With Much Thanksgiving

I have a lot to be thankful for this year.

I hope that the Holiday finds you healthy and with loved ones.

-K

Dinner and a Movie

"Don't worry, about dinner tonight, I'm bringing it down." he said.

"Are you sure? I was just going to heat up some leftovers."

"We can have the leftovers if you don't like what I bring." he countered.

At this point, I was baffled. AG can make a mean pork chop, so I don't doubt that he can cook, and to keep the leftovers handy didn't sound too promising. I had no idea what he could be talking about.

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An hour later, we stood in my kitchen. I watched expectantly as steam hissed out of a small, cardboard box. AG had brought down MRE's (Meal Ready to Eat) for the both of us. Mine was BBQ pork, with clam chowder and a piece of lemon poppyseed pound cake.

The olive green packets didn't look very impressive. Neither did the clear green bag with a white piece of styrofoam in it. The instructions were to add some water and prop the bag "on a rock or something" and showed a handy illustration with the bag tipped, supported at an angle by a "something". I also had a plastic flask which I dumped water and powder into to make my lime green energy drink. Both packets also came with a single serving of coffee, matches, salt, sugar, creamer packets, AG had a mini-tabasco sauce, and napkins that double as toilet paper.

I was pleasantly surprised.

The BBQ pork came with two compressed pieces of wheat bread, cheese spread, and BBQ sauce. The flattened bread and cake products were kind of weird texture-wise, but they didn't taste bad. And the sandwich was filling, I couldn't even finish my meal. (This was probably a good thing because AG says that 1 MRE has a full day's calories packed into it.)

I got a little impatient waiting for the soup to heat up, so it was kind of lukewarm, but it was really hearty, with big chunks of meat. AG's meal was chicken noodle soup that scalded my tongue (guess he's not the impatient one of the two of us!), an energy bar, chocolate shake, and a full package of peanut M&M's.

Apparently, there are about 30 different flavors, and I'm told the Vegetarian Omlet option is the absolute worst. When the guys eat together, there's a great deal of bartering cheese spread for peanut butter, and that sort of thing. It's also not cool to dig through the supply box and pick the meal of your choice.

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As for the movie, we sat down to watch "High Fidelity" and I was promptly asleep in 20 minutes curled up next to AG on the couch. Not a bad date.

Dear Starbucks,

I am almost ashamed to admit how much I enjoy your Gingerbread Latte. However, what I do NOT enjoy is at the very end of it, I always somehow nearly gag myself with the last sip when something solid and chunky hits the back of my throat. Tonight I actually bit down on a piece of it, and I'm just guessing here, but it was semi-crunchy and I think that it may have been an honest-to-God actual piece of ginger, or maybe a clove?

ARE YOU TRYING TO MAKE ME BARF?

There should not be chunks of anything at the bottom of one's coffee, particularly when they have paid over $4 for said coffee! So please, please, please lose the chunks. I would like to just order a latte and not sound like a prima donna when I ask the barista to get me a Grande-Skinny-Gingerbread-Latte-No-Whip with all of the SH!T hand-strained out of it.

Thank you,


-K

Busted!

This year I have been moonlighting at one of the community ED's nearby. It's a different type of patient mix-- most of the patients are insured, and maybe it's all in my head, but they seem to be more polite, and actually follow-up with their private physicians. I typically work a shift or two a month for extra money. I don't want to miss any time that I could be spending with AG before he deploys, and to be honest, I really don't want to give up too many of my days off.

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Anyway, the other night, working at two different hospitals came in handy. I was working with my friend, M, and I grabbed the next chart and walked into the room. It was a young woman who was complaining of bilateral knee pain, and told the nurse that she hadn't been able to walk for the past 3 days. When I walked in, I was surprised to recognize the girlfriend of one of my patient's that I had seen the night before in my base hospital. I remembered her because he was there for a big, long rule-out appendicitis workup and she proceeded to hound the nursing staff constantly and paced back and forth across the department making phone calls (and demanding we feed said boyfriend immediately, despite his reported pain and vomiting, once it turned out that he didn't have appendicitis).

So, I called her on it, and she said she hid the difficulty walking the night before because she was concerned about her boyfriend. Fine. I asked her how she got to the hospital that night because when thinking about pain meds, you typically don't want to give a bunch of narcotics to someone who is about to drive home. That's when she said that she walked to the hospital. ???

Hmm, so I now I have someone who wants narcotics (allergic to ibuprofen, and acetaminophen "doesn't work") for an injury that doesn't make any sense. So, I gave her a shot of an anti-inflammatory that she'd never heard of, and sent her on her way. Reportedly, she'd had months of intermittent pains, no trauma/fall, and a normal physical exam, which to me means no need to waste any time with x-rays/imaging.

Just before she walked out to the waiting room, I ask her how the boyfriend's doing, and she says, "His belly doesn't hurt no more, now it's his teeth."

Hmm...

I sit down next to M, and see what he's up to. Wouldn't you know it, he's right in the middle of writing a prescription for narcotics for a young male with dental pain! I tell him the story, and mention how the guy just got discharged from our ED with narcotics the night before.

So, we both walk back to the guy's room, and I just stand there silently while M grills him for not telling him about the prescription he'd just gotten the night before. He doesn't deny anything, and just sheepishly says that he never filled the first one, but that he still has it at home. M tells him to go fill the first script because we're not giving him anything tonight, and out the door he slinks.

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I am sure that this happens all the time, but as I typically work just in one location, I don't see it that much. With electronic tracking, we now can easily look up just how many times someone's been in our department and what they've been given, so it's easy to tell if they have prematurely run out of their pain meds. However, there's no way to link between hospitals, so we can't really tell just how much someone's trying to abuse the system. This couple will probably still continue their quests for meds, but hopefully it will be to hospitals 3, 4, and 5 instead of the two I'm at.

Missing (parts of) Persons

I get a lot of work-related emails. Most of it is just instant-delete type junk, but this one made me laugh:

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EM Residents and Faculty,

Need your help with an issue here, digits with no owners....

Since August 2008 we have had three separate cases where finger tips or most of a thumb were found unlabeled on trays or in drawers in a bag. The most recent was yesterday. It is impossible for us to track what providers may have been involved in these cases as specimens were unlabeled. I have attached some hospital polices that address this, but I think _______ from pathology sums it up nicely that if the resident is in doubt, put the specimen in a container, label it with patient's name and MR# and send it down to pathology with a requisition. We'd appreciate your help, I'll be sending a reminder to the orthopedic residents as well.

Thanks

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So, I don't know who has been leaving dismembered body parts laying around (or worse yet, shoving them in a drawer?), but it is kind of brings up some funny imagery of body parts just lying around everywhere in random drawers.

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Recently, I saw a prisoner who got one of his front teeth knocked out when he was punched in the face. He tried to put it back in himself, but when he woke up the next morning, he found his tooth lying on his pillow.

By this point, the tooth was no longer salvageable. We put it in a specimen cup and asked him if he'd like to keep it. He said yes, at which point the guards interjected and said that he couldn't take it back to jail with him. We asked if they could store it for him with his personal belongings, and were given a line about there not being enough storage space in the jail.

I had thought about sending his tooth to the lab to have them identify it, just for the kick of seeing a label on the computer that said Incisor; likely human, but in the end, the thing just got red bagged.

dFwMP

Last night, I happened to glance down the hallway and there they were-- gleaming, copper-colored calf boots with a good 5-inch heel. They belonged to a young woman, and how she managed to walk in them I will never know, but it reminded me of a couple of strange cases that I had recently. In the Emergency Department, it sometimes seems like patients seem to come in clusters with the same injury. One shift it is asthma-day, the next is heart-failure day, etc.

The other week, I had two bizarre high-heel related injuries. The first was a young woman who got clubbed in the face by a stiletto. She had a D-shaped laceration present just below her eye. A few centimeters different, and she would have been like that guy in whatever horror flick that was dies after a stiletto to the eyeball by a crazy stalker woman.

The very next night, I had a 30's male come in with an eye injury. He had a lot of bruising and swelling just under his left eyebrow. He also had some loss of his peripheral vision, and his pupils were asymmetric, and the one on the left was not quite round like it should be. Into the CT scanner he went, and there was no bleed. Ophthomology came and saw him and diagnosed him with an iris sphincter tear. As for how he injured his eye, it turned out that it happened in a strip club. Apparently, he was sitting too close to the stage, and when one of the "dancers" swung around the pole, she ended up hitting him with her heel. As you can imagine, there was a lot of chuckling about his mechanism of injury.

So maybe instead of calling them FMP's, we should call them "Don't F With Me Pumps".

Step Away from the Computer

If you are taking the time to read this, I hope that you have already taken the time to vote today. Ok, it may be for selfish reasons, but I hope that most Americans are out there voting and glued to the television today-- that way they're not coming into the Emergency Department with their sore throats and belly pain of six months that must be fixed post-haste (come in all you want after midnight tonight!).

We don't have televisions in our department. I think it would be interesting to do a survey of departments across the country and see if there's any spike in visits at the places that do equip each room with a TV on days like today.

Like a lot of people, I'm sick of this two-year marathon of campaigning, but at least I made a decision at the end of it all. Part of me is secretly hoping that my candidate loses, so if things don't turn around, I can continue with my shrug and "Don't look at me, I didn't vote for him!" mutterings.

Sadly, I went to my local Starbucks to claim my free cup of election-day coffee, only to discover that they had gone out of business, and I refuse to go to the ones downtown where you have to pay for parking!

This morning, all I had to do (after finding my unmarked, unadvertised voting site) was state my name and sign somewhat similarly to the old signature they had on file. No goverment ID, no recitation of a DOB or SSN, nothing. Maybe someday we can actually learn how to tally votes without any questions of validity, but unless there's a landslide today, I predict weeks of arguing to follow.

Um, yeah...

It's been a while since I've written anything here, and it is not for lack of activity. Today is day 14 since I have worked a shift in the Emergency Department. Two weeks ago, Army Guy and I packed up my Saturn and drove off to Ohio to spend a week with his family and high school friends. (AG's car threw a fit and decided to throw a piston while he was driving down the other weekend, which ultimately led to selling it to an "auto recycler" and the decision to rent a car until he deploys.) I had never met any of them before, and was nervous-- although mostly about if I would make a good first impression with the family's 20 year-old Sheltie. The week flew by though, and it turns out that AG and I actually like each other enough to survive long car rides!

This past week, we went to Chicago to attend the American College of Emergency Physician's annual assembly. It is basically four days of death-by-powerpoint followed by late-night drinking/dining with one's co-workers. My program pays for each senior resident to attend because it is also a good networking opportunity for residents to look for job openings across the country. AG was also able to go with me, so he spent the days exploring Chicago and then we would meet up each evening. The last night we managed to squeeze in a date night and went to see "The Brothers Karamosov" at Looking Glass Theatre. The stage itself was pretty small, but the performance blew us away, as we usually go to local community/college theater.

Halloween ended up being pretty quiet. We passed out candy to the local trick-or-treaters, and then went to see a local production of "Dracula", which turned out to be in a church basement of all places! It didn't quite compare with the professional theater company, but it still was a fun way to spend the evening.

So, it's been a busy couple of weeks, and I am not exactly looking forward to my shift tomorrow!