You Don't Know D _ _ _

The PICU is running at about half-capacity this week. As a result, we had the Inauguration coverage playing live on the television in Room 1. There were about a half a dozen of us clustered together in there at one point, when suddenly--

"Who's the guy in the wheelchair?" a lone voice questioned.

"That's Dick Cheney, he strained his back packing, or something." I said.

"Who's Dick Cheney?" she asked.

"Only the current Vice President, who's been in office for eight years." scoffed my attending.

"Dick Cheney, you know the guy who shot some guy in the face while he was out turkey hunting," a nurse chimed in. (Well, at least she was sort of right.)

"Oh yeah, that guy... Huh, I guess I've never seen him before," she said, defensively.

There was kind of a long, awkward pause and then people started guessing who Nancy Pelosi was. To their credit, they did recognize Steven Spielburg...

Brr

-11F is really just too silly to go outside.

New Low

The other day I confronted a woman who was seeking pain meds. The medical student saw her first and there were a few things during her presentation that just screamed that this lady was going to be trouble:

1. Abdominal pain x 1 year

2. Recent month-long admission with no diagnosis

3. Multiple abdominal surgeries

4. Allergic to morphine, "Only Dilaudid works"

5. "I need a PICC line, no one can ever get an IV on me."

At first I felt mildy guilty for being cynical, but as the case unfolded, it turned out she had lied to us during the interview. When I had asked if she could be pregnant, she said, "No." When I told her that she was, she said, "Oh yeah, the hospital yesterday said that, too." Her pain had been coming and going for about a year, so there wasn't anything to do emergently besides some basic labs and physical exam.


We got ready to discharge her and she asked for pain meds. As it turned out, she already had a prescription for narcotics from another hospital, but it wasn't very pregnancy-friendly. I don't like talking down to people, but in this case I told her that the only way I would give her a prescription for a pain medicine was if she gave me her other one to destroy. So we traded prescriptions. Let's just hope she doesn't call the other hospital up saying she "lost" their prescription. In the meantime, I've sent a nasty-gram to her primary physician. I will still probably end up with a letter from the Board of Health in a few months letting me know she got multiple prescriptions from different providers, but at least she left my department with a prescription for a safer drug.

Just before discharge, I looked her up in our computer system, and the only thing listed was a previous admission for what turned out to be pseudoseizures and there was a mention of "drug-seeking behavior". When we confronted her, she didn't deny seeking pain meds, but now I wonder if I didn't miss the real diagnosis.

Sigh

I have been meaning to post more, but it's been a busy week with lots of minor headaches.

A couple of weeks ago, I signed up for direct deposit at my moonlighting job. Last week, I got the paystub, but somehow no $ showed up in my bank account. I gave it a few extra days becuase of the holiday, but nothing came of it. So, I went into the bank. I showed them the pay stub, it had the right account number on it, and several phone calls later, the bank manager had it figured out. For some reason, the hospital, despite being given a voided check, put a New Jersey routing number on the account instead of my actual routing number.

So, I called the hospital.

I explained that the wrong routing number had "somehow" been put on the account, the bank was returning the check, and could they please put the right routing number on it to fix future checks. Apparently, this was too much to take in, so I had to wait until the payroll person could get back to me.

The next day, the payroll person calls back. She says that she can't understand why the check didn't go into the account, that she looked up the routing number for Bank of America by my zip code (not New Jersey, btw) and it should have worked. At this point, I tell her that the routing number doesn't have to do with my physical address, it has to do with where the account was opened, and it matches the account number, not the bank branch I visit.

This is where it gets more stupid.

I tell her that the bank account was opened in Arizona, and she says that she's "not authorized to send paychecks to Arizona." I try to explain that when you do your banking with a major company, you don't have to change your account numbers when you move across the country, they stay the original number and routing number as when they were opened. I halfheartedly try to explain how things work electronically and there is no actual paycheck that goes to Arizona and then back here, and that the bottom line is that I just need the right routing number that matches my check put on the account.

At this point, she says that she has to talk with corporate to see how she can get my check out to some bank in Arizona. I tell her that it's not "some bank", it's just Bank of America, with a different routing number than the local one. I mention how at my main hospital, I have direct deposit, and there was no issue with getting it set up. However, she is unwilling to type in the routing number on my check and is hung up on putting in a number by my current address.

At this point, I decide it would be more convenient to just deposit the check in person every two weeks rather than spending more time on this. So, finally she agrees to just continue mailing me my checks. Before she hangs up she says, "And it will be much quicker for me to just mail the check to you, rather than me mailing it to Arizona and them having to mail it back to you to be signed." ARGH!

I have a sinking feeling this income is going to be on both my 2008 and my 2009 W-2's, but I think I'd just rather take the tax hit twice than talk to her again.

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Then there's been the argumentative not-sick people fake coughing/wheezing and not understanding why I can't admit stable bronchitis, the people demanding IV antibiotics when they aren't appropriate based on their culture results, and of course, the "my doctor sent me here for an MRI" crowd.

I'm back to doing floor medicine for the next four weeks. I'm sure I'll be stir-crazy and wishing I was back in the ED by the end of it, but for now I'm looking forward to getting out of the department.

Happy New Year!

Happy New Year! I decided to finish off 2008 by breaking my right pinkie toe. It was stupid-- I was putting away laundry and just managed to stub it hard on the corner of the bed. I've iced it, buddy-taped it, and have been taking ibuprofen when I can remember to. Most of the time, it's fine, but it has caused me to hobble around and try to heel walk on that side at work the last two nights.

Behold, the unhappy piggy (ignore the sad state of my toenail polish):

All in all, 2008 has been a great year: I fell in love, ran a half marathon, had a great Alaskan adventure, and have signed a contract for my first "real" job. My family and friends are doing well, and I really can't complain. Overall, I feel happy and confident, and can't remember the last time that I have had so many things to look forward to.

2009 however, is off to a violent start. I worked the overnight shift, and despite starting out with an empty ED, it was crazy. At midnight we wore party hats and toasted each other with sparkling cider. We potlucked, and waited for the chaos. It finally started at about 1:30. Multiple patients with multiple stabbings, several overdoses, too many head lacerations to count, and every kind of skull fracture/head bleed combo imaginable: depressed fractures, non-depressed fractures, subarachnoid bleeds, subdural bleeds, intraventricular bleeds with impending herniation. That last one is going to turn into the first homicide of the year... our charge nurse was joking at the beginning of the shift that there should be a door prize for the first homicide of the year like there is for the first baby born in a local hospital (yes, we are a dark-humored group).

I spoke with AG this morning, and he sounded in good spirits (although getting tired of lobster, poor boy!).

So here's to 2009: Bring it on!

Jet Lagged

Luckily, I was able to squeeze in a quick visit to my parents' home this past week. Originally, I had planned on leaving after my shift on Sunday night. I raced to get all of my dictations done and sprinted out to the parking lot in the snow. The usual 20-minute drive to the airport took over 45 minutes, and sadly my flight was canceled due to the current storm, which ultimately resulted in 13 more inches to the already established impenetrable wall of white fluffy stuff on my lawn.

ALL of Monday was spent in various airports and my new route included an extra layover and routing through O'Hare, where 200+ flights were canceled. So, I arrived in Phoenix late Monday night, over 22 hours later than planned.

The visit home was brief, but great. It was good to spend time with my quirky brothers and sister-in-law. We helped make gingerbread cookies on Christmas Eve. For reasons unknown, my mother had acquired a lobster-shaped cookie cutter, so many a ginger lobster was born. Being the reclusive group we are, we skipped the hometown Santa parade and gathering of the masses in the town plaza, and headed off to our traditional candlelit church service. The failing octogenarian organist played at 1/3 the correct tempo, and appeared to have a dissociative fugue during the 4th verse of "Joy to the World" as she suddenly began playing a different song with her left hand, while somehow continuing on with her right. It was very strange.

Many a homemade tamale was scarfed down by yours truly. The javelina are again on the rampage, and gobbled up mom's poinsettias by the front door. I hope they get a tummyache.

My parents loved the GPS unit that my brothers and I pitched in on. (It's always more fun to me to watch other people open the gifts I picked out than opening my own.) The MRE's sent by AG were a big laugh, although having arrived later than planned, there wasn't a good time for us to make a meal of them together.

Christmas Day there was prime rib, mashed potatoes, green bean casserole, homemade rolls, Yorkshire pudding, cranberry jelly, and cranberry relish. Sister-in-law outdid herself again with a chocolate cream pie and blackberry/raspberry cheesecake in addition to the assortment of holiday cookies. AG was able to call and is doing well. Apparently, there's a surplus of lobster and steak at the current base he is at, poor guy!

The flight home was uneventful. Half of the snow had melted away in my absence. No sooner had I made it in the door, when I got a call asking if I could work the overnight shift as someone had called out sick. I already had the early shift today, so that wasn't possible, but I got up extra early in the morning and called in to make sure they weren't in overwhelmed mode.

Today was the usual list of suspects: headache, nonspecific abdominal pain, chest pain, acute exacerbation of chronic back pain, neck strain, suicidal ideation, scabies, vaginal bleeding, et al. Guess it's back to the grindstone!

Santa's Knee

It has been snowing a lot here lately. The snowblower has piled snow up past the the height of the doors of my car on each side. I have a narrow driveway, so there's barely room anymore to drive down between the walls of snow.

The other night I was working in the Pediatric ED, when I happened to glance over at the adult side. There, in room 19, was a man in his 60s wearing a t-shirt that tugged at his beer belly, red suspenders, and blue jeans. His long white hair snaked past his shoulders and he had a full scruffy beard. Both hands were bandaged with gauze and were obviously now reduced to bloody meat as blood was ominously spreading across the dressing. As it turned out, he'd stuck not one, but both hands into his snowblower.

For only a brief second, I thought about grabbing the closest screaming tot and plopping him/her down on Santa's lap. Perhaps AG and I should start with a dog...

Drats

Last week we wrapped up the first arm of our rat study. The study was time consuming, in that I had to drive into work 2-3 times per day to check on them and do testing. It was also interesting in that we learned to develop our protocol along the way. For example, one of the symptoms that we were looking for was renal failure, so we were monitoring urine output. At first, we were going to base this on cage weights, but that seemed too variable. Then we decided to line the cages with an absorbant pad that we could easily glance at for urine output. The rats responded in kind by chewing up the pad to make nesting material. Finally, we had to resort to wire cages with pads below to collect specimens. This, of course, required more paperwork.

This was the control arm of the study, so we were giving the rats a known chemical compound, and then treating them with placebo (saline). The next arm of the study would be administering the same weight-based dose of chemical to a new group of rats, only this time administering a likely antidote with the expectation that there would be less behavioral changes and less cellular damage.

Our dose of toxin was based on an "established" LD50 from other people's research (Being a child of the 80's I'm going to call this O.P.R.). LD50 is short for lethal-dose 50, and means that 50% of subjects receiving that dose should die. This is somewhat variable given that nothing in medicine is exact. From OPR, death or at least renal failure was expected to develop in 3-5 days. Our control arm was 10 days long.

Unfortunately, we ran into a huge problem: NONE of the rats died. There was some weakness noticed with behavior testing and at least one of the rats was doing some odd drunken head-bobbing, but that was about all that we noticed.

Being the suspicious women that we are, we had ordered extra rats in case some of them failed the baseline neuro testing, so we had a few extra rats to work with. On day 6, we gave those extra rats double the LD50 and....

NONE of them died, either!

So now there's a huge problem with our study in that if our chemical compound is not actually toxic at the dose we gave, we can't really proceed with the antidote arm. We have contacted the people behind OPR, and not really gotten anything other than, "hmm, that should have worked." Currently, our tissue samples are with the pathologist, so hopefully there will be some sort of changes at the cellular level, otherwise we have to either ditch the remainder of the study or do another study to first determine the proper LD50.

In trying to figure out what went wrong we've thought of:

1. Maybe our chemical isn't what the label says it is (and it didn't have an expiration date), so we have sent samples to an outside lab for analysis.

2. Maybe by administering saline we prolonged the renal failure and study wasn't long enough to reach our endpoints of renal failure/death.

3. Maybe our math was wrong, but it's been quadruple-checked.

4. OPR was wrong, and we need to do a separate LD50 study.

So there has been a lot of learning with this project. Either way, I have something to present for my required academic project, but I really wanted this to work. There have been a few accidental contaminations in consumer products with this compound, and it would have been cool to be part of the research behind developing a protocol for treating an ingestion. There are still blood tests pending as well, so for now, I am crossing my fingers and trying to be patient.

12-Month Countdown

525,600 minutes, 525,000 moments so dear.

525,600 minutes - how do you measure, measure a year?

In daylights, in sunsets, in midnights, in cups of coffee.

In inches, in miles, in laughter, in strife.

In 525,600 minutes - how do you measure a year in the life?

How about love? How about love? How about love?

Measure in love. Seasons of love.

"Seasons of Love" - RENT

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I hate goodbyes. Yesterday, when we left to take AG to the base it was still dark outside. The moon was full, and it was frigid, with the thermometer reading below zero. This was the moment I had been dreading for several months. I hate getting emotional, and worse than that, I hate being emotional in front of people.

The past week, his parents and I helped him pack, and clean out his apartment. I now have an attic with a great big pile of army duffel bags and Rubbermaid storage containers. Being on an elective block, I was fortunate to be able to spend a lot of time with him this past week, but somehow it is never enough. His parents were a huge help, if they hadn't been there I would probably still be cleaning and packing today.

Family and friends no longer say their goodbyes at the airport, so we dropped him off and watched him pile into a van. He still had several hours of waiting to go before his flight. When we drove away, the sun was rising, and because of the weather, there was a strangely bright beacon of light that appeared to be shooting up from the sun.

In a way, it is easier now that he is gone, in that now it is just a year-long wait before he comes back. The dreaded goodbye is over, and the waiting is out of my control. Due to his position, he should have occasional Internet access and phone usage, and compared to the places that the other battalions are going, he's going to probably one of the safest areas. I am fortunate in that I have a supportive family, friends, and a busy work schedule to distract me.

New Vocabulary

Well, it's official: AG and I are engaged. We exchanged Christmas gifts early as he is leaving for Afghanistan later this week. I thought we were done when he suddenly pulled a ring box out of his pocket, dropped to one knee, and asked me to marry him.

Of course I said, "Yes!"

We have talked a lot about the future over the past few months, and although we had talked about marriage, I didn't think that he was going to propose before he left because there's been just too much other stuff going on. Being a traditionalist, he made what must have been a very anxiety-provoking phone call to my father to ask for his permission.

Now I just have to get used to saying the word fiance.

Strung Out

I just finished putting up more Christmas lights. Last year, I was working in the ICU up until the week of Christmas, so I just didn't bother. The year before, I was disappointed to see that the strand of lights that I had bought didn't span the width of the house. When I went to buy more lights, I was disappointed that the store was sold out of the weird snowflake-style icicle lights that I had bought.

This year, I saw that Lowe's was carrying the right kind of lights, so I quickly bought another strand. I put up the lights last weekend and was agitated that I now only had enough lights to span just over half the width of the house (it's really not a big house, so this was puzzling). Today, I put up two more strands of lights, and now they wrap around to the side.

Putting up lights is somewhat of an adventure. It requires balancing a ladder in the mulch of my unevenly surfaced flower beds. While I was on the ladder, the snow flurries started. An elderly woman stopped on the sidewalk and complimented me on how she likes looking out the front of her house and seeing all of the lights. This was nice to hear as I tried to balance towards the house in anticipation of a failing ladder.

As I got around to the side, I realized that I could no longer use the more stable inverted V-shaped option of the ladder because the slope on the side of the house is too steep. So, I resorted to propping the ladder against the side of the house. While reaching up and somewhat backwards to reach the nails, I was reminded of a news report that I heard a few years ago. It was something about how the risk-taking center of one's brain typically matures at age 25. For me, this is definitely true. (Apparently this has never happened for "The Phoenix" in regards to her driving!)

Like my father and his mother, I am a true worrier. Last week, I screamed as we slowly went down a hill on the four-wheeler. Maybe it's occupation-related. After reducing ankle fractures from four-wheeler and ladder injuries, not to mention toe amputations from lawn mowers, I guess it's somewhat of a miracle that I don't wear full football gear every time I leave the house or operate machinery.

The good thing about being precariously perched against the side of my house on a slope was that if I fell backwards, I could shorten my fall by landing on my neighbor's suburban. Perhaps they had OnStar? Maybe it would automatically call for help when I hit the roof?

To my dismay, I ran out of nails for the lights about 10 feet along the side of the house. So now I have a clump of lights hanging down. Oh well, I'm not getting back on that ladder for a few weeks...

Stuffing

My holiday weekend got off to an unusual start last Wednesday. AG and I had planned for an early start, however at the last minute, I found out that the meeting I had been waiting for the past week to occur was going to happen at last that morning.

My rat study is finally becoming an actuality. However, to make it happen we had to have one more day of animal training. Bits of white fur went flying as we learned to do saphenous vein draws, gavage feedings and how to sedate the little beasties. At one point it was somewhat festive as the lab expert showed us how to deftly guide a rat into a cylindrical bag with an opening at the end to make the feedings easier. As she guided the rat into the bag further, with it scurrying towards the opening and tail hanging out, I couldn't help but think of how this was similar to squeezing frosting out of a tube when cake decorating! Our test subjects gave the ultimate sacrifice in the interest of training us for autopsies, and I wondered if there was anyone else on the planet thankful at that moment that rat dissections are relatively straightforward.

Meetings when you are in a rush never seem to end, and I quickly raced home to help load up the cooler with snacks and AG and I were off, an hour and a half later than planned. It was a long drive, prolonged by Lake Effect snow that hurled at the windshield and increased the weight of our eyelids. We were on our way to his aunt's house out in West Virginia. Along the way, signs read "Buckle up for next one million miles" and I knew I was far from home when an Amish buggy, complete with horse, crossed over an overpass.

Finally, we made it. His parents soon joined us, and we all settled in for the night. The next morning, visitors progressively arrived, until we had 30+ people situated at three different tables. (AG's family is like mine in that neither of us will ever make it to the adult table.) I don't know how his aunt did it all, but she was able to orchestrate plenty of room for everyone, and somehow managed to have the dinner dishes washed and stacked while the rest of us nibbled at an incredible selection of pies.

Thanksgiving morning, AG and I went for a bit of a ride four-wheeling, followed by target shooting out in the backyard. I had never fired a gun before (I always refused to go out with my father and brothers, being the petulant teenager that I was), and took turns at two different rifles and two different handguns. I actually did pretty well with an older bolt-action style rifle than with the other ones which had fancy magnification scopes and laser-sites. Something about just lining up the iron sites and watching casings flip out of the rifle each time I cocked it amused me. I did alright with the 0.22's, but when I switched to a 0.40 caliber handgun, is when I took a beating. For the next two days my arms were sore, just from lifting the weapons, and bracing myself when I fired them.

After Thanksgiving, we drove back to AG's parents' home. Over the weekend, we met up with several of his friends and family, and did an early Christmas gift exchange. I think that you can tell a lot about a person by their friends and relatives, and it's neat to see him in that kind of environment. The weekend went by all too fast, with lots of hurried goodbyes before he leaves for deployment, but I was happy to see that he has such a strong, supportive network.

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!