20 Out Of 10

Blog Funeral

2011-08-20T10:56:00.000-07:00

I have been in denial about the life left in my blog for a long long time. I keep thinking, "soon, I'll get back into it and start updating it again," but soon never materializes. This week I started a new job at a regional call center as an advice nurse, and thus it seems a bit silly to continue an ER blog.

I could just change the blog and share my adventures in cubicleville with everybody, but: 1. it would probably be a bit boring. 2. I would be fooling myself to think that I am actually going to maintain a blog with three kids and a busy life.

With all that said, a eulogy:

It was a good blog, but it bit it.

Thank you to everyone who participated over the years and for all the great comments and support. It was fun.

Long Time, No See

2011-02-20T15:38:00.000-08:00

Just a quick note here. It has been over a year since my last post, and for a long time I've been wondering if it is just time to pull the plug on this blog. After thinking a lot about it, I'm not going to do that just yet. With three kids 3 and under, life has not been quite so free as it was when I started the blog, but I hope that as the kids get older and less time-intensive, it will give me more time to work on updating the blog, so if you are still subscribed to this feed, don't bother deleting me just yet. I'll try to post a little more often, though probably not regularly.

I am deleting my 20outof10 gmail address, though, because I get a lot of junk mail there from people saying "how much we love your blog, and oh, by the way, would you post this article and link to my blog?" when it is obvious they haven't even looked at my blog.

If you really need to get in touch with me, just leave a comment on any post, as I get email notifications of comments.

Thanks.

Feces

2010-02-04T12:03:00.001-08:00

WhiteCoat's got a great post up on his blog. I'll give you a sneak preview:

...I don’t know any adults who have developed post traumatic stress disorder from taking a dump...

I'm Sorry, Sir, I Don't Remember How To Do My Job

2010-01-16T10:06:00.001-08:00

When you stop to think about it, it is rather interesting to consider that an emergency nurse is one of the few specialists in the medical field that rarely gets to really practice their specialty. That is because very little of what actually comes through the doors of the emergency room really qualifies as an emergency. So I spend most of my day pushing Dilaudid and Zofran, and very rarely do I actually perform emergency procedures. To the point that I'm very nervous to get a true emergency - not just because somebody's life is in the balance (a good reason to be nervous) - but because I haven't set up a vigileo monitor or titrated nitroprusside or helped with a cutdown or identified a pneumothorax in a long time. And please don't come to me with your premature baby coming out. Yes, I have an NRP certificate, but that's all theory with plastic babies. Hand me a real one and I may panic.

And that is why I take on each true emergency with nervous excitement. I'm here, after all, to save a life, but after all those ankle sprains and reflux pains and migraines, I'm just a little bit rusty on my A's, B's, and C's, so give me a minute before you stop breathing completely.

A Paramedic Gets it Right

2009-12-25T16:37:00.000-08:00

I have great respect for paramedics. Having to be on the frontline and running into situations without knowing what to expect in order to help others is among the highest levels of bravery. I really love, though, when I hear stories like this one, taken without permission from a blog of one of our family friends:

Let me paraphrase the backstory: This man (one of the greatest men I've ever known, incidentally) fell off of his roof last month and broke several ribs along with a collarbone and some other injuries, leaving him in the hospital for three days and off work for a month. Fortunately, he is doing better now, but here is the story he tells of a great blessing he got (with names removed):

About 10 days after the fall, and after a big wind storm which left our yard strewn with branches, [my wife] was again outside working by herself. A firetruck pulled to the front of the yard and 5 firemen got out - they told [her] that they were responding to a false-alarm fire nearby, when one of the 5 (a paramedic who had assited me to the hospital) noticecd [her] working outside and knowing the situation, suggested they take 20 minutes and help out. What a blessing they were to her - the whole yard was cleaned up in those 20 minutes - it would have taken [her] several hours. We've been truly blessed!

Finding that kind of love and service anymore is so rare, and I give huge props to these firemen for giving of their time when they could easily have just gone back to the fire station to rest and get ready for their next call. What a great story to embody the spirit of Christmas.

Merry Christmas, everyone!

Nashville Pulse, But Not For Long

2009-12-21T22:19:00.001-08:00

It's late, and I'm too tired to figure out exactly what dysrhythmia Nashville Pulse is using for their logo (came across it in the app store), but I think it is some kind of heart block. Among the many problems with this heart rhythm, I'm a little concerned about the length of the pause immediately before this dying blip. Also, this patient appears to have a U wave and an S-and-a-half wave, and is it just me or is that atrium not getting much loving?

Z-Coil Shoes

2009-12-02T20:33:00.000-08:00

I have always laughed at that those shoes that are becoming more and more popular with nurses with a giant spring on the back. They look goofy.

And yet as my plantar fasciitis continues and I go home from work in pain every day, I've become a little desperate. Tonight, I stopped by my local uniform store and tried out some Z-Coil shoes. I was a little bit dismayed at how comfortable they were, because I didn't really want to talk myself into getting silly looking shoes. I was also a little bit dismayed at how much they cost.

That said, I think I am going to pull the trigger and get them anyway; unless someone who has worn them can talk me out of it. That's where you come in. Go ahead. Do your worst.

I Think I Know This Patient

2009-11-26T10:25:00.001-08:00

but then again, I think we all know this patient.

Definitely worth three minutes of your lives.

Unless you happen to be an all-too-typical ER patient. Then you will find this offensive.

The One That Got Away

2009-11-23T07:12:00.001-08:00

This one was from several years ago, and I may have mentioned it already in a post, but it invaded my dreams last night, so what better dream therapy than to bore you all with it.

I was an ER tech at the time, so I don't know all of the details, (as an aside, it is interesting to see life from both sides of the ER bubble. I thought that I was so involved in patient care as a tech, and now that I am an RN, I realize that I really didn't know anything about what truly goes on in the ER. I'm sure it would be a similar jump to go from nurse to doctor.) but I remember this guy was a really nice guy. He was probably about 50 years old with a great sense of humor and he and his brother were joking back and forth every time I went in the room to do anything. He had come in for sudden onset of debilitating leg pain.

A few hours later, I was working in another area of the ER, so a different tech was to take him down to radiology for an imaging study. Somehow along the way, he coded and was rushed back to the ER. One code was already in progress (I was tied up in that one - another devastating and unexpected code), but whoever was free went to help save this guy. In all, they tried for an hour and a half but had to call the code.

As I think back on it, I have to think that the most logical explanation for this guy's code was a PE, but that seems too simple and I had the impression that the nurses and docs were confused and had no explanation. And the poor brother was devastated. One minute he goes in to the ER with his brother to get some pain pills for a leg injury, and the next minute, he is signing the mortician's paperwork. And as if he needed the case compounded, nobody on staff was assigned to be with him and explain what was happening, so he stood outside the door to the room watching CPR go on and on and on, not knowing what to expect or how to take what he saw.

As you will hear from anybody who has been involved in codes, they are very stressful for the team working to save someone's life, and often, in some kind of attempt to maintain sanity, and cope with the situation, a few jokes will get cracked. Such was the case here, and because nobody ws with the brother and he couldn't hear what was happening, he just assumed that nobody cared about his brother and perhaps even that they were making fun of him.

All in all, it was a very sad night and a hard one for the entire staff. By the time all was said and done, three codes had been run simultaneously, with the only survivor being the 88 year old with dementia and a laundry list of health problems, while the two younger, generally healthy patients both getting the wrong kind of discharge. What I will always take away from that night, however, was the vision of the brother of the patient I described and the 16 year old daughter of the other patient, both of whom were standing outside the door in shock, trying to find a way to cope with what they were seeing. I did what I could to try to comfort the daughter and explain what was happening, but I was young and new at this and didn't know what to do.

When they teach you the ABCDEFGHI mnemonic in your TNCC and ENPC classes, please don't gloss over the F is for Family part.

Today's "Reason For Your Visit"

2009-11-20T06:23:00.001-08:00

When a patient checks in at our ER, they are asked to fill out a half-sheet of paper with name, phone, SSN, birth date, and "reason for your visit".

Whenever I work triage, I write down the interesting ones and have been building up a list. Some are funny, some embarrassing, and some just tickle my warped sense of humor. I try to give the benefit of the doubt. I know that these people are hurting and just want to be seen, but it still makes me shake my head to see some of the things that patients can come up with.

Thus, my regular (as in whenever I feel like it) series, "Reason For Your Visit." Please keep in mind that spelling, punctuation, and capitalization are copied directly from the original paper.

So let's get to today's Reason For Your Visit:

hurt ankle rolled ankle

Unfortunately, I got the triage done before the whole poem could be written. I later found it laying on the floor, scribbled on the back of a tongue depressor:

Inside, outside, upside down
I walk a lot to get around.
Oh, no! twisted, bent, and pulled
My foot moved how it never should!
hurt ankle rolled ankle, ouchie ow!
Let's get to the ER now!
Nurse, oh nurse, you little elf,
Dilaudid won't inject itself!
Get me back or I'mma holla,
Fix me now on your tax dolla!
Thank you, thank you. Happy clam
I really like green percs and ham!

How to Get Seen Faster

2009-11-20T06:09:00.001-08:00

ERP has a post up about how not to get seen faster over on his blog. Read that (hint: how it should be done), then consider this:

A month ago, I was told to leave my four other patients to triage a boisterous lobby patient. "Just check her out and see how she is doing," the manager told me, as she escorted her into an empty room in the ER. I dutifully triaged her and went through the litany of ridiculous questions forced upon us by Jay, Co.(TM), and at the end of that marathon of pointless questions, I pulled out the thermometer to get her temp. As I was so doing, the doc walked in, asked her why she thought she would get seen any sooner by making a fuss in the lobby and told her that she was going to wait her turn, then walked out. As soon as she found out that she was to go back to the lobby, she started screaming and kicked over out vital signs stand and broke it.

Her reward: getting chased into the parking lot by the nurse manager as she stormed out, and getting escorted back to an ER room so that the doctor (who she yelled at for being "unfriendly") could see her, because as we all know, we can't have an unsatisfied customer.

And the 5000 dollar paperweight on the floor? Written up as a loss. To this day it still hasn't been replaced.

And that, among many similar stories, is why I quit that job and am about to start at a better hospital.

And that, among many other reasons, is why I have been very sparse in my blogging of late. Thanks for sticking with me. I haven't given up the ghost yet.

Mercy Mercy Mercy Me

2009-10-02T23:43:00.001-07:00

Oh Mercy, what a load of crap this show is.

I don't expect medical perfection from the shows I watch, but can we please get a writer or two who have actually seen a hospital before? Please?

A particularly egregious example: old man on a respirator (on a med surg floor...) with the tubes right next to him but nothing going into his airway. The nurse goes over and turns off the monitor (not the respirator) and the man instantly flatlines (as indicated by the beeping from the machine that she just turned off) and another nurse calls out the time of death. I hope they have very good malpractice coverage.

Or another example would be the time that the med-surg nurse barges in to the ER with an ambulance patient and shouts orders only to be turned down by the ER doc who spends the rest of the two episodes as an internist.

Or the urine drug screen that told the doctor exactly how much oxycontin was in a patient's system. A urine drug screen only indicates the presence of drugs, not amount, nevermind that it isn't even specific to oxycontin. In reality, the only thing the doc would have known is that the patient had taken a percocet in the last 48 hours.

Or the guy who gets compartment syndrome which makes him spontaneously get dizzy and pass out. He wakes up after having had an emergency bka surgery, except he is in the same bed (what, they can't afford a recovery room in this hospital?) with no monitoring equipment.

Here's a great one: the master's level nurse who has never set foot on a nursing unit before. I want to attend that university that requires no clinical or preceptorship up through a master's degree.

I also enjoyed how the nurses seemed to float wantonly between med-surg, ICU, ER, and oncology units.

Along those lines, did anybody else notice that the woman who was found unconscious in a donut shop bathroom and whose lung function was deteriorating to the point of death, was:
A) on a med-surg floor
B) with no IV
C) with no respirator
D) with no resuscitation attempt despite not having any POA or living will. Let me tell you, if you make it your hospital policy to make unconscious people DNRs, then you are just begging for some mondo lawsuits.

Oh, and don't get me started on the needle decompression.

So why did I sit through two hours of this drivel? Chloe. She's cute.

Don't tell my wife.

Typo of the Day

2009-09-26T11:21:00.001-07:00

A nurse using our computerized medication charting system couldn't find a simple heart medication. I found out the reason: He was searching for asspirin.

Epi Strikes Again

2009-08-11T22:06:00.001-07:00

When Epijunky really gets into the prose, you just can't stop reading, especially with a climax as good as this one.

I really connected with this line:

As much as I wanted to strangle Elle for calling us for the fourth time in seven days, I treated her as I’d treat a family member.

And that is the true art of healthcare - stepping away from how disgusted we may personally be with patients and still treating them as well as we know how medically. It can be pretty hard sometimes, and every once in a while (as was the case here) treating them like family means giving them a nice hearty slice of reality.

Office of the National Nurse

2009-08-02T10:48:00.001-07:00

Can somebody explain to me what the draw of having an "Office of the National Nurse" would do besides put several more salaried positions onto an already burdened tax system? I know that the default answer is "give nurses representation," but I want something more concrete. Besides being a puppet, what would this position actually accomplish?

What Works on the Floor, Doesn't Necessarily Work in the ER

2009-07-31T21:09:00.001-07:00

Good idea on the floor: 4:1 nurse ratios. It helps keep the nurses from being overworked. Result for the ER: management wont even consider the much safer 3:1 ER ratio because "we are just following the law".

Good idea on the floor: printing rhythm strips on monitored patients. It proves that someone is paying attention. Result for the ER: Despite the patient's heart rhythm clearly documented on the EKG we just got and their telemetry reading being displayed 2 feet from the doctor's head, I still have to take the time to go print a rhythm strip and sign it.

Good idea on the floor: hourly rounding. It gets the nurses up out of the piles of mandated paperwork and into the patient rooms. Result for the ER: I have to leave my crashing patient in 5 to go fluff the pillow of the ingrown toenail pain in 6 to prove that I'm "customer service oriented"

Good idea for the floor: treatment goal posted on the whiteboard. It gives everybody an idea of what, specifically, that patient is hoping to achieve. Result for the ER: with patients rotating in and out every hour or two, there is no way to keep up with individual goals. The end-product: everybody's white board says "goal: to feel better." Yeah, that's a nice one to have up on the board at the end of a failed code.

Do you have any others?

Centers for Medicare Stupidity

2009-07-21T21:57:00.001-07:00

Kevin says it so well.

Schwarzenegger Replaces Most of Nursing Board

2009-07-13T23:22:00.001-07:00

This alarms me a little, as I think that based on my experience, most allegations against nurses (at least the ones that I've heard about) are false, or at least overblown. I am a firm believer in cause and effect, and nurses who are defacing the profession deserve what they get. I like the idea of cleaning house and getting a fresh start, and I agree that years to investigate wrongdoings is far too long, but I fear that a new nursing board that is put
in place solely because the last board wasn't swift enough to punish
nurses may go overboard (no pun intended)

What do you think?

Today's "Reason For Your Visit"

2009-07-11T12:45:00.001-07:00

Dissness

I think everybody has been there before, but the answer to being dissed isn't an ER visit, it is a night out on the town with good friends. Then again, to some of our patients, we are their good friends, and what better way to forget your sorrows than in a good Dilaudid cocktail?

Today's "Reason For Your Visit"

2009-07-08T22:55:00.001-07:00

sic

[sic]

Your Long-Overdue Update

2009-06-23T19:37:00.001-07:00

Hello to all my faithful blogees. I know it has been quite a while since my last post, but hopefully you will understand what with the move and all. We are finally getting settled in our new home and are loving the improvement in weather from Washington State. I started at my new hospital over the weekend, and I feel a little like a new grad again, because nearly all the equipment is different, many of the meds are different (I had never even heard of Norco before) and so many of the policies and procedures are different that there is a huge learning curve. That said, I love my coworkers so far and I can't argue with the pay raise (more than 1.5 times my previous salary with only a modest cost of living change).

Perhaps the biggest change is going from a 3:1 patient ratio to a 4:1 ratio. I thought that I had to run before, now I have to fly. One of my coworkers told me about her old ER out east where they would work 6 or even 7 patients per nurse. I'm the kind of nurse that really enjoys taking the time talking with my patients and learning who they are and what they need. So far in this new place, I feel like I only have time to run from task to task and then I'm getting a new ambulance. I'm confident that I will adapt and everything will go okay, but it is still a big change and makes me feel just a little overwhelmed so far.

I'll try to get back to doing more regular blog updating, but bear with me as we finish getting everything settled and getting to know our new area... and lounging by the pool soaking up the sun. I have a tan for the first time in years. It's very nice.

Is It Just Me...

2009-06-04T12:47:00.000-07:00

Or is there something refreshingly appropriate about scheduling the Obama White House Spectacular right after "I'm a Celebrity, Get Me Out of Here"?

Just saying.

The Walmart Shooting

2009-06-04T00:22:00.001-07:00

I live less than half a mile from the Walmart in Lakewood, Washington where a security guard was executed yesterday as he walked out of the store carrying a bag with some money in it. The shooters, the getaway driver, and the Walmart employee who was the girlfriend of one of the accomplices and apparently was feeding inside information to them have all been arrested and are behind bars.

Needless to say, this has shaken things up in the community a little. I first became aware of it as I was trying to drive home about 20 minutes after the shooting when a fat topless man with a bad farmers tan was detouring traffic off my street. "That's odd," I thought as I begrudgingly detoured. When, a minute later, I realized that although I was about 2000 feet from home, it would probably be half an hour or more given the state of traffic, I decided to call the local police office (everyone should have their local police office number in their cell phone) and told them, "you probably know this already, given the 5 helicopters flying around overhead, but something is going on out here as traffic is at a near stand-still and some random guy without a shirt is directing traffic off of 75th street." The lady's response: "oh, that is because there is a stalled vehicle over there... and also another incident."

Something wasn't adding up, and I've lived here long enough to know that there aren't usually several helicopters floating around overhead, so I called my wife and told her to close and lock the doors, because something strange was going on. As I was about to turn back onto my street, two police motorcycles came roaring up with lights flashing and started directing traffic, and guess who's car was the second in line and would now be forced to make a big u turn and go around the back way to get home. If you guessed Barack Obama, you have a very poor grasp of current events. By the time I got back to where my house was, I decided that with two little girls at home and no idea why police were rerouting traffic and helicopters were making what looked like slow searching patterns overhead, that I should make sure I didn't need to go home and get my family and leave for a while. I parked a little off the street and walked up to the corner where an officer was directing traffic. After a few minutes he looked over and saw myself and another man standing there and asked what we wanted. I said, "I just live right over there and I want to make sure that everything is safe with whatever is going on here." His response: "Are you kidding? There are more cops here than at a police convention. This is the safest place around."

So I went home, told the neighbor who was cutting wood in her garage to close the door and lock the house and went in to try to find out what was going on. As the story has been coming in, it seems like a carefully planned robbery involving an employee who had been timing the coming and going of the security guards, a getaway driver, and the two perpetrators who waited for the moment to kill the armored truck employee and run off with the money. I had been in the store just a couple hours earlier and my wife later told me that she had been planning on sending me back on my way home to pick up some diapers. My brother's mother in law was actually in the store at the time of the shooting, though she was in the back of the store and she said that she heard a loud sound and thought, "hmm, that sounds like a gunshot," but shook off such an absurd thought and went about her shopping.

It is a little scary to think just how close to home this occurred, but this could have happened anywhere, and so it doesn't make me feel any more unsafe. In fact, I decided this morning that I would go shopping at Walmart today to show a little support; perhaps even to prove that a couple scumbags with a gun and no brains wouldn't change my life or make me cower in fear. Whatever the reason, I expected to walk into a shell of a store with a few scared customers with bowed heads walking quietly through the aisles.

Instead, I found a busy and bustling store that was about as full as I had ever seen it, with people going about their normal lives. It would be easy to assume that these are just heartless people who don't care that a life had been taken here just a day before, but I prefer to be the optimist and say that these were people of a like mind to me, who decided that the best way to heal the wounds is to get about business and show that we are not afraid. By the end of the day a healthy memorial was already developing with flowers and cards and news crews standing around filming.

It was a little strange to walk through the entrance to the store and think, "here is where a man died," but for a reason I have a hard time expressing, I feel that one of the best ways I could honor a man who died faithfully fulfilling the duties of his employ, is to help that business and the flow of culture and community to not be shaken.

Less than 24 hours from now I'll be driving a moving truck out of here, but I'm sure that it will be quite some time beyond that before all of the psychological implications of an event like this are fully sorted out in my mind. All I can say for those involved in this unconscionable crime is that I dearly hope that they never again get to enjoy the blessings of freedom and peace of mind that they so brazenly stole from a whole community for a few thousand dollars.

When I went to Walmart today, I saw good people trying to make sense of it all, but trying also to go about their lives and not have their freedom, their faith, their innocence stolen. Seeing that, I think, helped calm the quiet fires in myself and restore some of that faith in the goodness of people that so few, with cold and thoughtless actions, would seek to take away from me.

And I hope that you will go out today and look around you and see the great people who are everywhere around, just doing their best to create a life of happiness and love. Take it in, and hold it close to your heart, because some day, you may need to pull that thought out and embrace it to you as you try to make sense of the senseless.

My thoughts and prayers go out to the family and friends of that poor young guard, who was just trying to do an honorable service as he made his way through helicopter school to become a pilot, and to all the armored truck guards who will now forever be glancing in the shadows around them wondering if perhaps they are next.

...And In The "Threatened By A Fortune Cookie" Department

2009-06-02T19:56:00.000-07:00

How about opening up a fortune cookie and finding this one:

"Only put off until tomorrow what you are willing to die having left undone."

So is the "fortune" telling me I'm dying tonight? Maybe that really wasn't chicken after all.

And along those lines:

This is the fortune cookie that I opened a couple weeks ago while eating at a Mongolian Grill. If you have a hard time seeing the picture, it says, "Next time order the shrimp."

Nice to see a sense of humor in these guys.

Today's "Reason For Your Visit"

2009-06-02T17:57:00.001-07:00

When a patient checks in at our ER, they are asked to fill out a half-sheet of paper with name, phone, SSN, birth date, and "reason for your visit".

Whenever I work triage, I write down the interesting ones and have been building up a list. Some are funny, some embarrassing, and some just tickle my warped sense of humor. I try to give the benefit of the doubt. I know that these people are hurting and just want to be seen, and if I were the patient, whatever I wrote down may just end up on a list like this as well, but it still makes me shake my head to see some of the things that patients can come up with.

Thus, my regular (as in whenever I feel like it) series, "Reason For Your Visit." Please keep in mind that spelling, punctuation, and capitalization are copied directly from the original paper.

So let's get to today's Reason For Your Visit:

THROWT HURT / CANT EAT SWALLOW

Is that an African or a European swallow?

Star Trek

2009-05-27T22:57:00.001-07:00

I watched a fair amount of Star Trek when I was younger, but as I got older, and as the spinoffs came, I completely lost interest. I never got into Deep Space 9 or Enterprise or any of the other shows, but I remember enjoying watching some of the original series and I liked the Next Generation series even more.

I would never say I'm a trekkie. Just enough to know most of the characters and to know that a red-shirt ensign dies on every episode.

So I went in to seeing the movie this evening with a little skepticism. Yeah, the movie has an 8.4 rating at IMDB, placing it in the top 100 movies of all times, is directed by the man who brought us Mission Impossible 3 and the always entertaining TV show Alias, and yeah, every review I have read says it is amazing, but then so went the hype about Batman Begins, and that, while good, didn't live up (despite an amazing score by my homeboy Hans Zimmer).

This one does.

From the universally outstanding acting performances, to the gripping action from minute 1 until the end, to the special effects to the music, there is very little to critique in this outstanding film. For the Trekkies, there are lots of hidden jokes (I saw it with my brother who is a big Star Trek fan and he pointed out a lot of them), for the casual fans even there are inside jokes that you will get, and even for those who couldn't care less about Star Trek (like my mother, who shocked me with the revelation that she liked it) the film doesn't leave you behind - at least not completely. The young actors who have the nigh unto impossible task of portraying cultural icons do a great job of playing the characters in such a way that it seems that you actually are watching these characters in their younger days.

You still have to suspend your disbelief a little bit in some scenes and a lot in others, but if you can join this fantasy world, you will be held spellbound from beginning to end and walk out of the theatre hoping for more sequels.

And that is perhaps the best part about the whole thing: the plot was constructed in such a way that there is a lot of room for more sequels that can be completely and believably independent of the previous Star Trek movies, including the last several train wrecks that they threw at us.

So get off your chair, put your hospital gown and stethoscope down, and head on over to the cinema to enjoy what will hopefully become a sci-fi classic before it leaves the big screen, and see if you laugh as hard as I did at Kirk's line as he is being choked by the Romulan.

2 enthusiastic - and slightly surprised - thumbs up.

Today's "Reason For Your Visit"

2009-05-27T13:07:00.001-07:00

have Epilepsy have headache

have Epilepsy, have headache, heck, have whatever you want! I'm just giving it away!

Leaving on a Jet Plane... or a Uhaul.

2009-05-18T17:06:00.001-07:00

Life has been interesting of late, with the culmination being a new job offer (actually two, but I could only accept one of them), and a trip down to my new state to get a license and complete the paperwork and look for a house.

That's right, I will soon leave Saint Bigold Hospital and travel to warmer climes, where I will start a new position in a smaller ER in a bigger hospital. 16 beds instead of 25, but the census is the same. What does that mean? Hallway beds galore, baby! I'm not a big fan of hallway beds, but when the weather is great and the new base pay is better than my current overtime pay, I'll deal with a hallway bed or 6.

So that and a move and some sickness running through the family and a recent muscle strain and just being generally busy have kept me from posting as much as I would like. I still plan on keeping the blog up, but the sparseness of the posts will likely continue for a bit until we get settled in to our new place. I still have a huge backlog of "reasons for your visit" as every new shift in triage brings in piles of them, so I'll try to post some of those from time to time.

Oh, and in case anyone who cares really cares, I think Adam will win and deserves to win American Idol. I still hate his over the top stage shows, I continue to almost universally love his studio recordings when he tones it down and just concentrates on singing. Too bad I can't write in for Anoop, though.

Today's "Reason For Your Visit"

2009-05-09T12:24:00.001-07:00

employee exspose

Even if we ignore the spelling, it still sounds like a soft core porn title. (did I just inadvertently increase the traffic to my site?)

Dear Jennifer

2009-05-08T17:31:00.001-07:00

I got your email. Do you really read my blog religiously, or are you just saying that so that I will pay more attention to your advertisement?

Sincerely,

Me

Posted from my iPhone.

American Idol

2009-05-05T22:42:00.001-07:00

Best quote of the night (by my wife):

"that had to be the single worst note ever sung on American Idol." (referring to Danny's girl's camp scream.

Runner up:

"ouch, he sounds like Grandma with a bad cold." (me, referring to the notes leading up to the fateful scream)

Other notes:

• I still don't like the register he sings in, but man does Adam have amazing voice control.
• I didn't see this thought coming, but I realized after that last duet that it should be an Adam/Allison finale.
• I miss Anoop.

Posted from my iPhone

Today's "Reason For Your Visit"

2009-05-04T11:27:00.001-07:00

<Doctor> Said Come here NOW. Turning Blue.

Normally when I see something like "turning blue" on a sign-in form, I can laugh a little and take my time confident in the knowledge that people walking in the front door aren't turning blue, and that when a doc sends someone to the ER POV, it is generally just something that the doctor doesn't feel like dealing with.

Not this time.

Well, actually I suppose he wasn't turning blue so much as he was turning grey. He was gasping for breath and spitting out mono-syllabic words. The color was completely gone from his hands and fingers and lips. In fact, Nancy Pelosi probably had more signs of life than this guy. I hooked him up to the sat monitor and got low 80s down into the 70s. This is where my triage ended as I scrambled to get him back to a room and on some oxygen and a heart monitor. Unfortunately, we were slammed and I never did find out what ended up happening to the guy, though I fear that he may not have made it.

I was left wondering what on earth would possess a doctor to send someone with known respiratory and cardiac issues over to the Emergency Department in a private vehicle. It boggles my mind to think that you can complete your training to become a doctor and not recognize the need for an ambulance when it is staring you in the face. Okay, so you said go NOW. It is important to let the family know how important it is to go the ER immediately and not stop for a latte on the way, but don't you want this guy accompanied by some ACLS-trained medics who can do the 12-lead and put him on oxygen and ausculate for lung sounds and intubate if needed? All the family can do is panic, which is precisely what they did - and rightly so in this case.

For the sake of this Doctor's patients, I hope that there is something more to the story that I'm not aware of, because otherwise I wonder how he is allowed to practice medicine.

Today's "Reason For Your Visit"

2009-04-29T18:25:00.001-07:00

Slip on Ice. on 1/8/09. Lowse Back Pain. Pain when sitting. Walk. Et.

Thank you. for your visit. to our ER. To sit. Walk. Et. It means. A lot. to us. (And yes, I have experienced back pain and it is very lousy.)

In Memorium

2009-04-22T23:46:00.001-07:00

Anoop, you will be missed.

On the plus side, now that I don't really care about anybody left in American Idol, maybe I'll have time for other things.

American Idol Top 6... er... I mean 7

2009-04-22T01:52:00.001-07:00

So you may have noticed that posts are coming few and far between lately. Don't despair. I'm still gathering material and keeping it safe and preparing to get back into it again, I've just found myself with very little energy lately, and sitting at the computer and composing award-winning posts has taken a back seat to playing with my kids and exploring the wonders of the iPhone.

Even American Idol has lost some of the glamour, as evidenced by my ever-shortening reviews from week to week. Here are my thoughts for this week (I'm going from memory here - sue me)

Lil needs to go home. 4
Allison continues to show raw talent, but it is too raw for me to really get behind. 5
Danny hasn't really wowed me in a long time, but at the same time he hasn't been terrible either. 5
Adam gets nervous on stage or maybe he just thinks he needs to sing way too high when he is balladeering. Then he hits the ~~painful scream~~ glory note and I'm left repeating myself: I'm sure I'll like the studio version. 4.5
Kris is starting to grate on me. I find myself wanting to like him, but I'm getting tired of the whiny tone of this voice. From reading a few blogs, everyone else seems to be wetting their pants with glee on this performance. I just didn't care for it too much. 5
Matt did better than I thought he would with such a dumb song choice, but this is a bad song to try to sing live and he didn't blow it out tha box like you have to with such a song. 5
Anoop has an amazing smooth, silky voice and used it well on a boring and repetitive arrangement, and I'm not sure what happened on the last note, but something was off. He is still the only contestant I really care about, and I don't understand the hating from Simon. 6

My predictions: Lil and Allison are going home. Update: I looked at dialidol, and they have Lil as the top vote-getter. Why, America? So I'll say Allison and Matt.

Now I need to get to bed, as I have to get up for a boring 8 hour training day in five hours. Dr. Pepper, don't fail me now.

American Idol Top 7 - One Word Reviews

2009-04-15T00:28:00.001-07:00

A very talented group continues to deliver mediocre performances. Yet again, I'll probably enjoy Adam's toned-down studio version, but I hate hate hate him live.

Allison - Amateur. 4
Anoop - Beautiful. 8
Adam - Stupid. 3
Matt - Forced. 5
Danny - Distant. 5
Kris - Whiny. 5
Lil - Okay. 5

Predictions: Bottom 3: Lil, Allison, Matt. Going home: Matt

Today's "Reason For Your Visit"

2009-04-08T00:28:00.001-07:00

Broken Ankle Sprain

This sounds more like a CYA diagnosis. Just wait until the x-ray results come back and cross off the first or the last word.

American Idol top 8 - the short, short version

2009-04-08T00:15:00.001-07:00

Each week, I seem to have less and less to say. This week I didn't even bother taking notes.

Allison impressed me - wasn't expecting it. Adam was in the same boat as always for me: great vocals, but I just don't like his live singing voice. I'm sure I'll like the studio version. Anoop was good and I look forward to the cleaned up studio version. Lil stanked it up. Matt was okay, but sounded a little like a sheep. Kris sucked big time. Scott sang his best yet and it was still a yawner. I like Danny less each week. I'm actually kinda bored of him.

Okay, so in the end, that probably wasn't shorter than last week, but I find my interest in this season of American Idol fading. The only one of the bunch that I really care about is Anoop, and when I tried to vote for him, the phone line was busy. I thought that would be good news, but when I tested other numbers they were all busy, too. If Anoop gets kicked off, I'm suing American Idol.

Finally, for your viewing pleasure, I leave you with this freeze frame of Adam sitting on the toilet. Seriously. Go back and watch the first couple seconds of his performance. Brilliant.

(sorry for the poor quality - taking a picture of a TV screen with the little iPhone camera doesn't lend itself to world class photos.)

Today's "Reason For Your Visit"

2009-04-05T23:09:00.001-07:00

CHEST PAIN!!!

He had a cold.

Are You One of Those People?

2009-04-01T14:08:00.001-07:00

So I'm sitting at the nursing station, entering an assessment into the EMR, and I'm focused on my task. (Just ask my wife - when I focus, everything else goes away.) Apparently the telephone was ringing. I don't really pay attention to the telephone ringing because the unit secretary answers the phones, but apparently the unit secretary was away from the desk.

I cam out of my haze of focusness to hear one of the nurses at the other end of the nursing station saying, "can someone get the phone, please?" and then, looking at me, saying "apparently only certain people can answer the phone here."

An acceptable chastisement... if she had not been standing around with two other nurses taking pictures with her cell phone at the time.

So apparently I should have stopped doing my job to answer the phone so that you could continue to get paid to stand around and do nothing? Apparently only certain people can answer the phone... and apparently you aren't one of those people.

American Idol top 9 - "and I thought these were good singers" edition

2009-03-31T23:40:00.001-07:00

Noop Dogg - just okay, partly due to crappy backup singers. 6
Megan - hot mess. 2
Danny - crap. 4
Allison - utter rubbish. 3
Scott - a little off key at times, but nice. 6
Matt - stupid song, mediocre perfomance. 5
Lil - too nasal then too shouty and overall too boring. 4
Adam - he just can't resist being stupid on stage. 3
Kris - good. Not great. Stupid end note. 7

Predictions: bottom 3: Megan, Allison, Matt. Megan goes home

On an aside, although I have almost universally hated Adam's performances, I have quite enjoyed - or at least solidly tolerated - his studio versions, with Ring of Fire being one of my favorite studio versions so far this year (though not as good as Anoop's Always On My Mind).

Testing

2009-03-31T19:39:00.001-07:00

I just installed this app for my iPhone to be able to post to my blog (yes, that means I got the iPhone and I love it - but more on that later).

So testing testing one two three... Oh and hello from the hospital parking lot.

Just Surviving

2009-03-31T06:35:00.001-07:00

Have you ever had one of those days where you feel like you are just surviving?

That pretty much describes the last month or so for me. My whole family has been sick on and off, and sleep has somehow become an alarmingly precious commodity, and when I go to work, somehow I just manage to survive the day only to get home for a couple hours with the family and crash.

Please don't give up on me, though. I've continued to collect stories and thoughts that will eventually become posts, but right now, I'm just surviving.

American Idol Top 10 - Mediocre Motown

2009-03-25T23:13:00.001-07:00

I like these quick reviews.

1. Matt - He was aiiight, but the song didn't really go anywhere. 6/10
2. Kris - Not terrible, but he's no James Taylor. 5/10
3. Scott - My wife said, "I'm officially sick of his voice." Me too. 4/10
4. Megan- Trainwreck. Goodbye. 3/10
5. Fact: Anoop's voice can melt steel, but I could think of several better song choices for him. 7/10
6. Michael - How is he still in this? 4/10
7. Ground Rounds - Shouty. 4/10
8. Elvis Lambert - Good job, but way too high and mousy for me. 6/10
9. Danny - He wasn't finishing his words, and why would you say that Smokey knows best, and then not take his suggestions? 6/10
10. Allison - Good, but not as good as David Hernandez last year. 6/10

All in all, kind of a boring night.

My predictions: Megan, Scott, and Michael in the bottom three. Michael goes home.

Today's "Reason For Your Visit"

2009-03-23T23:02:00.001-07:00

Dizzy, Vomitting, Diahreah, CHILLS, abdominal ache

I guess he just really wanted to be sure I knew about the chills. He was also apparently a little bit upset about having to be around his wife Diahreah. I can't see another reason for putting her name on the list of problems.

My New Band

2009-03-22T10:55:00.000-07:00

Okay, so just for fun, I found this little game on a relative's blog, and thought it would kill a few minutes, so off I went. I don't have photoshop on this computer, so I did what I could with Microsoft Paint (which is not very much). Also, I didn't use the first Wikipedia article, because it made no sense whatsoever, and the second one just happened to already be a band. That's fine, though, because I never follow the arbitrary rules in these memes anyway.

CREATE YOUR OWN BAND AND DEBUT ALBUM!

To Do This

1 - Go to “wikipedia.” Hit “random”

or click http://en.wikipedia.org/wiki/Special:Random

The first random wikipedia article you get is the name of your band.

2 - Go to “Random quotations”

or click http://www.quotationspage.com/random.php3

The last four or five words of the very last quote of the page is the title of your first album.

3 - Go to flickr and click on “explore the last seven days”

or click http://www.flickr.com/explore/interesting/7days

Third picture, no matter what it is, will be your album cover.

4 - Use photoshop or similar to put it all together. (I don't have photoshop and didn’t spend a ton of time on mine)

And here is the result:

I Can't Afford It

2009-03-22T08:10:00.000-07:00

Happy has a post up about patients telling him that they want to quit smoking because it is too expensive. I've seen some of that, but more, I've seen stories like this one from a month or two ago:

Patient's Significant Other: "Oh, can we get a prescription for neosporin for this tiny little abrasion to her cheek? We can't afford the medication."
Me: "um... I think your best bet is to go to the dollar store and buy some. That's cheaper than any copay and works just as good."
Patient's SO: "I don't even have a dollar."
Me: "so then how are you going to pay the copay on the Vicodin and Flexeril?"
Patient's SO: "My insurance doesn't have copays."

So I walk over to the provider and ask her if I can get her to add bacitracin to the prescription for the poor packaday smoker who can't afford her meds. With said prescription in hand, and my wallet hurting from the tax hike I'm about to get for buying meds for someone who refuses to take personal responsibility for their own health, I walk back in the room just as the patient is handing some kind of receipt to her SO. The only problem is that the receipt is being pulled from on top of a pile of money that she pulled from her pocket.

Yeah, you don't have a dollar... you have 40.

And this is why even good hearted idealists like me get jaded.

Improving the ER - Idea 426432

2009-03-22T00:49:00.000-07:00

Install a CT scanner in the ambulance entrance. The medic stretchers can just roll right through and get the CT scan out of the way on the way in the door, because we all know that these days the docs are all going to order one anyway to avoid the ever-present lawsuit threat.

Bonus: An Ativan spritzer could be included in the CT scan, so that you don't have to do any of that messy IV stuff.

American Idol Top 11

2009-03-18T00:13:00.001-07:00

I'll be even quicker tonight:

1. Michael - Really bad song to try to show off vocals with. 4/10
2. Allison - Was that a sheep up there? 5/10
3. Kris - Nice, but it felt just a little like he had to force some of those notes. 7/10
4. Lil - Big song makes Lil's voice seem little. 5/10
5. Adam - Weird. Just weird. 2/10
6. Scott - Nice, but a little weak. 6/10
7. Alexis - Is it just me or did she just sing the word "Jolene" over and over? Brooke did this song better. 5/10
8. Danny - I listened a second time and didn't like it as much. 7/10
9. Anoop - I listened to this one five times and I'll listen many more. Perhaps the first song of the year that I will probably go and buy the studio version. Did I ever mention that Anoop is my homey? 9/10
10. Megan - I'm officially sick of her voice. 5/10
11. Matt - It wasn't bad, but it wasn't great. 6/10

So there you have it. Once again, you could kick off all the girls tonight (Alexis, Allison, Adam, Megan, Lil) and the show would be none the worse for it.

My predictions: Megan, Allison, and Michael in the bottom three, with a chance of Alexis sneaking in there if her fan base isn't loyal. Megan goes home.

Calling All iPhone Users and Critics

2009-03-16T00:00:00.001-07:00

I have been using a pocket PC since 2003 when they were big and klunky. A few years ago I switched to a phone version to avoid carrying around both my PDA and my cell. Most recently I have been using the XV6800, which is a competent phone but which has some frustrating features. As I have been looking at the options for upgrade, I've been drawn to the iPhone, but my loathing for all things Apple have had me very much doubting any decision to support the company of all things rotting fruit.

Nevertheless, my interest has constantly been piqued when I have seen others using it, and a couple times I've had a chance to play with one. I've also tried to play with the Google phone and a few other, newer Windows Mobile phones as well as the Blackberry Storm. Then the other day while walking around the new mall in our area, we walked past an Apple Store, and so I decided it would be fun to go tinker with the iPhone. Thanks to some inexplicable rule that says that nobody in an Apple Store can be comfortable, we were required to tinker while standing next to unnaturally high tables, and after just 15 minutes or so, we left with slightly kinked necks and sore feet. And yet the joy of simplicity and the power of the phone's capability lingered. So yesterday when I had a chance to go out on a Daddy-Daddy date (that's personal time and not an obtuse reference to some kind of gay liason), I went back to the mall and sacrificed my body by spending three hours playing with every app I could and toying around with all the features.

By the time I was done with all that biz, I definitely had iPhone lust. And yet the problem remained: do I really want to pay all the extra money that it would cost to upgrade to the AT&T plan and leave my month-to-month plan with Verizon? So I went over and talked to the peeps at the kiosk and the (surprisingly) easy-going and non-pushy saleswoman walked me through what it would entail and how I could get a plan to fit my needs. In the end, it turns out that my wife (who is not into the whole computer-in-your-pocket type of phone) can get a simple phone with mp3 ability but not much more and I can get my iPhone with all the bells and whistles and accompanying data plan, and the net effect on our monthly statement will be... nothing. It will be the same cost, so the only difference will be the price of the phone itself and, unfortunately, the 2 year commitment.

So after looking around and talking to people I know (including one person who works for Microsoft), nobody has yet said anything to talk me out of taking the plunge and betraying my very being by purchasing and actually using an Apple product.

That is where you come in.

What I need from you, faithful reader, is to talk some sense into me... or further my resolve to go ahead with the iPhone.

And while you are at it, answer me a few questions if you can:

* How well does Outlook sync with the iPhone?
* From what I have read, there is no way to get my mobipocket ebooks that I have purchased to switch over to the iPhone. Is that true?
* One of my favorite programs on my pocket PC is kidcolor, which is a little drawing program that locks down the operating system so that I can let my daughter scribble to her hearts content, which is great for waiting rooms and church meetings. Is there anything like that on the iPhone?
* For anyone else who has made the plunge to iPhone, is there anything that you didn't expect you would miss but now you do?
* I use skyscape and epocrates on my pocket pc. What are the best medical programs on the iPhone, and is it true that skyscape on the iPhone requires you to re-purchase each program annually?
* That sucks.
* Does anybody have any experience using AT&T navigator? Is it any different than Verizon's Navigator?
* Other questions that aren't coming to mind right now.

So there you have it, faithful readers. Convince away. Talk me into it. Talk me out of it. Laugh quietly to yourself and move on with your lives, but remember, a young man's very soul hangs in the balance, and you will have to live with your decision for eternities to come.

You may now speak your mind.

How to fix the Backyardigans

2009-03-14T14:02:00.001-07:00

Do you have children? Then you probably know about the backyardigans. My daughter loves this show. I want to pull my toenails up through my intestines and out my left ear when it is on.

So it was with great interest that I came across this post by Jay Black about some ideas on how to make the show more current. I hope that the show's producers are paying attention.

Today's "Reason For Your Visit"

2009-03-12T22:37:00.001-07:00

heR thing is hurting

This one comes courtesy of a mother of a little toddler who was complaining of pain on urination. In case you were wondering where the pain was, it was in... you know... her thing. This, of course, is not to be confused with little miss thing*.

* I just put "little miss thing" in google, and it gave me this. I can only imagine the psychological trauma that girl in the picture will go through when she is 16 and realizes that her mother made her wear that headband. I'm just saying...

Today's "Reason For Your Visit"

2009-03-11T23:54:00.001-07:00

theeth
~~Swooling~~ thorat sore

Everybody makes spelling mistakes sometimes, even me, in my state of near-perfection can maike mistaykes, but every once in a while you get one that just makes you wonder if English is a person's first (or second or third) language. In both cases above, the answer is a sad yes. Particularly in the second example, where she must have realised that she was spelling swelling wrong and so she crossed it out only to murder her next attempt also.

And theeth just leaves me dumbfounded. I keep trying to come up with something clever to say about it, and words fail me, so I'll just let you look at it one more time and marvel.

theeth

American Idol Top 13

2009-03-11T01:34:00.001-07:00

I'll be quick tonight:

1. Lil - I can see why people like her, but to me, she is a one-trick pony, and I don't like her trick. 5/10
2. Scott - He is just so darn likeable. 7/10
3. Danny - He took a crappy song and blew it out the box. 9/10
4. Michael - He beat my expectations, but then again, my expectations weren't very high. 4/10
5. Speaking of low expectations, Jasmine gets a 7/10 - the best female performance of the night.
6. Kris - My wife thinks he is cute. I think his wife is cute. 7/10
7. Allison - Another one-trick pony. She's good in her niche, but you can only pull songs into your niche for so long. 5/10
8. Anoop is my homey, and the judges are stupid. 9/10
9. Jorge - Boring. 4/10
10. Megan - She has a spicy, unique voice, but like any spice, I can only stand so much of it. 5/10
11. Adam - I was enjoying the toned-down beginning and was looking forward to getting behind it. Then it got bad. Then it got terrible. Kara said he was singing notes she didn't even know existed. That's right, Kara, because they don't exist. It is called screeching, and it is usually what animals do as they are dying. 3/10
12. Matt - I couldn't really understand him. Not bad. Not good. 6/10
13. Alexis - She swallowed so many words, she's going to need some Tums. Way overdone. 5/10

So there you have it. You could kick all six girls off tonight (Alexis, Allison, Adam, Megan, Jasmine, Lil) and the show would be none the worse for it.

My predictions: Jorge and Michael go home. Maybe Allison or Megan instead.

Today's "Reason For Your Visit"

2009-03-10T00:25:00.000-07:00

Neck, shoulders, Back

Oh, and by the way, I FELL FROM THE TOP OF A BUNKBED, but why bother putting the actual reason for your visit on the line that says reason for your visit?

Today's "Reason For Your Visit"

2009-03-07T06:30:00.000-08:00

Back pain and Leg

As it turned out, not only did she have a Leg, but, in fact, she had two. Needless to say, I rushed her right back.

Sick

2009-03-07T04:29:00.000-08:00

I don't know which is worse:

Being sick
The feeling of letting down your co-workers by not coming in
The knowledge that Big Brother is in the background somewhere notching another mark against you
Having to get up so @#$%$ early in the morning to decide if you are sick enough to call in so that they don't send a small detachment of assassins to your house.
Not being able to get back to sleep

And then there is the trying to stumble through the actual sick call itself:

"Um, hi, this is Braden, and I'm calling... oh, um, it's Braden Nurseykindaguy and I'm calling... oh, um, from the ER... yeah, RN. Um, what was I saying? Oh yeah, I'm *mindstartsracingtotrytofigureouthowtosaythiswithoutsoundinglikeatotalhoserwimploser* um, not coming in today. Oh, why? um, because I'm not feeling well... I mean, I've got a fever and chills and my stomach is hurting and I feel like I may throw up and when I went to the bathroom just a minute ago... what? Oh, you don't want details? Okay, just let the ER know please. Okay. Don't hate me. Mmmbye."

Okay, I'm going to go lay back down and pretend like I'll be able to get back to sleep. We'll see how long that lasts. Mmmbye.

Today's "Reason For Your Visit"

2009-03-06T23:34:00.001-08:00

Remove Stin

She actually meant, "Remove Stitches". At least I think that's what she meant, because that's what I did. Hopefully I wont get a lawsuit across my desk in the next few days asking me why this lovely young lady is still walking around with all of her Stin still in place, and where, perchance, I may have placed her precious stitches.

Here's to keeping my fingers crossed.

Anoop

2009-03-06T07:31:00.001-08:00

Yay!

American Idol Results - Anoop Anoop Where Have You Been All My Life Edition

2009-03-05T00:12:00.001-08:00

My TV came dangerously close to having a remote control flung through its innards as wildcard pick after wildcard pick after... wait a minute... is that Tatifreakinana? Whatevs, peeps.

Where was I? Oh yeah, as they got ready to call the last pick, my arm was cocked (can I say that on live television?) and ready to fling away, but luckily, my TV was spared a mild disembowelment when Anoop's beautiful name was squirted off the tongue of my dear friend Simon.

Now the important question: of these 8 singers, who will the judges pick? And the choices are:

Tatifreakin - No prayer of making it. She is back to bring in the same types of people who slow down to see how much blood there is at the rollover accident. Fodder.
Megan Corkrey - The judges sure seem to love her, and man does she have a cute smile. I think she has a very good chance to make it through. In fact, dare I say it, one spot is hers to lose.
Jasmine Murray - The weirdly cute teenager who the judges brought back even though she was horridly horrible in her top 36 performance would need to knock it out of the park while the other singers all puked on Simon's shoes during their performances in order to get a ticket to ride the top 12 express.
Jesse Langseth - I think that the judges are more wild on her than her voice supports, but that said, I really like that she seems to be an intelligent contestant who does more than just blindly do whatever anyone wants. Because she breaks the typical mold, I think she has an outside chance.
Von Smith - No way. They picked him because they needed an easy person to eliminate. Fodder.
Matt Giraud - I really like his potential, but when he sang that trainwreck of a song last week and then said that it represented the style of music he wants to sing, he lost a lot of my support, and I think the judges felt similarly. He has a chance if he can really get out there and bring it, but I see the judges picking Ricky or Megan over him.
Ricky Brady - We didn't get to know him at all before the top 36, and I think that the reason is perhaps that they want to grant him the title of dark horse, because a "suprise" success brings in ratings. He has a good chance to make it through. If you've never heard anything from him, check him out in this youtube clip of some song called "Love Me Like LA." Not brilliant, and the song is missing something, but he certainly can sing, and even more than that, can emote with his voice, which I appreciate.
Anoop Dog - Dear American Idol, I know where you live. Sincerely, Me. Seriously, though, I think he is the most likely to get through, if for no other reason than that Simon said he was the easiest pick to bring back. I want him to sing My Prerogative. We only got to hear 5 seconds of it in Hollywood Week and it sounded like he really nailed it.

My prediction: Anoop, Ricky and Megan make it through, although if the producers want to avoid an 8-4 guys/girls split, they may sneak Jesse in over Ricky. Matt would be the other one that might just sneak through.

Oh yeah, and Scott Macintyre, Flank Steak, and Jorge Nunez made it through from this week. I think Scott may be able to win me over, I hate Lil Tritips style of music, and I could maybe enjoy Jorge as a Latin artist if he would lighten up a bit. Nobody I'm really excited about, though.

Today's "Reason For Your Visit"

2009-03-04T14:55:00.001-08:00

Bad tooth ache on Right side Bottem

I'm not sure how I was lucky enough to triage one of those rare cases of Dentobuttia, but the book royalties should be enormous.

American Idol Top 36 Week 3

2009-03-04T00:16:00.001-08:00

So the last 12 of the top 36 are up this week and ho-diddly-hum who cares. I look down this list of singers and I couldn't care less if they all got in a plane crash tonight. As long as it wasn't next to my hospital.

1. Von Smith - You're All I Need To Get By (Marvin Gaye)

Dear Von,

You are not Marvin Gaye.

Sincerely,

Me

5/10. Okay, in retrospect, it got better as he went on. I'll make that a 6/10. (But he is still not Marvin Gaye)

2. Taylor Vaifanua - If I Ain't Got You (Alicia Keys)

I wish she would enunciate, because I like her voice, but I can't understand a lot of what she is singing. Once she hit the chorus, she nailed it, but I think the shaky beginning hurt her a lot. 6/10

3. Alex Wagner-Schmagner - I Guess That's Why They Call It The Blues (Elton John)

Yes, he's dorky, but he's funny. Before he even starts singing, I like this kid. Then he starts singing. When he's not trying too hard, he sounds okay, but unfortunately for him, he's trying too hard for most of the song. Simon nailed it: "You are like a little hamster trying to be a tiger." He shouldn't go through, but I could see him getting the "lovable guy" vote. 5/10

4. Arianna Afsar - The Winner Takes It All (Abba)

Very shaky performance coupled with boring song = too much for her big voice to overcome. 4/10

5. Junot Joyner - Hey There Delila (Plain White T's)

Didn't he sing this in Hollywood week? I wonder if it is possible to sing this song any slower? He has a nice roughness to his voice, but so does Danny, and he's no Danny. 6/10

6. Kristin McNamara - Give Me One Reason (Tracy Chapman)

I can't put words to why I didn't like that performance, because if I have to rate her vocal performance, it would be at least an 8 or a 9, but in the end, I was left feeling cold. 6/10

7. Little Girl Marshall - I Will Do Anything For Love (Turkeyloaf)

That was the most boring exciting performance I've seen. The music got big and the words got fast, but the boring stayed steady. 4/10

8. Felicia Barton - No One (Alicia Keys)

Kind of opposite of Kristin, I don't know why I liked this performance given the pitch problems, the timing being off from the backup singers, and the horrendous haircut. That said, I liked it. 7/10

9. Scott MacIntyre - Mandolin Rain (Bruce Hornsby)

A few weak points, but overall a good job. He's got a lot of potential. 7/10

10. Kendall Beard - This One's For the Girls (Martina McBride)

She's cute. This song is dumb. She sounds just like every other wannabe female country singer who has tried this song. Paula says she gets the prize for the best outfit. I say she gets the prize for the best burlap bag. 5/10

11. Jorge Nunez - Don't Let the Sun Go Down On Me (Elton John)

What's up with the eyebrows, homey? This is a credible performance, but he's got David Archuleta's shoes to fill, and Jorge, you are no David Archuleta. 6/10

12. Lil Rounds - Be Without You (Mary J. Blige)

She loves her name. I think it sounds like a cut of beef. She's a good singer but like Kendall, she seems kind of generic for her genre. Also, she was really eating her words at the beginning. 6/10

My predictions: Scott, Lil and Jorge make it to the top 12.

Who should make it: I don't really care, because I can't get excited about any of these singers. I just hope Drama Queen doesn't make it.

Live With the Consequences of Your Actions

2009-03-02T12:45:00.001-08:00

Scalpel or Sword is one of my favorite ER blogs, and I usually find myself agreeing whole-heartedly with what he has to say, but today, I found a post I couldn't support. His premise was that it is okay to not be completely accurate on the medical record so that a patient doesn't risk losing their insurance plan. Go read the post. Here is the comment that I left for him:

I'm also scared of socialized medicine, and wouldn't vote for Obama even if he offered me a 13 dollar per week tax cut, but the principle of accepting the consequences of your actions are solid conservative principles.

If you don't want to find yourself down on the list of kidney transplant patients, then here's some advice: STOP DOING DRUGS!

The idea that people can do whatever they want and get away with it is a solidly liberal principle, and quite frankly, I'm a little shocked that you would go along with it. You don't have to go tell the cops, but if a patient comes in with a very real health problem (even if it isn't the reason they gave for their visit) and you ignore it, are you really doing them a service?

When they come in with a near-fatal overdose in a month and the attending doc has no history to go by, will you have done her a favor? When she is living on the street thanks to a habit that could have been broken early on with some help will you have done her a favor? When she needs a liver transplant due to the alcoholism that so often accompanies drug use, will you have done her a favor?

I'm not trying to say that you will be responsible for any possible downfall that she may take, but when you seek to cover the sins of another, you are certainly not doing them any favors.

What do you think?

Today's "Reason For Your Visit"

2009-02-27T18:11:00.001-08:00

MVA IN Room 24 w/wife

I suppose if you are going to have a car accident, having it while already in the ER is pretty good because you are assured prompt care. I'm just not sure how you got your car into room 24 to begin with... and we may have a hard time getting the ambulance in there.

American Idol Results - I Heart Brooke White Version

2009-02-27T00:12:00.000-08:00

The good: Brooke White

The surprising: Kris Allen made it. I kind of like him so far.

The meh: Allison made it. I think she did okay singing, but I don't think that she will prove to be versatile and it is a shame that she is through over Mishavonna who I think is a much better singer than her.

The expected: Adam made it. He's good, but I just don't like his style.

Hopefully we will see Matt Giraud and Mishavonna in the Wild Card round. But I still want my Anoop Dog.

To File Away Under Crazy Lab Values

2009-02-26T19:15:00.000-08:00

We get a surprising amount of DKA in our ER. As far as I know, we are not located near any candy manufacturing plants or orange groves, so I'm not sure why we get so many patients with sugars out of control. I know in a previous ER that I worked at, we had one patient who came by once or twice a week with a sugar of 500, bringing new meaning to the term "uncontrolled hyperglycemia." I never did find out what happened to him.

But now that I'm in this new ER, I have found that my blood glucose monitor is very friendly. It seems like a day doesn't go by that the machine doesn't tell me "HI", to which I always respond, "HOW ARE YOU" but rarely ever get any kind of a meaningful answer. Usually when I get a result like that, I can count on a call from the lab about 30 minutes later to report a critical high sugar of 650 or even 700.

But the other day took the cake for me when I got word that a patient had a sugar level of 1479.

I later learned that what had happened was that he was supposed to get a liter of blood, but instead was transfused a liter of Hershey's Chocolate Syrup.

Sad.

Today's "Reason For Your Visit"

2009-02-26T17:25:00.001-08:00

I think I have amona It's hard to Breath and Coughing STuff up.

I will admit that when I called this patient up to triage, I had no idea what amona was. That's okay, though, because I'm pretty good at winging it, if I do say so myself (which, obviously, I do).

Fortunately, thanks to the wonder that is Wikipedia, I found out what amona is. Apparently, it is a settlement in Gaza where Israeli police are accused of using excessive force in evacuating some homes that were ordered to be demolished.

So armed with this knowledge as I now am, I would certainly have changed how I triaged the patient. The next time someone says that they have Amona, I'll just beat them over the head with a police club until they give in.

American Idol Top 36 Week 2

2009-02-26T11:20:00.001-08:00

To all my rabid fans who have been bombarding me with e-mails asking me where I've been for the past week, please let your fears be alleviated. There, that helped nobody, because nobody e-mailed me asking me if I'm still alive. It's okay, though, because my Mom says I'm special, and that's really all that matters, right?

Anyway, I've been working like a busy little bee and now I have 7 days off to enjoy laying around and watching TV and blogging and sundry activities of laziness.

1. Jasmine Murray - Love Song ()
Jasmine comes into this show with a good chance of advancing - she's had a lot of screen time, is very attractive and confident and has a great voice. The she sings. Starts out bad but gets better, but not better enough. If the producers want her, they'll have to wild card her. 5/10

2. Matt Giraud - Viva La Vida (Coldplay)
Here we have the only contestant from this round that I really wanted to see advance to the top 12, but what the @#$%#$% kind of song is this for him? Who is that sheep up on the stage and what did they do with Matt? 4/10

3. Jeanine Vailes - This Love (Maroon 5)
This week's sacraficial lamb is Jeanine. She's in the top 36 and we've never heard anythign about her. Just another example of the stupidity of American Idol's producers. So now she has to knock it out of the park. She sounds like she is singing backup for the backup singers. Ouch. The judges keep mentioning her legs. Probably because they have nothing else good to say about her performance. Yeah, she has great legs, but what's up with the pointy face? 2/10

4. Nick Mitchell - And I'm Telling You (Somebody)
I'm not convinced that Nick is really a great singer, but I have to admit that from the beginning to the end of the song, I was smiling and laughing. Thanks for the entertainment, and thanks for splashing a little water on Idol's face. The quote of the night comes from Kara: "You wear the same shirt every night, just like Simon." 7/10 (mostly just for the entertainment factor)

5. Allison Irehata - Alone (Heart)
I try hard to judge these performances based on performance, but when you get a personality so devoid of intelligence (I believe airhead is the appropriate term), it takes a wallop of a performance to overcome it. Add this to the fact that she just looks bad singing, and despite a pretty good vocal, I have to keep it real. 6/10

6. Kris Allen - Man in the Mirror (Michael Jackson)
The song starts off a little weak, but as he gets going he gets really good. It takes some real skill to pull of a Michael Jackson song, and I think in the end he did it. I don't know if it will be good enough to overcome the pre-show hype of Matt G and Adam, but I hope they bring him back for the wildcard round (unless they pick him over Anoop, then I hope he trips and falls in a deep hole). I just wish he would stop doing the stupid fingerstappingonthemicrophone thing. 8/10

7. Megan Corkrey - Put Your Records On (Every American Idol Contestant Ever)
I really like the edgy quality to Megan's voice, but she is doing something funky with it tonight. It feels like she is trying to push each word out individually and there is no cohesion to the song.

Dear Megan,

My daughter's doll called. She wants her dress back.

Sincerely,

Me

5/10

8. Matt Breitzke - If You Could Only See (Tonic)
Surgeon General's Warning: Do not attempt to pass stool while singing boring songs. 4/10

9. Jesse Langseth - Betty Davis Eyes (Kim Karnes)
I actually kind of like her personality, but whoa baby is she not attractive. Anyway, the combination of her swallowing the end of every word and her pulling the mic away from her mouth after every word didn't do her any favors at all. 4/10

10. Kai Kalama - What Becomes of the Broken Hearted (Some Old Guy)
The judges roasted him, but I just loved this performance. I thought he was strong and in tune and really owned the phrasing. Weird facial expressions. Great voice. 8/10

11. Mishavonna Henson - Drops of Jupitor (Who Cares)
I hate this song, but it is hard to find any faults with her performance. Another inexplicable roasting from the judges will result in her not getting through, which is too bad, because she was far and away the best female performer of the night. 8/10

12. Adam "I'm a Girl" Lambert - Satisfaction (Rolling Stones)
Adam manages to keep his high-pitched girliness to a somewhat reasonable level, but he is just not my style at all. That said, I have to admit that he has amazing control of his voice and uber-confidence. He will get through. 7/10

If I had my way, Kris Allen, Kai Kalama, and Mishavonna Henson would make it through this round.

Prediction: Adam, Allison, and Matt will make it. We will see Kris, Megan, and Jesse in the wildcard round.

American Idol Results - America Sucks Version

2009-02-18T22:21:00.001-08:00

The good: Danny made it; Tatifreakinana didn't.

The bad: Ann Marie didn't make it.

The ugly makemewanttothrowmyremoteattheTV: Anoop didn't make it.

Really. Anoop didn't make it. After Michael serves up a hot steaming pile of crap, America still voted for him over my homeboy.

America sucks.

American Idol Top 36 Week 1

2009-02-18T11:51:00.001-08:00

Last year, I made a blog called A Million Percent Yes, in which I opined on all things American Idol. It was fun, but a lot of work, and I never really got any kind of readership. When the season ended, my readership dwindled even more, and over the past few months I've averaged less than one visit per day, so I've decided to leave that blog in the dust pan of history and just post my ruminations here.

I know that this is an ER blog, and many people who read my blog couldn't care less about Idol, so I'll try to limit myself to a weekly recap and then my thoughts on the results, with maybe an additional post here and there. To those (Nurse K, I'm looking at you) who want pure ER blogging experiences: please just skip these posts. It's not hard to do. To everyone else (Dad, I'm looking at you) who wants to know more about my particular take on Idol: enjoy.

So this week we had our first live performance. They have broken the top 36 into 3 groups of 12 and each week the top male and top female vote-getter and the second place overall vote-getter will move on to the top 12 while the rest hope that the judges have pity on them and put them in the "wild-card" round in three weeks. I hate this format, just like I hate pretty much every other decision that the producers of this show have ever made, but it is what it is, and until someone makes a better singing competition, I'm stuck with this.

Going into the show, I have pegged Anoop, Danny, and Ann Marie as the three I would like to see advance, but I also really like Stevie and what little I've heard of Ricky.

Off we go, then:

1. Jackie Tohn - A Little Less Conversation (Elvis)
Jackie says, "my goal is to get Paula up and dancing," My wife: "that's not hard." Her performance? Yuck. Just yuck. And what's up with that outfit? Wait a minute, the judges liked it? At least Simon keeps it real. 4/10

2. Ricky Braddy - A Song For You (Leon Russell)
I found a youtube of a song of his a few days ago, and the dude can sing. When he is live, he seems to have a breathingintothemic problem, but I kinda like his voice. That said, I don't think this song is showcasing the best of Ricky, and that's too bad because given that he's had no screen time up to this point, so he has an uphill climb. Based on the judges' over-reaction to his performance, I think he will be picked in the wildcard round. 7/10

3. Alexis Grace - I Never Loved A Man (Aretha Franklin)
I don't like the "dirtied up" Alexis as much as the one who auditioned. paraphrasing another blogger (I don't remember who it was so I'm paraphrasing) said that it is sad that to "dirty herself up" she had to look like a cheap hooker. My thoughts exactly. When you do that, you lose the "single mother" pity vote. She out-rocked Jackie, but I still don't like her. In other words, I'll give her props - she can sing, but it's just not my style. I hope she grows on me, because I fear she's here to stay. 6/10

4. Brent Keith - Hicktown (Jason Aldean)
I like a lot of country music, but I despise this type of country song, and it is a really really bad choice for Brent. It does nothing to show off his vocals, and in fact the music is so strong in the background that it is hard to hear anything beyond just the fact that he is, in fact, singing. Not terrible, but not good enough. 5/10

5. Stevie Wright - You Belong To Me (Taylor Swift)
Here lies Stevie Wright. She was a good singer, but she bit it. I had such high hopes for her after her audition, and then this pile of hot mess comes tumbling out of her. It started off too low and in the wrong key and only got marginally better. Her voice comes across as weak and shaky and she has poor breath control. And I'm no expert on facial expressions, but it sure looks like she knows how bad she is doing. Paula said it best: "It wasn't the Stevie that we fell in love with." Goodbye, Stevie. You will be missed. 4/10 (generous because I like her)

6. Anoop Desai - Angel of Mine (Monica)
I love this guy. I've been listening to his performances as soloist in his college singing group the Clefhangers, so when I heard he was singing Angel of Mine, I had high hopes because he really did a good job with it in his group. Unfortunately, he came out and sang a kind of flat, boring version of it, without the flair of his Clefhangers version. Also the background singers really ruined the song. I still voted for him 5000 times, because he's my homey. 7/10

7. Casey Carlson - Every Little Thing She Does Is Magic (The Police)
She's cute, but I'm not on the ohlookhowhotsheis bandwagon, especially with that terrible haircut. Luckily, she can sing, right? Wrong, I guess. She starts off weak and then goes off key. Then it gets worse. Then I throw up a little bit in my mouth. My wife called it "campy" but I think she's being generous. But I feel a little bad for her as the judges rip her to shreds and I can see she is right on the verge of tears. 2/10

8. Michael Sarver - I Don't Want To Be (Gavin Degraw)
I'm not a big fan of the original of this song, but with his constipation faces and forced singing, he is killing the song. And still I want to like him because he seems like a good family man, and I respect that. Oh, and did anybody else note how much his wife looks like Charlize Theron? 4/10

At this point in what I expected to be an incredibly strong group, I am terribly disappointed. Perhaps if I didn't put so much stock in a stupid show it wouldn't matter, but as my wife so deftly remarked, "they're dropping like flies."

9. Ann Marie Boskovich - A Natural Woman (Aretha Franklin)
Let me just say that I want to make babies with Ann Marie's voice. I've been in love with her, hoping she will be my Karen Carpenter (without the sad ending) ever since I first heard her in the auditions. So when I heard she was singing Aretha, I groaned a little on the inside. Anyway, she did a credible job, but she doesn't have the type of voice, nor the presence that Natural Woman demands, and I'm afraid she's done herself in. And yet, even in this terrible song choice, the ease with which she is able to get those smooth vocals out makes me pick up the phone and vote until my fingers are numb. 7/10

10. Stephen Fowler - Rock With You (MJ)
So I'm not entirely sure why he got through to the top 36 after forgetting the lyrics twice and then walking away in Hollywood. Nonetheless, here he is, and there he goes. Simon often uses the term "cabaret" to describe a performance. This is the perfect application for that description. He sounds shaky and unsure of himself and very very weak. Incidentally, Simon decided on "corny" to describe this one, and I have to agree. 3/10

11. Tatifreakinana Del Loco - Saving All My Love For You (Whitney)
I know she can bring it when she is not acting completely batty, but does she really think she can take on Whitney? I sure hope not, because I don't want to deal with her insane fakery and posing. She reminds me of an ex-girlfriend of mine in that way. So what do I think of her singing? Here's what I wrote on my note paper: EXPLETIVE! 8/10 (but I still didn't vote for her)

12. Danny Gokey - Hero (Mariah Carey)
The most pimped contestent gets the pimp spot. Do you think the producers want to put him through? The thing is, he doesn't need the pimping with that well-controlled roughness in his voice and impressive range. Put that together with his Robert Downey Jr looks and pity-vote-generating backstory and he'd have to fall pretty hard to fall at all. I found him just a little nasal, but it's hard to be hating on his voice. Also, the arrangement felt very rushed, like he had to barrel through it, which was too bad. My wife was sitting next to me in a state of rapturous ecstasy, so it must have been good. 8/10

And with that, we are done with one of the more disappointing episodes of Idol that I can ever remember watching. Nothing in the episode changed my mind about my three favs, but I'm worried that Alexis or *gulp* Tatifreakinana might just squeeke through. Also, I'm worried that Anoop was a little boring and might not get the votes he deserves.

Prediction: Danny, Alexis, and either Anoop, Michael, or Tatifreakinana get voted through, with an outside chance of Ann Marie coming through. We will see Ricky and two of the other three mentioned above that don't make it back in the wildcard round.

Incidentally, I've heard that the wildcard round will not necessarily be singers from the top 36. Does that mean there is hope for David Osmond?

Today's "Reason For Your Visit"

2009-02-18T01:04:00.001-08:00

ask me

Okay, I will... after I ask everybody else.

Today's "Reason For Your Visit"

2009-02-16T07:01:00.000-08:00

Busted ear drumb

Dear patient,

You made a spelling mistake. The last word has one letter too many, but you'll have to try to figure out if you should remove the b or the r.

Sincerely,

Me

Two Things That Bring Me Joy

2009-02-16T00:03:00.001-08:00

In church today we talked about Joy. Actually, I'm not really sure what we talked about because it is incredibly hard to pay attention when you have two little ones demanding your attention, but I think it is a fairly safe bet that joy was in there somewhere. Other safe bets include a discussion of the Superbowl, ancient American racing techniques, and jello molds.

But I digress. Tonight, I found great joy in a new television program that I discovered called "Top Gear," which is a British show.

Now anyone who knows anything about British television knows that they are rivaled only by the Japanese for insanity on film, and Top Gear certainly delivers a lot of insanity (though not quite as much as "Incredible Bonzuke"). The premise of the show is... um... I'm not totally sure exactly, except that the subjects have to include machine-powered locomotion in some form or another. I've now seen three episodes and I can safely declare the hosts of the show legally insane. It is a funny show, but not in the laugh-out-loud way you get from The Office or Whose Line Is It Anyway or anything involving Keanu Reeves attempting to play a dramatic role (especially a dramatic role involving an accent), but the guys on the show know no bounds in what they will attempt to do with vehicles. I saw stunts involving seeing how much air they could get for a mini-cooper with the Lillehammer ski jump, a contest to see who could make the best boat out of a car, and a contest with semi trucks involving driving through mobile homes and brick walls.

In short, the kind of show that only a guy could love (though once I talked my wife into sitting down on the couch and watching, she got a few chuckles in as well).

Before I get onto my other joy, let me tell you about a few other TV programs that I have grown to enjoy: The Chaser's War on Everything (G4 on Wednesday evenings) is an Australian comedy-prank show that takes the whole concept of "what if" to a new level. Speaking of pranks and what if scenarios, Howie Do It (some channel on some night) is a fairly garden-variety prank show that involves a little too much pimping of Howie Mandel, but nevertheless has some great scenarios. Good for a little mindless entertainment is the food network show Chopped, which features four random chefs who have to make an appetizer including a bevy of "mystery ingredients" in 30 minutes. At that point the chef with the weakest dish according to the standard three-judge panel is cut, leaving three to prepare a main entree and then two to prepare dessert. Think of it as Mini Top Chef but without the cute hostess (unless Ted Allen happens to be your thing. He's not mine). I've also enjoyed the new TNT show Leverage, though admittedly I have four episodes piled up on my DVR. It is kind of like Ocean's 11's little brother - not quite as good, but it makes the team because how can you turn down the star player's family member? And in case you didn't know that I like American Idol, you will find out very well over the next couple of months as I share my humble opinions with you every week.

Anyway, now that I'm sick of typing, I come to the real joy. TV is fun, but it can never replace the joy that my family brings to my life. Watching these shows is fun, but would be nowhere near as fun if I didn't have my wife to watch them with me. She is my best friend, and together we can pretty much turn any boring old TV show into our own mini Mystery Science Theatre 3000 with snarky comments flying at warp speed, and arguments about who should win really stupid competition shows like True Beauty (Seriously, have you seen True Beauty? Why do we watch that juvenile, asinine, and ridiculous show?). I'm blessed with a great marriage to a woman who appreciates my humor, tolerates my death farts (but just barely), gives me my space, but stays by my side, and, lest we forget, is totally hot.

Add to that my 22 month old, who is the most amazing source of laughter and happiness for me. Every single day I am amazed by new things she has learned and new cute things that she does. Tonight she was putting a blanket over her head and asking where she went. Then, with the blanket still over her head, she said that she was "happy" and bouncing her head from side to side. She is also a little jokester - more proof if I needed it that I'm the Daddy. Granted, a one year old doesn't usually come up with screamingly funny humor, but she sure tries. Tonight when I put her to bed I said "Goodnight" and she responded by saying "Goodnight Mommy," to which I always respond "I'm not Mommy." Then she said, "Goodnight Gramma," seeing how far I would take it, so I blew her a kiss and left, only to hear as I closed the door, "I not Gramma!" I think these stories probably fall in the "you'd have to be there" category, but just let this serve as your official warning that I'm breeding and infecting the world with more wannabe comedians. But at least I'm infecting the world with dang cute wannabe comedians.

I love my youngest daughter, too, but she is still kind of in that eat drink cry poop phase and I don't have any particular stories that would make you go all melty. Soon enough, though.

Anyway, there you have my life in a nutshell. Work, sleep, family, TV, and baring my soul for you, faithful reader.

Who could ask for anything more?

Today's "Reason For Your Visit" - Body Parts Edition #1

2009-02-15T07:53:00.000-08:00

Right index finger
Left shoulder
Neck
Heart
Right Rib Cage
Shoulder
Ankle

And this is just a handful. I understand that when you want to get seen, you don't want to spend a lot of time writing a novel, but perhaps you could at least specify what is wrong with said body parts. Are they missing? Infected? Cut? Broken? Hurting? Ugly? Overweight? Mildly gangrenous? Is gangrenous even a word? Does it really matter, after all, it is my blog and I can do whatever I want? Should I have put a question mark at the end of that last question? Does anyone care?

Sorry, got distracted. Anyway, I particularly love the visit from the Tin Man thrown randomly in the middle of that list. I suppose he probably went to his PCP, but found that he couldn't get in for several days, and since Dorothy was already coming to the ER to have her bunions looked at, he may as well see if we could finally and conclusively end his search. Lion was going to come for moral support, but he just couldn't bring himself to do it, and I think scarecrow was found wandering aimlessly around in the diagnostic imaging department. Let's just hope that the Wicked Witch of the West (please visit www.www.com) doesn't find out about the no-drinks-at-the-nurses'-station rule, because so far that is the only thing keeping her at bay.

Typos

2009-02-15T00:19:00.001-08:00

No matter what I do, I always type a few words wrong when charting:

alle xtremities instead of all extremities
deneis instead of denies
teh instead of the

What words do your fingers not know how to type correctly?

Image Credit: typolover.com - found via google image search

ER as Primary Care Clinic

2009-02-14T23:48:00.000-08:00

I had a long day of triage yesterday, and in true Friday the 13th fashion, had some weird ones. There was the blood pressure of 201/102 (I'm sure there is a hidden message there, but unfortunately Tom Hanks was otherwise occupied and could not decipher it for me), the chronic back paineur-frequent-flier who suddenly decided that if he announced that he has numbness in his groin, he would get back faster, the chest pain who initially told me that the pain came with deep inspiration and coughing *thank you, back of the line for you, ma'am* and then when it comes her turn for triage, says, "no, the pain is constant and I haven't been sick lately, and I'm not coughing at all. Oh, and it radiates to my left arm." My BS alarm was working overtime, but when a patient says that, I have to at least order up an EKG and some blood tests. I still wasn't about to bump another patient out of a bed for that one (incidentally, not only did the EKG come back NSR, but the social worker made a trip out to see me to let me know that this patient was on "the list" at 4 other hospitals for abuse of Emergency Services and had a list of psych problems longer than my left arm. So long, in fact, that Happy would have told her to stop smoking.*

But what really got me was how many patients I saw that were sent by their doctors. It was probably less than 10, but it felt like every other patient. Some of them were pretty legit, like the possible sepsis, or the asthma exacerbation (although she was speaking in full sentences and was in no apparent distress, her lungs sounded very tight and wheezeful,** and she had only previously had asthma during pregnancy).

Then there was the parade of the others, like the RLQ pain that needed a workup for R/O appy FROM 5 DAYS AGO, the high blood pressure patient that got no workup other than a blood pressure check and a trip to the ER (Dear Doctor, perhaps if you had, I don't know, TALKED TO YOUR PATIENT, you may have discovered that he was out of his blood pressure medications. I do believe that your medical license permits for you to write for BP med refills. Signed, Me.), or these gems (from the patient's own "reason for your visit"):

Dr C#$%^ office told me to come in for my Chronic back pain
Referred from Primary PhisicioiN to E.R. (I don't remember the actual chief complaint, but I do remember it was unimpressive enough that I dumped her back in the waiting room)

Then this one made me laugh out loud:

DR A#$%# J#@$@ up and quit on his patients and I need my meds.

Not sure of the story behind that one, but he earned himself a trip to see the PA and get a couple days' worth of meds and a referral to a new PCP.

I'm also amazed at the number of patients sent in by their dentists for antibiotics. The Dentists know that we cannot do anything more than give a handful of Vics and some penicillin. I'll never understand why they can't have the patient come in to the office, sit in the chair for 1 minute to have their teeth glanced at, and then walk out with a prescription and an appointment for a week or two later.***

Finally, there was the direct admit patient who was told to come to the ER to be evaluated "in case there is something I missed." I would comment on that one, but I don't swear.

* Incidentally, I'm actually on Happy's side in the stop smoking debate, but it is still fun to joke about because he takes it so seriously and Nurse K takes her exception to him so seriously in turn. Calm down, children.
** made-up word for the day.
*** Okay, so I do understand it, and it is spelled M-E-D-I-C-A-R-E but it is still dumb.

I Survived Friday the Thirteenth

2009-02-13T23:38:00.000-08:00

...and all I got was this lousy headache.

12 hours of triage with no backup is rough.

Today's "Reason For Your Visit"

2009-02-12T00:40:00.001-08:00

Tachacardyla

Needless to say, I was quite surprised when I saw this one. I'm sure you are consulting your reference books as we speak (okay, as I type and you read. Okay, I typed this long before you read it, but you are ruining my point here with your nitpicking). And yes, you are correct in your conclusion that the Tachacardyla did indeed go extinct in the late Jurassic Period.

Unfortunately my digital camera was broken and someone erased the security tape, so you are just going to have to believe me when I say I was there. I saw it. I will never be the same.

American Idol Top 36

2009-02-12T00:37:00.001-08:00

So for all of you medical types that are just dying to know what it is that Braden thinks about the top 36 on American Idol, I say:

Tatiana? Really?
Nathaniel? Really?

Otherwise, I don't have too much beef with the contestants chosen, but still, even at the final 36 there were some contestants that we've never even seen before and others that we've only seen glimpses of. What's wrong when I know Tatiana's bra size, but I've never heard of Ricky Braddy or Arianna Afsar or Jeanine Vailes?

So for what it is worth, from what I remember of the singers, my favorites so far are Anoop Desai, Danny Gokey, Stevie Wright, Anne Marie Boskovich, Brent Keith, Scott Macintyre, Matt Giraud and my wife says we liked Kai Kalama, but I don't remember him. I seem to remember liking Felicia Barton, too.

But herein lies the problem: Anoop, Danny, Stevie, Brent and Ann Marie are all together in the first week of competition, and they are only going to advance the top male, top female, and next top vote-getter, meaning that at some of my peeps aren't going to make it. If I have to choose, I take Anoop, Danny, and Anne Marie.

In fact, that is my top five for the whole competition so far. I hope the two that don't make it in round one will get through in the wild-card round. Perhaps as I get to know the other contestants, I'll change my mind.

And for those of you keeping score at home, I find Nick Mitchell (Norman Gentle) funny and entertaining, and I don't mind him going to the top 36 to break up the monotony in a good way, but I hope he doesn't make the top 12. I take my top 12 very seriously.

We now return you to your regularly scheduled ER blog.

I Scored 79 on the CIPC!

2009-02-11T20:19:00.001-08:00

Yay! I can move to Canada!

If you go to the Canadian Immigration Points Calculator, you can determine if you are eligible to move to Canada. Good to know, just in case.

To get into the US, you only need to be able to swim and dodge bullets.

Shameless Baby Bragging Pictures

2009-02-10T13:54:00.001-08:00

I don't often post pics of the family, but sometimes I can't help myself.

Here is the youngest all dressed up to go out last night (and apparently also ready to lecture at the local university):

And here she is in her bassinet, laughing at yet another great joke by Daddy:

And here is the older girl dressed up to go out (in our mess of an entry hall):

I don't know what I did to be blessed with the two cutest, sweetest kids in the country - I would say the world, but I hear that there is a really sweet kid in Zimbabwe - but somehow I got them. Little one has grown into the most mellow baby ever. She'll wake up and then just chill while looking around pondering the deeper meaning of the universe. Older one is always surprising us with new words she is learning and she always says "please" and "thank you" and "excuse me," even when she is mad. There is nothing cuter than an angry 20 month old saying "no thankee, Daddy."

My wife is hot, too, but she wont let me post a picture of her on my blog. So in place of that, here is an approximation:

See what I mean?

Thanks for Saving Me. Give Me Money.

2009-02-10T09:47:00.001-08:00

Image via Wikipedia

Hat Tip to Happy Hospitalist - It appears that some aren't completely satisfied with the gesture from US Airways to the passengers of flight 1549. You will remember this as the flight had the engines blown out when it ran in with a flock of Canadian Geese over a city of 18 million people, and was put down gently on the Hudson River with no casualties whatsoever.

Do a quick search of results of water landings, and you will come to appreciate the skill of the Captain in manuevering this nearly impossible feat. Then the crew successfully and professionally evacuates a sinking plane and everybody is rescued with no more serious injuries than some bumps and bruises.

Now in a gesture to the passengers on board, US Airways is offering them an upgrade to super-elite status (which, from what I can gather, allows one to use special executive lounges, have priority for seat selection, bypass lines at the airport, go through special security checkpoints, have extra checked baggage allowance, etc) for one year.

I'll be the first to say that super elite status wouldn't mean much to me because I don't fly very much, but it appears that some observers, and possibly even some passengers are now pushing back, saying that they are entitled to more more more.

"I think if you survive a plane crash, being upgraded permanently is a good gesture too," said Fred Berretta, 41, of Charlotte, NC, where the Airbus A320 was headed.

[another passenger says] "They are happy they had such amazing results, and they applaud themselves, and then give us a small token?" she said. "That's how I take it."

Then of course, the all-important random blogger opinion (I know, hypocritical, whatever.)

Seriously, these people have survived something, all of them btw, that, statistically speaking, they had hardly any chance of ever experiencing and they get one year. Maybe a lifetime might be cool? Seeing as none of them will ever want to fly again, let alone fly on your stupid airline…

And finally I find a voice of reason

I’m curious: whenever someone gets into an automobile accident, do they write to Toyota saying that they deserve a new car for free for the rest of their life? No? Then this is the last time I want to hear about how the people who survived the crash deserve anything more than they’ve received. If the passengers on the plane believe their was negligence of some sort, go ahead and sue. Good luck with that.

Of course, if you go to the comments from the original link by Happy, you get some gems:

"Mayor Bloomberg has also given them special permission to smoke indoors."

"This was an act of geese. Canadian geese, no less. Not only is no one doing anything about this, these foreign geese are actually protected by the Migratory Bird Treaty Act. I, for one, am outraged."

"Maybe they should try to track down and sue the geese?"

"Sue Canada!"

"Any survivor unsatisfied with the gift of THEIR LIVES should be rounded up dropped into a flock of migrating Canada geese. Land on your own this time you ungrateful bastards."

"the reality that these people are already among the very wealthiest in the world, that being able to fly at all is a privilege unenjoyed by 98% of humanity, seems to be lost on both the 'survivors' and the commentators."

And my favorite:

"They should just give them tshirts that say 'My jet went down in the Hudson and all I got was this lousy tshirt'"

This sense of entitlement just baffles me - and scares me - that people think that anything that happens to them should be someone else's fault and should be compensated. Now before I get lambasted for being uncaring or whatever, let me explain that I understand what a traumatic experience this can be, and I understand that not every passenger (or, probably, not very many passengers) is so ungrateful. But when you voluntarily board an airline to reach your destination faster than you could by taking a car (or walking, like most of the rest of the world has to do), and then that airline suffers an unforeseen and unforeseeable incident for which they bear no liability whatsoever, and that 99 percent of the time would mean the deaths of most or all on board and which results in a random ER blogger typing run-on sentences that are so long that even he doesn't really know what his point was going to be when he started them, and everyone survives with their lives, then perhaps you should owe the airline some kind of gift.

I think if I had been on board that plane, I would find a way to send a bouquet of flowers to Captain Sullenberger every year for the rest of my life to thank him.

This is kind of like you coming into my ER in full cardiac arrest for 15 minutes with no chance of survival and somehow I revive you to full health with no neurological deficit, and then you coming up to me and saying, "I think I shouldn't have to pay my ER bill because that was very traumatic. Oh, and give me money. And your wife."

Welcome to America, land of the entitled.

You Just Love Me for My Infant Tylenol

2009-02-10T01:47:00.001-08:00

So a few months ago, I wrote a post titled "Infant Tylenol and the Mystery Dose" about the frustrations that parents feel about trying to find the right dosing for infant tylenol.

I mean really, how silly is it to sell INFANT Tylenol and then in the instructions put "for under 2, consult your doctor." Well then why not just make it a prescription drug?

Anyway, apparently there are a lot of people out there who feel me, because that has consistently been one of my most visited posts, and if you do a Google search for "infant tylenol dose," my post is number 6 on the results page. Of course now that I am posting about it again, I'll probably get even more visits (kinda like what Epi went through when she noted that she was getting visitors who were looking for "best boob blog" and then started getting tons more. Seriously, she is now number 8 on the results page, though I don't recommend looking for that particular string of words while you are on the work computer.) Oh, and hello to all the new people who are visiting my blog trying to find the best boobs. To you I say "Hello. I'm Braden. You will be here for about 15 seconds while you determine that I do not, in fact, have any pictures of boobs, and while yes, my boobs have started to jiggle a bit as I run down the stairs, that is not necessarily such a good thing on a hairy-chested guy. Please take your hormones and go elsewhere. Thank you." (Did you notice how I used AIDET to accomplish that? My patient satisfaction scores should go through the roof on that one.)

Okay, I got distracted. And now I'm not even sure what my original point was. That's what I get for trying to blog at 1 AM while the T3 kicks in. I think I need to stop before I start giving out my credit card PIN number. I can't have anybody find out that it is 12345, because that is the kind of combination an idiot would have on his luggage.

Oh yeah, where I was before the ADOBSO kicked in: please, peeps, just put a good dosing chart on the box of infant Tylenol, because what's going to happen is the parents are going to come to us, and we are just going to give them a dosing chart and charge them 90 bucks.

Dear parents: if your kid is just a little fussy or has a little fever, then it is 10 milligrams per kilogram. If they need more pain relief or fever reduction, you can go to 15 milligrams per kilogram. If you are really worried, or they are really hurt, then get them in to be evaluated by a doctor (I said that for the lawyers). You can convert your child's weight in pounds down to kilograms by dividing by 2.2, or use an online conversion calculator.

So if your child weighs 22 pounds, then they are 10 kilograms, and therefore the dose range is 100-150 mg (10x10 and 10x15).

If your child is 14 pounds, then they are 6.5 kilograms, and therefore the dose range is 65-100 mg (6.5x10 and 6.5x15). You will note that I rounded a little. This is okay because among all the measuring devices ever invented by man, there are none that surpass the infant tylenol dropper for sheer inexactitudeosityessnous. Trust me, you are going to have a hard enough time trying to get 100 mg, let's just forget the idea of being able to figure out 97.5 (or more exactly 95.45, since I rounded the weight a little, too).

disclaimer: blah blah blah not a doctor blah blah blah don't take medical advice from me blah blah blah your lawyer doesn't know where I live anyway blah blah blah if your child is sick enough that a dose of Tylenol is the making or breaking point, and yet you are still searching for advice from a random nurse's blog then you probably should be letting Grandma and Grandpa take care of the kiddos from now on.

Image ~~stolen~~ borrowed from somedood on flickr. Found via Google Image Search. All rights reserved and all that jive, yo.

The Patient Watcher

2009-02-10T00:58:00.001-08:00

This was overheard as I was walking through the nursing station:

Hospitalist to ER Doc: "Are you seeing 12?"
ER Doc (with slight sneer): "I'm watching 12." Looks over to see empty room... "hey, where'd she go?"

Dear ER Doc,

I guess you weren't really watching all that closely, huh?

Love,

Braden

Medical Software for the IPhone

2009-02-09T14:53:00.001-08:00

I currently use a Windows Mobile pocket PC phone, but I'm toying with the idea of getting an iphone, but I'm concerned about being able to get my medical software that I rely on - drug guides, medical dictionaries, etc.

Any other iphone users out there that can reassure me?

Today's "Reason For Your Visit"

2009-02-09T14:20:00.001-08:00

At least this patient censored herself.

Today's "Reason For Your Visit"

2009-02-05T05:50:00.000-08:00

Pain

I suppose this is like me showing up at McDonalds and being asked what I want and responding, "food". I'll take "could you be more specific" for 1000 please, Alex.

Osmond Out? Really?

2009-02-04T23:49:00.001-08:00

I suspect that you are just going to have to put up with some American Idol rants over the next couple of months. Don't worry, this is still an ER blog, but from time to time those purists out there that don't want to deal with non-ER stuff will just have to skip a post or two. This is one of them.

I just got done with an hour of AI Hollywood Week and the general feeling is "who cares" except that they kicked David Osmond off and didn't even bother to show us why. Instead we get 20 minutes devoted to whiny crybabies that nobody cares about.

But David Osmond? That guy had the whole package and was definitely one of my big front-runners. And to add insult to injury they just mention it on the fly before getting back to more stupid bikini girl drama. My wife and I looked at each other and for the rest of the episode we just kept saying "that guy made it through, but Osmond is out?"

Stupid American Idol.

The Man Rules

2009-02-04T21:56:00.001-08:00

I found these from a friend who's wife found them from she-can't-remember-where. They are too good to pass up. I made a couple of small changes, but I really can't take any credit at all for this.

So without further ado:

THE MAN RULES

We always hear "the rules" from the female side. Now here are the rules from the male side. These are our rules!

1. Men are NOT mind readers.

1. Ask for what you want. Let us be clear on this one:
Subtle hints do not work!
Strong hints do not work!
Obvious hints do not work!
Just say it!

1. Learn to work the toilet seat. You're a big girl. If it's up, put it down. We need it up, you need it down. You don't hear us complaining about you leaving it down.

1. Sunday sports: It's like the full moon or the changing of the tides. Let it be.

1. Shopping is NOT a sport. And no, we are never going to think of it that way.

1. Crying is blackmail.

1. Yes and No are perfectly acceptable answers to almost every question.

1. Come to us with a problem only if you want help solving it. That's what we do. Sympathy is what your girlfriends are for.

1. A headache that lasts for 17 months is a Problem. See a doctor.

1. Anything we said 6 months ago is inadmissible in an argument. In fact, all comments become null and void after 7 days.

1. If you won't dress like the Victoria's Secret girls, don't expect us to act like soap opera guys.

1. If you think you're fat, you probably are. Don't ask us. We'd rather not have to lie about it...

1. If something we said can be interpreted two ways and one of the ways makes you sad or angry, we meant the other one.

1. You can either ask us to do something, or you can tell us how you want it done. Not both. If you already know best how to do it, just do it yourself.

1. Whenever possible, Please say whatever you have to say during commercials.

1. Christopher Columbus did NOT need directions, and neither do we.

1. ALL men see in only 16 colors, like Windows default settings. Peach, for example, is a fruit, not a color. Pumpkin is also a fruit. And of course, we have no idea what mauve is.

1. If it itches, it will be scratched. We do that.

1. If we ask what is wrong and you say "Nothing," we will act like nothing's wrong. We know you are lying, but it is just not worth the hassle.

1. If you ask a question you don't want an answer to, expect an answer you don't want to hear.

1. When we have to go somewhere, absolutely any thing you wear is fine... Really.

1. Don't ask us what we're thinking about unless you are prepared to discuss such topics as baseball, the shotgun formation, or motor sports.

1. You have enough clothes.

1. You have too many shoes.

1. I am in shape. Round IS a shape!

1. Thank you for reading this. Yes, I know, I have to sleep on the couch tonight, but did you know men really don't mind that? It's like camping.

2. If you have any questions, please see rule number 1.

American Idol Hollywood Week

2009-02-04T00:57:00.001-08:00

Okay, so I'll admit it: I like American Idol.

But I hate American Idol.

I like the competition, I like seeing the contestants grow and stretch, I like seeing the different personalities, I like playing judge from my couch, I like seeing the dream come true for these kids (yowzas, I'm old enough to call these kids kids. I'll be right back - I need to go take my metamucil and change my depends).

I hate the producers. Already in the auditions, they would show us 5 or 6 that made it to hollywood and then tell us that a total of 10 or 20 made it through*. What about the others? The show just feels dishonest to me with the heavy-handed production. Why can't we just see some talented singers and decide for ourselves what we think?

But it came to a boiling point for me tonight while watching the first day of the "Hollywood Week". We are told that 147 people made it through to Hollywood and they all sang in front of the judges over a two day period. They then proceed to come out on stage in groups of 8... and the stupid producers show us one or two or sometimes even three of them. That's it. The other 5 or 7 contestants can go jump off a tall building. They don't even get face time. A lot of the time we only see them from the back.

147 sang, and they showed us 23 of them**. Seriously... 23 out of 147. If you left that percent as a tip at a fine restaurant, you would get the evil eye from the waiter.

I know that my wife and I are addicted to these reality TV competitions (We faithfully watch AI, AGT, SYTYCD, TC, NFNS***, and even catch the really really dumb ones like nashville star and blush and true beauty and the painfully bad last comic standing), and I know that none of them actually show us reality, but can we at least get some semblance of being part of the show? I don't even know the names of most of the people who are supposedly "the best singers in America" because the powers that be decided that they will only let me see their pet singers.

And the most frustrating part of it all is that despite my anger at the stupid producers, I will continue to watch faithfully, because I'm Braden and I'm addicted to American Idol.

* Actually (and I hate to ruin this for those poor innocent souls who believe everything American Idol shoves at your face), did you know that when they show the auditions, they are mixing two different days? That's right despite them making you think that 10,000 people came in front of the judges and you get to see thousands lined up and stadiums full of people, in reality, only about 100 people get to sing in front of the judges. Those stadiums full of people actually sang in front of mid-level producers in some back room somewhere and those deemed good enough or bad enough to make for compelling TV are called back several weeks later to sing for the judges. This makes the bad auditions especially cruel, because they already knew how bad these singers were when they invited them back, but they don't care because it makes for better ratings, and, as Happy Hospitalist likes to point out, ratings=more****.
**by my count, plus about 5 more that get mention but no real air time.
*** If you know what all those acronyms mean, you are probably addicted to reality competitions as well.
**** I'm paraphrasing here.*****
***** By the way, have you ever seen anyone asterix an asterix before? Now you have.

*$%#* And for the record: contestants that have really stood out to me so far: David Osmond, Danny Gokey, Scott McIntyre, Anne-Marie Boskovich, Anoop Desai, Nick Mitchell (for the entertainment factor only), a couple others whose names I cant remember (so did they really stick out so much? hmm), and maybe some of the ones that the idol producers decided I shouldn't get to see.

Okay, I'm going to bed now. Thanks for letting me rant. Good night.

Today's "Reason For Your Visit"

2009-02-02T07:30:00.000-08:00

Complication of Livery Biopsy

I'm not quite sure what to do when I see this complaint. Definitions of livery range from a uniform worn by servents to coagulation of paint to a royal gift of land. I can see how Bill Clinton could have to have a uniform biopsy, and maybe if it was lead paint, they might take a sample... but why come to the ER?

Quote of the Day

2009-02-01T22:37:00.001-08:00

From Michael on "The Office" tonight:

Nobody should have to go to work thinking "this is the place where I might die today. That's for the hospital."

Not on my watch.

The Threat of Bodily Harm

2009-02-01T21:04:00.001-08:00

Sorry, not a nursing post here.

Recent times in which the television set was in danger of bodily harm from projectile missiles:

1. When David Cooke won American Idol
2. When Neal E Boyd won America's Got No Talent
3. When the referee ruled that last play a fumble

7 people over to my house and we were all rooting for Arizona (9 if you count my daughters, who were somewhat unwittingly roped into rooting for Arizona... okay, so the 3 month old just slept and ate and pooped, but the 2 year old had a great time cheering with everyone else. And as long as we are still parenthetical, I guess I could take one away for my brother who just played on his nintendo DS the whole time, but was nominally rooting for Arizona). All-in-all a great game with lots of drama and lots of ups and downs which kept us on the edge of our collective seat all the way to the end. The 65 yeard TD run by Fitzgerald with under 3 minutes left had us all yelling so loud I was worried we might get mistaken for a jumbo jet taking off.

Oh well. Congrats to the Steelers.

Today's "Reason For Your Visit"

2009-01-31T00:09:00.001-08:00

Medical Problems

Upon seeing this note, I immediately pushed this patient to the front of the triage line, as it is increasingly rare that patients coming to the ER have actual medical problems. Take my patient a few months ago that rushed over to the ER after developing "a severe goiter in my neck and I couldn't breath or swallow anything." You might think this patient presented in a tripod position with drool coming out of his mouth and a neck the size of a small country. You might think I could look at his nailbeds and see the azure waters of the south pacific in those oxygen-starved parenichiums (paronychii?). You would be wrong. I actually found a very talkative and pleasant man with no breathing abnormalities and no distress whatsoever. Capillary refill normal and intact, even pulses, no paresthesias and a GCS score of 187.

That is why when I see "Medical Problems" on the slip of paper, I know it must be serious. Right?

Letter Scramble

2009-01-29T11:03:00.001-08:00

As long as I'm on the Wordnerd kick, here is something that I find truly amazing.

I hvae seen tihs a few tmeis, but I am aywals bwlon aawy by how esay it is to raed. The ieda is taht as lnog as you lvaee the fsrit and lsat ltetres in pcale, you can tlaltoy ranrragee all the ohetr lttrees and it is slitl redalbae. Tehy say tihs is bceusae we dnot raed all the lrettes in ecah wrod, but rthaer sikm oevr wrods and flil in the balkns wtih our mnids.

I cnat get oevr waht the hmaun mnid can amopccislh. It mkaes you wdneor, tuoghh, if we are so sramt, why do we siltl hvae MTV? And why wulod my petanit form the ohetr day gvie me wtear inetsad of unire? Taht is a qsuteoin for the aegs.

Warning: Wordnerd Post Ahead

2009-01-29T09:55:00.001-08:00

Interesting Pile is quickly becoming one of my favorite destinations on my Google Reader dial. I only recently discovered it, but it is a site of a librarian who posts links to all kinds of lists. Top 10 this and List of 30 of that and 20 worst this. Much of it doesn't interest me, but that is a good thing because every day I am inundated with 10 or 20 of these lists, so if I just find a few interesting ones per day, it takes up much of my valuable time. If only they weren't so stinking, well, interesting.

Today, one of the links was to Bookninja - a site that I have never heard of - who post a list of the 100 most beautiful words in English from the alphaDictionary. This is according to Dr. Godcomplex who arbitrarily picked them out of his rectal cavity.

Anyway, apparently he bases this on the sound and meaning of the words, probably using the same formula that Medicare uses when determining reimbursement levels.

Of course, to wordnerds like me, I have to put my two cents in, so I went through the list and found 13 that I actually think are beautiful, based on my formula, which is "does it sound beautiful" (read: cool). To his credit, he did get my two favorite words: plethora and loquacious, and in his "bonus" section (which, interestingly, is just a continuation of his alphabetical list) mentions tintinnabulation. Otherwise, he failed miserably - Fragile is one of the top 100? Really? After muddling through his list, I went to my list (yes, I have a list - 240 words strong so far - I openly admit that I am a nerd) and grabbed 50 that should have been on Dr. Goodwimp's list but were apparently not as worthy as elixir or diffuse or glamour or ripple.

So to all my hopeless wordnerd colleagues out there, please enjoy the 13 honorable mentions from Dr. Goodlord, and then look at what a real list of wonderful words should look like.

Did I mention I'm a nerd? If not, I'm a nerd.

From Dr. Goodweird's list:

7 blandiloquent Beautiful and flattering.
20 ebullient Bubbling with enthusiasm.
26 ephemeral Short-lived.
30 eschew To reject or avoid.
33 ethereal Gaseous, invisible but detectable.
49 imbue To infuse, instill.
54 inure To jade.
62 lithe Slender and flexible.
63 loquacious Talkative.
83 penumbra A half-shadow, the edge of a shadow.
86 plethora A great excess, overabundance.
96 scintillate To sparkle with brilliant light.
100 surreptitious Sneaky.

From my list:

Abrogate
Alacrity
Anachronism
Attenuated
Bequeath
Burgeon
Cacophony
Circuitous
Confabulate
Dearth
Deleterious
Discombobulate
Efficacious
Egregious
Emaciated
Epistemological
Equanimity
Extemporaneous
Heretofore
Ignominious
Indubitably
Insinuate
Intrinsic
Juxtaposition
Leviathan
Machination
Magnanimous
Malapropism
Masticate
Nomenclature
Obfuscate
Ornery
Paraphernalia
Parturition
Pedantic
Perspicuity
Precocious
Preternatural
Quixotic
Resilience
Repository
Reticent
Saltatory
Superfluous
Triumvirate
Unconscionable
Unremitting
Vitriol
Voracious
Writhe

Today's "Reason For Your Visit"

2009-01-26T06:23:00.000-08:00

Heart Pains

You may think that you know who this patient is, but I assure you, it really wasn't Anne Murray.

Filler (or Braden's Musical Tastes)

2009-01-25T19:59:00.000-08:00

A while ago, KeepBreathing at RT101 had some time and nothing constructive to do, so he shared a list of songs that he likes by putting his music list on random mode and just listing out what songs came up.

If it's good enough for RT, it's good enough for me!*

Richard Cocciante - Si Tu Me Revenais
Celine Dion - Where Does My Heart Beat Now
Piotr Tchaikovsky - Romeo and Juliet Fantasy Overture
John Williams - Theme From Jurassic Park
Garth Brooks - Unanswered Prayers
Juanes - Nada Valga Sin Tu Amor
Mark Chestnut - Almost Goodbye
Colin Raye - If I Were You
Antonin Dvorak - Allegretto Grazioso from Symphony Number 8
Karen Carpenter - We've Only Just Begun
Metallica - The Unforgiven II
Foo Fighters - Everlong
Benny - Llueve Luz
Francis Cabrel - Je T'aimais, Je T'aime et Je T'aimerais
George Gershwin - Rhapsody in Blue
Gerard De Palmas - Au Paradis
Anne Murray - A Little Good News
David Archuleta - Imagine
Howard Shore - The Bridge of Khazad Dum
Inside Out - Jackie Chan

Some notes on the songs:
I love youtube. The only song I couldn't find: Boomtown by Toby Keith, so I skipped it. My least favorite song on this list: #2. My favorite: #5. I went to see the Lord of the Rings Symphony performed live twice. Amazing. The first time while standing outside the symphony hall, Howard Shore walked right by me, but I didn't notice him until he was 10 feet past me and he pretended to not hear me when I called after him to get a picture.

* I did this with my entire music collection, but then realized that I have a lot of music on my computer that I never listen to and doesn't belong on my list, so I made a playlist with all the songs that I actually enjoy and that is where this came from. Otherwise you would have found chapters from audiobooks and Christmas music and stuff that my wife made me rip from her CDs. Also I hate rules, so I skipped some songs that I didn't feel like putting on the list. Live with it.

Short Post

2009-01-25T16:59:00.000-08:00

I've noticed that I've posted a lot of long posts lately. Here is a nice short one to give you a little bit of a break.

You're welcome.

Why I Work in the ER

2009-01-25T16:30:00.001-08:00

Recently we had a staff meeting where the guest speaker asked each of us to introduce ourselves and say why we like working in the ER. Since then I've been meaning to put up a post about why I like working in the ER but laziness has had a firm grip on the better of me.

Until today.

The 2008 elections taught me many things, one of which is that girlvet and I run just about completely opposite on every political issue. That said, here is her reasons for why she likes the ER:

TOP TEN REASONS WHY I WORK IN THE EMERGENCY ROOM
by Madness (AKA girlvet)

1) The HOURS - I work 12 hour shifts during the day. I work 5 shifts in 2 weeks. So I am off 8 days in 2 weeks. I work 10 days out of the month. I don't have to rotate. We have self scheduling. It works out good with my family.
2) My CO-WORKERS. People in ER are a fun, interesting group. They have interesting lives. They are not your everyday average Joe. Even the doctors are fun (!!)
3) Immediate GRATIFICATION. We really do help people. We relieve pain, help people breathe better, help them be less anxious, feel safe. That feels good.
4) The CHALLENGE. It is forever changing around treatments, technology, new programs within the hospital. Every once in a while something really interesting happens.
5) The VARIETY. Every day is different because every day we have different patients and they have different problems. We see people from all walks of life, in every variety humans come in.
7) SHORT TERM care. Most of the time we see people for 2-3 hours at a time and then they are gone. If they are annoying, or their family is annoying, they are gone in a short time. If they are having diarrhea or pushing on the light every 5 minutes they are gone in a short time. Only dealing with people a short time is a beautiful thing.
8) The HUMOR. Humanity always surprises. What people do to themselves. What they tell us. It keeps us amused.
9)The EXCITEMENT. After a few years in the ER when you feel confident in your abilities, critical situations are fun and challenging. It feels good that you can handle them.
10) The ACCEPTANCE. People who work in ERs can be quirky, different. We are an accepting sort. You can be a big of an oddball and its all good.

I have nothing to add to this list. The only difference is in my schedule - I work a variable schedule, which means that I pick from the unfilled shifts after everybody has been assigned their normal rotations. This generally works out well for me and I get to work mainly day shifts. Otherwise, we are in complete agreement on why we love the ER.

Now if we can just get the ER to run for President.