
We are irresponsible with our money. A large portion of us are living right at our means instead of less than our means. Everyone will incur medical expenses at some point in our lives. Why do we set aside money for Starbucks, but not medical expenses? Why do we understand that we will have to pay the electric company, but not for medical expenses?
It is because we are used to having a net. We are used to someone else picking up the tab. We see the trouble we've gotten ourselves into, and instead of fixing it ourselves, we look at our big huge government, the chunk of money that goes to them each year, and cry "Why aren't you providing us with health care!"
Our well being is our choice. In America, we have a choice to seek medical care or not to. Why, then, is it not the choice of others to pay for your medical care? If I am going to pay for your medical care, I will want laws put in that will force you to get preventative care. Oh yes. Your ass will be arrested if you do not show up at your doctors office for a physical. Why? Because it's less expensive. I still believe in freedom, and that money I earn is money I keep. I want as little tax money coming out of my check as possible. An ounce of prevention is worth a pound of cure. So your butt better be parked in the exam room BEFORE you need an ICU room for your heart problems you've neglected. Oh, and not following doctor's orders, taking medications prescribed, or exercising like ordered will be a federal offense.

Why is it broken? Our own (each and every citizen) irresponsibility
How do we fix it? We roll up our sleeves, sell the pretty shiny things we can't afford, and start saving for rainy days
Will it require money to fix? No! Responsibility? Yes!

We cannot continue to act like little children with the benefits of being an adult. Sooner or later, we will need a parent who will tell us what we can and cannot do and give you an allowance each week. And that will be a big government. We're headed straight for it if we citizens don't get our acts together and start functioning as real adults.

For the chronically homeless , sorry. Medical care is one of those sparkling benefits of being a productive citizen. I understand down on your luck. Believe me, I've been there. We should help those who are. But it doesn't last for ever, nor should it. The chronically homeless, the chronically poor need to "step up and play ball". I'm not paying for their lack of motivation or initiative.

***

Texas Kolaches

I love dough. It's like Playdough for grown ups. I love the feel of it between my fingers, love to knead it into something edible and devour it after baked. I've mastered pizza dough. It always comes out light and crispy. I can knead ingredients such as onions, garlic, or cheese into it. Twenty minutes later, I can have a pizza that tastes gourmet. Homemade bread? Easy. I do admit I haven't tried the infamous sourdough bread. But I intend to.

Kolaches are a different animal and I spent three hours one Saturday morning in intense training to master this dough. It was my father-in-law's recipe. I was warned by my husband my first go-round. "There's secrets to this recipe in order for it to come out like his do."
Pffft. I wiped my hands on a dish towel and confidently rolled my eyes at him. I'm a natural in the kitchen. If I can completely wing Thanksgiving dinner, I can make stinking Texas Kolaches.

For those Czechoslovakian people, or descendants, who are beating on their desks in angst wondering what in the hell did a Texan do to a precious, innocent kolache, well, we defiled it. Texas Kolaches are kolaches with sausage in the middle. A tasty breakfast which reheats very well. They are not dessert. Most call them sausage rolls. In Texas, because we put the state's name on everything, they are called "Texas Kolaches".

My first attempt, well...they were so-so. The bread wasn't as soft as when my father-in-law makes them. The best way to describe them is if you were to take a sausage and insert it into a household sponge and then bite into it...you might have an idea of what they were like. I tried twice and scratched my head shortly before admitting defeat. Mine were not as good as his. Mine would fill a tummy. But mine would not make a person's mouth water at the mere mention of them being made by me.
Well, now, muhahaha, they do. Three hours of training under my father-in-law learned me the little tricks to preparing the dough, the silky feel of the dough, and how not to murder the yeast.
Oh feast we will on these sausage rolls. We have 24 minus the four that have been eaten already. They are perfect. They are golden brown on the tops with soft, soft flavorful bread cuddling the piece of sausage it surrounds. The house still smells like fresh baked bread hours later.
I could rule the world with these puppies.

Why not go into nursing?

Agh! That dreaded question for premeds. Most don't have an answer to it because being a doctor is socially "cooler" than being a nurse and they haven't researched it. They travel down the path to doctorhood with blinders on and ignore the forks in the road.
So when asked, "If you say you want to help people, why not go into nursing", many premeds stare blankly at the individual asking such a ridiculous question.

I spent a grand total of 2 months volunteering in an ICU. That can get you a good seat for observing nurses. For one, you can listen in on their complaints about their job, how doctors treat them, how well they get to know their patient, and hear the most recent way they have saved some doctor's hiney.

Now that I'm in an ED and provide a liason between a nurse and doctor (as one of my duties), I've got another point of view. I see the doctor spend about 10 minutes with the patient and the rest of the patient's 3-4 hour stay, the doctor is gathering tests and thinking about a diagnosis and treatment plan. I see nurses carrying out the orders given by the doctor.

Nurses put up with a lot to carry out these orders. They take abuse from patients who are impatient. Doctors aren't in the room when the patient starts complaining about this being the third time their blood has been drawn, how they need more pain medicine, how they want to speak with the doctor, could they adjust their pillow, would they turn on the TV... And these aren't the combative or mean patients. These are regular people who don't feel well or are hurting.

Sometimes doctors don't see the nurse add a chest x-ray he/she knows the doctor wanted but forgot to order. Or the BNP, or the D-dimer. I guess what I am saying is often times nursing is a lot of behind the scenes work. It's a thankless job. When a patient tells the doctor thank you, the nurse is sometimes the one who kept the doctor from accidentally killing them. The nurse double checked with the doctor about orders for a medication the patient said they're allergic to. It's behind the scenes from the patient and often times the "thanks" from the doctor is expressed as them shaking their head at themselves, or an explicative hissed under their breath.

A consult walked into the ED, the other day, with his nose high up in the air. He spoke down to one of the best nurses who simply let it roll off her back, shaking her head as he wheeled around and strode off. Perhaps he's used to super nurses. Or perhaps he's simply on a pedestal. It looked ugly and didn't earn any respect from anyone. Perhaps lowered it.

I want to answer the questions, solve the puzzle, perform procedures and the like. An occasional thank you would be nice, but I don't expect it. However, I will never belittle a nurse. Ever. They're an extremely important piece of the health care providing pie. A good nurse is a godsend. A bad one can be your worst nightmare. Sometimes we all get wrapped up in our work and we forget how important another person is in fulfilling our duties. Educations are different, but the goal remains the same. Doctors do some pretty neat things and often get the "thank you", but nurses do a lot of the leg work. No one person is more important than the other. I think nurses do a lot to hold things together, to keep things running smoothly. I'm constantly impressed by what nurses put up with and the numerous job duties they perform. But, I don't want to be a nurse.

How to be a patient

I'm in a bad mood today. I didn't want to muck up Gruntdoc's website over a recent post regarding Dr. Keaton as the new president of the ACEP.

Correction (regarding the "Academy") to the article is found here.

Here is what I'd like to rant about:

"If you do come in [to the emergency department], there are certain things you need to bring with you. Bring your list of medicines, or the bottles. Bring your list of allergies. Don't make the assumption that I have those. Bring your list of doctors and their contact information, especially if you're from out of town.... If you have a list of medical problems, you want to bring it with you."

I started thinking about all of the sins patients commit when they come in. Then I thought, "Wouldn't it be great to hand out pamphlets on how to be an emergency room patient while they wait?"

In addition to Dr. Keaton's recommendations, the pamphlet should read:

- Do not assume your PCP is on his/her way.
- (insert list of common questions asked to patients) Rehearse your answers to the above questions. Keep answers to 30 seconds or less. Rambling is frowned upon.
- No lying (insert area for patient to write down all illegal drugs used recently).
- No sex in the exam rooms.
- Discontinue use of cellular phones when the doctor walks in (family members not involved in doctor/patient discussions should remove themselves from the exam room if they do not wish to hang up their phone).
- Treat the rest of the staff with as much respect as you give the doctor.

I think patients are beginning to get emergency departments confused with primary care offices. It's not first come first serve. No appointments. A patient can't call the doctor two days later with questions. The doctor doesn't have 30 minutes set aside to discuss all of their problems (see "No appointments).

I wish something evil could be done to those who fake asthma attacks to get a refill on their Albuterol. 99% sats....mmmm-hmmm...

Wow, am I in a foul mood today.

***

Grand Rounds 3.18

Grand Rounds 3.18 is here.

"In an unscientific poll of the blogosphere, about 40% of you gave this theme the finger, while about 60% of you found it interesting to the point of arousal. To the first group, I say, I hope we can still be friends. Meanwhile, the second group should sit quietly and think about what it has done."

I actually knew where it was going to be this time.
I am one who grumbled about themes. I submitted despite the fact that I didn't think it fit the theme and after writing an apology about it, I silently wondered if it'd show up prepared with an "I told you so".
Somehow, Signout managed to be able to include it. [scratches head] We should probably keep a close eye on her.
I still don't like themes, but her umbrella opened wider than I thought possible. So I must give kudos.

***

Pulled into arguments

Lately it seems all disgruntled patients or family members of a patient have been seeking my opinion on matters between the doctor and themselves. And it's in a plea for me to side with them and against the doctor (who would be my employer for the shift).
They are frustrated about what the doctor is telling them. Even though I understand this, I stare back at them, or show them the palm of my writing hand, when asked things like "Is what he/she is saying make any sense to you" or "Do you agree with this sh*t he/she is giving me".

Come on, patients! Do you really, honestly, think that I'm going to hug my clipboard to my chest, cock a hip out and tell the doctor to go to Hell, or to "start making sense now, d*mnit"? I'm sorry that he/she might not be telling you what you wanted to hear, but open your ears. And for the love of God, stop watching so many damned TV sitcoms. It's poison!

I am a silent observer, patients. Absolutely silent.


While looking for a picture to symbolize this silence, I stumbled upon this:

***

Amazing spray paint art

Wow! Simply amazing!
A work of art from start to finish


Here is a link to his website.

***

When the cat is away

The wife and her pets will play.

My husband is out of town this week and boy are we having a party! I get to eat when I want, watch what I want, the dogs (two rat terriers) sleep on the bed...we're living it up as much as possible.
Since he's gone, this of course means that I must grasp the opportunity before me with a firm hold and do what every wife should do when the husband is out of town.
And that is to rearrange the living room.
To keep my one and only reader numerous male readers interested, I'll explain with a drawing à la John Madden style:




[John Madden voice] You see, Pat, the TV set there on the left will run a switch with the recliner while the couch holds the line and, and, and, and BOOM! The living room is rearranged and the window will no longer reflect on the TV screen. That is how you rearrange living rooms. That is how you move furniture around and, and, and that is how you get things done. BOOM! Just like that. [/John Madden voice]

Don't you dare take my yellow crayon!

***

Habits before knowledge

I borrowed the image from this article at medscape which shows "bilateral interstitial infiltrate of the pulmonary bases". I know what infiltrate is, what bilateral means, but I had to Google what interstitial means exactly.
I've been trying to get a grasp on chest x-rays on my own. At times I look at them and think that I see some infiltrates. The doctor will come behind me and proclaim the x-ray to be negative. Or when I think it's negative, it's actually "lower lobe infiltrates". This happened with the last one I viewed. I whispered, "Dang it" under my breath after getting it wrong and the doctor chuckled.
"Chest x-rays can be tricky," he assured me and gave me a little bit of information on reading them. He gave me a quick course in looking at the diaphragm for clarity and demonstrated the value of being able to compare a new x-ray to an old one.
Still, they're quite a mystery to me. I know it's nearly impossible to read a chest x-ray and give an impression without any training. Still, I try.

The exposure I get through being a scribe leaves me wondering if it could hinder my learning, should I get into medical school. The experience I receive now is valuable in determining if medicine is the right choice for me. I listen to the doctors gripe about the uglier things with practicing medicine. I also see them wade through vomit to administer CPR to a patient. I listen to ridiculous, annoying, stories from patients and meet combative ones. I get to see them relieve the worries of parents by telling them their child will be just fine. And I witness the prideful, happy look on the doctors' faces when their heart swells inside their chest because of their last heroic deed performed, or because they proceeded with caution (or with their gut feeling) and wound up catching a life threatening condition hiding out inside of the patient. This nature of heart swelling often leads to giddiness in doctors.

Because of the intimate exposure I know what tests will be ordered with fairly good accuracy, based on watching a physical exam and how the patient responds. At times I will go ahead and write down on the chart what tests I am sure will be ordered while they are examining the patient, if I'm finished recording the history. I'm also able to catch and question when standard orders were not ordered. For instance, a chest x-ray wasn't ordered for a chest pain when it should have been. Usually the nurses will catch this, but there are a few that won't say anything.

Knowing how I learn, I wonder if this "knowledge" will hinder me. I know what the basic work-up consists of for an adult who complains of abdominal pain, nausea and vomiting. If I was asked why these test should be ordered, I'd bumble around and eventually shrug. I understand most (to a point), but an EKG? I don't know. Perhaps a problem with the heart can present with abdominal pain?
My point is if I know what to order before I know why, it will be difficult for me to learn and remember the why. Don't get me wrong. I love this job and I am not quitting anytime soon. My wish is to be a doctor who thinks about the patient's complaints and exam instead of one who follows a recipe book. And currently, I am following a recipe, the "standard" complaint vs lab orders, instead of knowing the what-for.
Perhaps it isn't a concern for most. Unfortunately, my brain is a funny little comedian and I'm the butt of all of its jokes.

***

Whether or not you're sick is weather related

Currently, the weather is fairly miserable. Freezing temperatures and rain coming down in sheets have kept the not so emergent patients at home, or work, or under a bridge where ever it is they spend their time. Most everyone had reason to be there.

Usually the ED is full with 10-15 waiting. Today we were about 65% full with triage completely empty. In the Urgent Care area there were 8 patients at most.

Mom always said not to get cold or else you'll get sick. I guess Mom's not always right.

***

Don't bother the scribe!

Yes, as an EMT who now stands on the receiving end of emergent patients, I must inform EMS of something important. I do this to educate, not to irritate, not to belittle.
If you are an EMT and bring in a patient with dyspnea who's gasping for air, sats in the 80's, who can barely speak audibly, whose eyes are rolling around in their head, who has a difficult history, who has a complicated ROS to document...


...do NOT tap my shoulder repeatedly and ask me, "What happened in room two" over and over until I finally turn around and say "I don't know." While we are in the room is NOT the time for that. I have to listen! I don't LIKE having to ask the doctor "Wha'd he say about such and such?" I'm supposed to know. I'm not there as an observer. Clipboard in hands + pen flying with slashes and circles = I am working. I wasn't even on shift when room two happened.
Leave me alone for a moment. Go to the desk and ask someone who doesn't look busy if you must know right that second.

I'm actually surprised at how much that angered me. I kept my mouth shut about it. I decided not to say anything. I'm not sure if I should.

'Splain this-

Exactly one year ago today, my husband fractured and sprained his right ankle in a motorcycle accident. He just called me this morning to tell me his father, who drives 18-wheelers for a living, fell out of his truck and sprained his right ankle.


January 8th is cursed! I will draw circles with salt next year.

Only Bugs Bunny could be capable

This must be a relative.

Working in a teaching hospital...

If you are a premed, or prehealth anything, working in a teaching hospital is a major plus on the scale of bonuses. PA students, medical students, and residents rotate through the ED all of the time. At times, you can pick their brains for little facts.
Yesterday, a PA student started her first shift on her rotation. In exchange for showing her a few of the ropes (as far as the computer system, where charts go, and layout), she began to demystify those darned squiggily lines of the EKG for me. I figure she was happy to take a break from being the student.
Also, with exposure to a teaching hospital, you pick up on things the attendings teach to their students. It is their job to teach the student, not the premed, and so you get answers to questions you are dying to ask, but can't, for free.

You have to think of the premed/doctor relationship like this: Each question from a premed fills up their own question cup. Some doctors have a tiny ketchup size cup and some have 7-eleven big gulps. The cup sizes can change, depending on how the doctor's day is going, or has been going. It doesn't empty until the shift is over. So, if you ask too many questions in one shift, the cup overflows and the doctor spills questions on themselves. This can displease them.
A focused premed can pick up on little signs which can tell them their doctor is beginning to struggle with the cup they hold. This is when you must stop asking questions and just shut up. When it's near full, you better have a good joke lined up to make them laugh. It makes things much more pleasant for you. Their ability to balance that cup is proportionate to how happy they are. Also, if you make their lives easier by way of actually making it easier, or more pleasant, they'll start to carry a larger cup just for you on a regular basis.

Anyway, yesterday a patient with abdominal pain came in. After all of the labs, CT's and such were completed, gallstones were the cause of her pain. Unfortunatly (or possibly fortunatly, depending on how you look at it), a CT revealed she probably had renal cell carcinoma, as is the opinion of the radiologist. The doctor asked the PA student if she wanted to come and listen in as he gave the news to the patient. As the doctor's scribe, this usually means I could go if I wanted to. I had some work I needed to do (I had never worked with this particular doctor, so I wasn't sure what size question cup he carried) but I still benefited.
Upon their return, I listened and learned about giving bad news and how doctors tailor the words they chose to each patient. As he explained it to the PA, if someone seems as though they won't follow up on it, he will put the fear of God in them and explain that the patient probably has cancer and how it might very well kill them. For this patient, who is concerned about her health, he believed she will follow up so he could be more gentle. He said to her that she needs to follow up and gave her a referal to a doctor who could see her Monday. He mentioned someone like that does not need to be made to believe that she definatly has cancer. He explained that he would want her to have some sort of life before she is officially diagnosed.
I tucked that free little nugget into my pocket.

I *do* have a hobby

...or three. I have this sailboat I learned to sail on when I was little. It's a Minifish, which is basically a Sunfish, only smaller. She's older than I am by only a few years. On days I could talk him into it, my father and I hoisted the 80lb hull on top of the car, loaded the sail and mast, rudder, dagger board, and drove to the lake. Excitedly, I drug the boat across the shore and into ankle deep water. I attached the rudder, set the mast and hoisted the sail. Once away from shore, I placed the dagger board (which doubles as a paddle), hooked my feet in the hiking strap and sailed away.
Some days we were perfectly in tune with each other. The hull skimmed across the surface of the water as I leaned out, my back just inches over the water. She occasionally would splash water on my face as we sailed along and I would laugh.
And then, some days, I would be a little too confident and she would throw me into the drink. After clearing my face of water, I would swim to the bottom side of the boat where the dagger board now served as a step. I would grab the edge of the hull and stand on the board which righted her. It was best to do this before the boat flipped completely over because then you'd be battling an underwater sail serving as the new keel.
We had plenty of good times together, just she and I. Together, we blasted across the lake as fast as we could. Waves from moterboats would crash against her hull, spilling water onto me. At times, we slowed down to explore a little nook. I remember very distinctly the gentle sounds of the water lapping against the hull.
At times, we explored the nook for longer than I planned since trees would block the wind. Once away from trees, the sail would rustle in the wind, I'd catch the rope, and away we went. She was a great friend. Always willing to go, always quiet and listening.

Between the years that I had left the house and when I reclaimed her from my father, she suffered some. If I remember correctly, she was out at the docks during a storm, blew away and bumped everything she could. So, she has a few bumps, bruises, and holes to tend to.
I promised myself last summer I'd have her out on the water, but I didn't even do more than move her out of the weather. Today, she sits upside down in a shed. For hours, I sanded her gel coat down in places it had cracked to reveal all of her bruises. I have my work cut out for me, but she'll be okay. It was disheartening to see the full extent of her damage, but it's the first step to her recovery.
My arms were too tired to continue any longer than I did today. I removed my coveralls, gloves, dust mask, and glasses. I looked back on her long exposed hull, ready for repair. My excitement matched hers because she'll be in the waters soon, flying across the waves with grace again. I gave her a pat on the hull as my promise, and turned off the light.

Designer defect baby

I can't believe I'm reading this.

Link

Cara Reynolds of Collingswood, N.J., considered having the procedure so she could have a dwarf baby.

In part, she felt she ought to be able to decide whether she could have a child that looks like her and her husband, Gibson, also a dwarf.

"You cannot tell me that I cannot have a child who's going to look like me. It's just unbelievably presumptuous, and they're playing God," she said.

RIP AC/DC Charger Adapter

Today my charger for my laptop died. The green LED light fizzled out unbeknownst to me until I looked at the level of battery charge on my laptop and exclaimed, "Holy moly!"
Today, I emailed Dell. I wonder if they'll get a knew charger to me before school starts Jan 16. I'm not holding my breath, but I do wait eagerly to see if I am treated nicely.

I have an M140. I've enjoyed it. It's only tempermental with my husband, who by the way was the last to use the charger. I think I shall ban him from that computer.
Anyway, it's happily done every task I've asked of it. I haven't played games on it though. I use it for school.

The countdown begins. Will it be here in time? Or will it be too late?

I just realized this means I have to check my junk email box. I have a junk email I use for things like this so my real email doesn't get bombed with tons of junk email (although it still does). Just great.


Update: I recieved the little jem January 2nd.

Update #2: I recieved a bill for the little jem January 9th. They will be recieving a tracking number for the returned part.

The man lives!

And without a pulse!

And here it is folks. A man with a mechanical heart.

The new mechanical heart, which is powered by batteries located in pouches on
Mr. Langevin's body, provides a continuous flow of blood so the patient has no
pulse.

I wonder how this complicates diagnosing other problems. Such as, should his body be in distress from another cause, it can show in blood pressure and pulse rate. He has neither. And is he wearing a medical bracelet now?