Sinking to New Depths

Recently, I enrolled in an Open Water SCUBA Diving Course. Fortunately, I am able to do all of the bookwork and quizzes online, needing only to visit a small dive shop for actual pool time and my dives. Today, I got into the pool for the first time. At first there was a little awkwardness, but once I was comfortable that I could in fact breathe under water, it all went pretty well. I have to return next week to finish up my pool skills, but I am lucky to have found a program that works around my schedule! Once you get certified, your card is good for life. The plan is to meet up with "The Phoenix" later this year for another awesome vacation adventure.

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Tonight I tried to make some brownies in honor of Ru coming in to town. They were just from a box, so it didn't require much effort on my part. My kitchen was smelling wonderful. The timer went off, and I expected to open the oven door to perfectly gooey brownies. Instead, I found a square pan of chocolate with a layer of oil boiling on top. Apparently, I forgot to mix in the eggs! Leave it to me to forget one of three required ingredients in a pre-mixed recipe and screw it up! The whole oil brownie brick went straight into the garbage.

Downsizing

Yesterday, I cleaned out my closets. Literal closets-- don't get all excited. Things I hadn't worn in the past year or two were thrown out. Things that were of questionable fit were thrown out. Gone were any shirts picked out by old boyfriends. Pants I could slide off over my hips without unbuttoning or unzipping were thrown out (When I started medical school, I weighed 125% of what I do now.). Oddly, things that had been tight that I would have thought would look good after losing another 10 lbs were still ill-fitting. And, things that were flattering when I was heavier, still hung on me with good shape. I guess there is some truth to clothes just being well made or not. By the time that I was done, I had SIX filled garbage bags of clothes to haul off to the Salvation Army. I think I got rid of about half my clothes (not counting workout and housework stuff).

Part of the motivator is that next weekend I am getting a roommate. My dear friend Ru will be here for an extended stay. She has whittled her material possessions down to what will fit into her compact car and has been heading my way over miles and miles of asphalt trails. She is braver than I am. Rather than moving out of employment obligations, she is just picking up and relocating for a while. It will be fun to have a friend in-house. I'm hoping we'll do some local trips and have many misadventures while she's here.

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This morning I ran a 5K with one of my friends. We banged it out pretty well, but our time was actually almost a minute slower than the last one we did in May! There's another 10K coming up in a few weeks' time, so I had better up my running schedule again.

The weather has been beautiful lately. A few days of rain have been followed by perfect skies. This afternoon I finally finished the second coat of paint on the deck, so gone are the ugly boards of pinkish-tinged primer that had been exposed for the past year. Unfortunately, the whole thing now needs a third coat to hide all of the brush strokes, but just being all one color now already makes it look much better! Suddenly, there is an almost air-conditioned cold to the breeze through the leaves. It's a warning of cold days ahead. There are so many projects I had put off last year until "the weather is nicer" and I am suddenly realizing the weather's now about to worsen. Argh.

Mystery Solved

Silk already solved the mystery about the psychiatry symbol for me. Based on my poor description, phonics and Greek language skills, she knew right what I was talking about! There's nothing quite like having a Mensan available to do one's homework... if only she had been around for those painful semesters of O-Chem in college!

Cashing Out

The other I day I picked up a chart in which the chief complaint read: ANGRY. The whiteboard wasn't much help, where under chief complaint, there was the shorthand symbol for psychiatry-- it looks like a pitchfork... sometime I need to look this symbol up, to see whether it's a reference to being tortured by demons or more likely, something far less creative.

Anyway, I sighed and started the long walk towards Room 15, our designated psychiatric room. There's nothing much different about it, other than that it is a physical room with a locking door (as opposed to a curtained off area, like most of our other bed spaces), absolutely no equipment in it, and covered, locked electrical outlets.

I asked my patient why had come in and he said that he was angry because his personal things were stolen from the shelter he lived at. He had filed multiple complaints with the police department and was getting no results. He said that he was here for someone to "write me a check to pay for all of my missing things."

After running through a long, exhausting social history and review of systems to make sure there was nothing wrong with him, we finally returned to his missing stuff. No, he wasn't angry enough to be homicidal. No, he wasn't going to hurt himself. I told him I didn't think we could write him a check, because we don't do that, but perhaps the social worker could see him and see if there was anything else that could be done.

Then I found my attending and told him the story. He said something along the lines of, "What do you mean he wants a check?" So, we walked down to Room 15 again, where my attending proceeded to tell the guy that we don't write checks, we take care of sick people. I know that we see a lot of people for routine stuff that should be covered by their regular doctor, but most of them at least come in with a medical complaint!

After waiting for over an hour for the social worker to arrive, the gentleman walked out. I don't know where he is going to get that check, but when he does, I hope that he gets one for me, too.

Doomsday

My laptop continues to drive me bonkers. In spite of spending $135 and painfully surrendering it for four days, it continues to charge intermittently and angrily flash the lightning bolt at me, threatening to go into hibernation mode at any given moment.

A smarter person would have backed up her photos and music a long time ago.

A more organized person would have already been shopping for the best deal.

Alas, I am not that smart or organized.

I just don't want to deal with it, in spite of the fact that every time I turn this blasted machine off, I have to question whether or not I am going to be able to coax it back on again. I have also tried just leaving it on continuously, which just seems to cause it to freeze up.

I am also thinking about making the switch to Macintosh as their customers seem to be happy, if not a little fanatical. At least for me, PCs tend to be trouble-free for about 2-3 years, and then they sort of self-implode in terms of efficiency. This laptop is going on 3 years now, and does it make any sense to spend any more money on this thing when a newer, faster model could be mine for approximately $700, although I think Macs start at $1000? And I am thinking of just getting a desktop computer as I am no longer homeless and relocating every 4 weeks.

Any recommendations?

In My Humble Opinion

Granted I am a wee bit short in the experience department, but in my opinion, if you manage to present with a broken neck, femur, and wrist, and still have the stamina to give me a "Come Hither" look after your sedation and dislocation reduction in the trauma bay, you are probably going to be just fine.

Although I suppose this was before the orthopods took a power drill to his tibia, shoved a rod through it, and left him with weights dangling off the bed... sometimes leeches and bloodletting don't sound like such crazy ideas.

A Sick Sense of Humor is Mandatory

So, "the other day" I saw this guy that had amputated his right ring finger. He had somehow crushed it at work and literally pulled the end off when he pulled it out from where it was smashed. He showed up accompanied by a leather glove in a Ziplock bag full of ice.

After I checked out his stumpy finger and saw the bone sticking out of the end of it, I wanted to look and see how the detached part looked. So, I took the glove over to the sink and proceeded to examine it... but not before plugging the drain as I have a bumbling co-worker who had the misfortune of dropping someone's tooth down the sink last year! Sure enough, I could feel something squishy at the fingertip end of the glove. I tried shaking the glove out, but the severed finger would not come out.

Here comes the punchline: At that point, I told the patient I wanted to cut off the end of the glove to get his finger out, but not before asking him if he cared, or was "attached to the glove!" Sometimes, I crack myself up!

Unfortunately, the detached skin was too soggy and devitalized to salvage (don't put things directly on ice) so I think we just threw it out. And, if you have seen Michael Moore's new flick, "Sicko" then you already know where unsalvaged fingers go...

Audited!

Do you know what makes for a fun day? How about checking your mailbox and getting a letter from the Department of Health? How about that letter being from that Narcotics Department?

Still not having fun?

I'm not in trouble. It was just a letter alerting me that one of my charming patients has been bouncing from hospital to hospital, and I was one of FIVE people who sent him home with a prescription for narcotics in a period of a few weeks. However, I do not appreciate having made the Narcotics Division's list.

Being in Emergency Medicine, there is no continuity of care. We have computerized records, so I am able to look up a particular patient's recent visits and hopefully someone documented what scripts they sent them home with. Unfortunately, there's no city-wide list, so other than reviewing our own records I don't have any way to prevent this from happening again. The best I can do is stick to supplying only a few days of meds at a time and referring people back to their regular doctor. Argh.

And You Thought You Were Having a Crappy Day

In that wild and crazy idealistic mind of mine, I would like to think that my job is about helping others. Sometimes though, it seems to take a drastic turn towards meeting someone's demands, rather than practicing any actual medicine.

Here's a story one of my co-workers told me about a horrific experience in which one of her patients workups suddenly went "crappy" the other night:

A male in his mid-forties presented to the ER with chest pain. He had several risk factors for heart disease, so he got the workup: chest x-ray, EKG, bloodwork, aspirin, nitroglycerin, oxygen, and maybe even some morphine for his pain. Midway through his workup, the patient decided that he wanted to leave, that there were better things that he could be doing with his time.

Unfortunately, the man had an IV site in his arm, so he had to be stopped before he hit the door as sending someone out with an IV site in place can lead to all sorts of headaches from providing them with easy access with which to deliver their "unprescribed meds" to infection, bleeding, or damage to the actual blood vessel. Not a good idea.

So the gentleman was stopped and escorted back to his room. In the meantime, another well-intending, but often clueless coworker of mine decided to have a heart-to-heart talk with the guy and convince him to stay. Getting him to stay consisted of fetching him a turkey sandwich . Fine. Whatever.

So the guy stays and waits for his labs to come back, all the while glaring at the nursing staff and demanding them to wait on him repeatedly. Finally, in spite of all the catering to his wants, he gets up and walks out the door... but not before defecating on the floor.

There's nothing that frustrates me more than dealing with rude people like that. Most people are fairly rational, and I think understanding when it takes time for their workup to get done or even when they get pushed back in the line a little bit when something more serious comes in. However, there's always those few demanding individuals that want everything done for their own convenience that cause the most problems.

Sometimes I think that the line between us and animals is very fine, if it exists at all. It's too bad he didn't make it out the door the first time, as a lot less time and effort would have been wasted.

Today's Headlines

Sorry I haven't posted in a while, thanks to those of you who have stuck around.

Lately I have been doing the overnight shift. The bad thing about the overnight shift is that you walk into a messy department. The good thing is that by sunrise, everything has pretty much calmed down.

I have been involved in no small amount of trouble over the past week. There have been shootings, stabbings, and the usual strokes and heart attacks. For the size of this city, we do pretty good. One of my attendings says that working on the pediatric side is pretty much like practicing veterinary medicine, because the infants can't tell you what is wrong with them. I think the same is pretty much true of trauma patients.

I generally don't get much of a story from them. It's usually something along the lines of, "I don't know what happened, I heard gunshots and then I realized I had been shot." Or the more classic, "I was walking to church when this guy just walked up and stabbed me in the chest."

It is generally the next afternoon when I wake up that I get the full story. There's nothing like hearing that the guy you spent 3 hours resuscitating was part of a string of retaliation while you sip your coffee. Or that the guy that died got stabbed because he called his girlfriend a "fatty". Hell hath no fury like a woman scorned, I guess. But then I guess it's better that we don't know what happened... easier not to develop a bias and all that.