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:

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

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

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"

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:

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

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

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

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"

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:

ask me

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

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:

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

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

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(s) For Your Visit:

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

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

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

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

12 hours of triage with no backup is rough.

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:

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

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!

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

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.

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

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

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

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"

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:

F

At least this patient censored herself.

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:

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?

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

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

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"

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:

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

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

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.