Saturday, August 20, 2011

Blog Funeral

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.

Sunday, February 20, 2011

Long Time, No See

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.

Thursday, February 4, 2010

Saturday, January 16, 2010

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

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.

Friday, December 25, 2009

A Paramedic Gets it Right

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!




Monday, December 21, 2009

Nashville Pulse, But Not For Long

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?

Wednesday, December 2, 2009

Z-Coil Shoes

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.

Thursday, November 26, 2009

I Think I Know This Patient

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.

Monday, November 23, 2009

The One That Got Away

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.

Friday, November 20, 2009

Today's "Reason For Your Visit"

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

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.

Friday, October 2, 2009

Mercy Mercy Mercy Me

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.




Saturday, September 26, 2009

Typo of the Day

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.

Tuesday, August 11, 2009

Epi Strikes Again

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.



Sunday, August 2, 2009

Office of the National Nurse

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?

Friday, July 31, 2009

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

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?

Tuesday, July 21, 2009

Monday, July 13, 2009

Schwarzenegger Replaces Most of Nursing Board

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?

Saturday, July 11, 2009

Today's "Reason For Your Visit"

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:

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?

Wednesday, July 8, 2009

Today's "Reason For Your Visit"

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:

sic

[sic]

Tuesday, June 23, 2009

Your Long-Overdue Update

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.


Thursday, June 4, 2009

Is It Just Me...

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

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.

Tuesday, June 2, 2009

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

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"

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?

Wednesday, May 27, 2009

Star Trek

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"

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:

have Epilepsy have headache

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

Monday, May 18, 2009

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

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.

Saturday, May 9, 2009

Today's "Reason For Your Visit"

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:

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?)

Friday, May 8, 2009

Dear Jennifer

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.

Tuesday, May 5, 2009

American Idol

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

Monday, May 4, 2009

Today's "Reason For Your Visit"

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:

<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.

Wednesday, April 29, 2009

Today's "Reason For Your Visit"

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:

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.)

Wednesday, April 22, 2009

In Memorium

http://knightleyemma.files.wordpress.com/2009/03/anoop1.jpg

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

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.

Wednesday, April 15, 2009

American Idol Top 7 - One Word Reviews

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

Wednesday, April 8, 2009

Today's "Reason For Your Visit"

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:

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

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.

http://i691.photobucket.com/albums/vv278/Pererau/25fd9f4f.jpg?t=1239174697

(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.)



Sunday, April 5, 2009

Today's "Reason For Your Visit"

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:

CHEST PAIN!!!

He had a cold.

Wednesday, April 1, 2009

Are You One of Those People?

http://portal.duf.hu/img/upload/200801/telephone.jpgSo 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.

Tuesday, March 31, 2009

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

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

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

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.

Wednesday, March 25, 2009

American Idol Top 10 - Mediocre Motown

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.

Monday, March 23, 2009

Today's "Reason For Your Visit"

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:

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.

Sunday, March 22, 2009

My New Band

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

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

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.

Wednesday, March 18, 2009

American Idol Top 11

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.

Monday, March 16, 2009

Calling All iPhone Users and Critics

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.

http://regmedia.co.uk/2008/07/18/rh_iphone_upright_2.jpgNevertheless, 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.