Wednesday, December 31, 2008

The Few Times We Succeed

I don't remember who it was (ERP, maybe?) who linked over to Monkeygirl at Musings of a Highly Trained Monkey.

It is a very nice post about one of the few times that codes end right.  Any ER employee will tell you that most of the time, when we start a full-blown code, we go into it knowing that the person will likely not survive, and if they do, they will not make it through their hospital stay, and if they do, they will be a vegetable.  But we have to try.  It seems a fitting way to end the year to celebrate one of the successes.  As she concludes: "that, my friends, is why we do what we do."

Monday, December 29, 2008

Did I Say Mac and Cheese?

Random story:

I was standing in line at the hot food section of the deli in a large grocery store waiting to order a little something to tide me over until I could get home.

The person in front of me in line was ordering a little of everything for his family, and the person serving the food didn't appear to be the most customer-service oriented employee I've ever seen.  At one point the guy and his wife were discussing what else they wanted and I could see that the employee had noticed a little bit of old food that had become crusted to the counter.  The guy turned back and ordered some Mac and Cheese then resumed arguing with his wife.   The employee grabbed the serving spoon, still looking at the crusted grossness, then proceeded to scrape off the grossossity with the edge of the spoon.  When she was satisfied, she took the spoon and scooped out the Mac and Cheese.

I didn't order any Mac and Cheese that day.

Saturday, December 27, 2008

Who Are Three People Who Have Never Been In My Kitchen

Yeah, I'm a nerd.

I've learned to accept it.  You may as well learn to do the same.

I say this as a preface to my confession:  I love Jeopardy.

I hadn't watched it in a long long time, and had forgotten how much I love Jeopardy until a couple weeks ago when my wife recorded it on the DVR on a whim and so we watched it together.  I enjoyed it for years and years just watching by myself, but it is even better when you have someone there by you to challenge you for who can get the answer first and congratulate you when you pull one out of your rump and it turns out to be correct.

Did I mention that I'm a nerd?

By the way, I'll give a thousand points to whoever can get the reference from the title.  Another thousand for whoever gets the other TV reference.

Saw Gah earlier today, my wife made a funny face by using her tongue to make it look like she had a giant lip.  I thought it would be funny to try to kiss her like that so I went in for the smoocharoo and... let's just say that this is a less-than-romantic way to kiss someone, so I turned away and said, "oh, so gross!"

My 20 month old daughter was right there the whole time and now every time I go for a kiss, she says "saw gah!"

You gotta be careful what you say around the kiddos.

* Editor's Note: my wife is a lot cuter than George Bush.  Just in case you were wondering.

Friday, December 26, 2008

Whatever You Do... Don't. Blow. Your. Nose.

The Nurse Resource has a link to an article about a woman who may have charges pressed against her for spitting on an ER nurse.  The article contained this gem:

"The saliva in question had already been cleaned off the nurse’s face prior to the deputy’s arrival."

Was this fact actually in question?

"Yes, officer, I have the spit right here dangling from my nose.  I've had to hold my neck back like so for the last 20 minutes while I wated because the darn stuff just wants to slide right off.  Would you like to take a picture?"

Anyway, we had a similar event in our ER a few weeks ago, and the officer said that they were going to charge the guy with felony assault.  Rock on.

Thursday, December 25, 2008

Christmas Music don't like to listen to too much Christmas Music.  In fact I try to avoid it starting in late October when businesses start inundating us with it, and all the way up until just a few days before Christmas.  Its not that I don't like to get into the Christmas Spirit and all, it is just that I get sick of the same songs repeatedly being beaten and tortured by greedy singers.  Growing up, my Dad liked to listen to Neil Diamond and Barbara Streisand sing the Christmas standards.  Both Jews.  Fine, but I'm going to make a Rosh Hashanah album.

Anyway, I've always loved the Carpenter's Christmas album (really pretty much anything by the Carpenters) and my wife also grew up listening to them on Christmas morning, so that is a tradition that we have now.  It is amazing, though, that every single artist out there seems to have a Christmas album nowadays.  This morning I went on Groovegshark (try it, you'll like it) to set up a playlist, and looked for my all-time favorite Christmas songs: Sleigh Ride and O Holy Night.

O Holy Night is a big song.  A really big song.  I don't think that some singers realize how bad it makes you look when you try to sing a big song and fail.  And yet it seems like everyone has to try it.  Very few can do it.  I discovered today that Josh Groban has a version of O Holy Night.  Perfection.  He sings it big and beautiful but does not fall prey to the temptation to overdo it.  Josh Groban could sing the ingredients on processed cheese and I would enjoy it.  In fact, if I weren't already married, and happened to be gay, and had a thing for geeky guys with ugly hair and was only judging based on voice, then I might just marry Josh.  Fortunately for me, I'm already married, not gay, and have a thing for geeky women with nice hair and judge mates based on a few additional criteria (like how will they look hanging on my arm at fancy restaurants).

I also discovered that David Hasselhoff, Jessica Simpson, Big Atomic, Go Fish and too many others all think that they can sing O Holy Night.  Yes, and I can repair the fuselage on a jumbo jet, but you probably wouldn't want to fly on that plane.

And if you want to be disrespectful and irreverent, go listen to the Southpark version of O Holy Night.  I have to walk a lot of stairs on my knees after listening to it, but I always laugh.  Repeatedly.  "Jesus was born and so I get presents.  Thank you, Jesus, for being born."  Also, enjoy how the choir in the background keeps correcting him.  When you are done, a couple of hours of self-flagellation should wipe the stains away and you can get back to the real spirit of Christmas.

Anyway, I've enjoyed my couple days of Christmas music, and now I'm looking forward to shelving it for another year.

Merry Christmas everybody!  Enjoy the presents and the food and the fun, but please do take a few minutes on this day to remember the Christ in Christmas and do something kind and loving for someone around you.  One day it'll come back to you when you need it most.

Pass Me Now, See You Later

I've heard of ER Nurses having license plate frames that say "Pass me now, see you later."

Tonight while driving home from my parents house, I was doing my usual routine for driving with low traffic volumes when I am in no particular hurry: set the cruise control to the speed limit and sing along with the radio.


A stretch limo goes flying past me at 15 or more miles over the limit.  I watched it go by and thought, "do people really think that they are above the law just because they are rich?*  Boy, would I love to see that guy get pulled over just to teach them a little lesson!"


State Patrol.  1 mile later I passed the limo.  I wonder how much the ticket will be for.

* I know, I know, the limo driver probably gets paid piddle and the rich snob in the back doesn't really have much to do with the speed that the car is going, but the symbolism is too great to resist.

Peripheral Vascular Disease

The aorta looked great with no notable problems.  Some mild wall thickening showed up along the iliacs and into the femoral arteries with turbulance more notable as we reached the popliteal artery, but flow at the dorsalis pedis was almost completely blocked.  In fact, I had to have my Dad come out and give me a push to get moving as I tried to turn around on his side street.

I hate snow.

Tuesday, December 23, 2008

Chief Complaint of the Day

This one actually hails back from a few years ago, but in the spirit of poor linguistics, I remember this complaint as entered in the computer by an ER registrar:

head lack

Sadly, I think that far too many of our patients and staff alike suffer from this terrible disease.

Then there was this final diagnosis by a Nurse Practitioner in the same ER (it may have even been the same day):



Monday, December 22, 2008

I'll Take Gameshows for 2000, Alex

10 out of 10 (does that make him half the man I am?) has a very funny post up about topics he recently saw on the 25,000 dollar pyramid.  Check it out.

Linguistic Pet Peeves

Nurse K has a post up from a week ago about linguistic pet peeves.  Specifically, she complains about people using worser when they mean worse.  This started a small firestorm in the comment section of people mentioning some other word usage that annoys them.  Here are a few of my big pet peeves:

Din for didn't
Irregardless for regardless
Aks for ask
Jewllery for jewelry
nucular for nuclear
Atenonol for Atenolol

What are some of yours?

Sunday, December 21, 2008

Dear Radiology Tech my dear friends over in diagnostic imaging:

I love you guys.  You are usually very quick to come and get the patients, are willing to wait a minute or two when I'm in the middle of something or when I'm coming in to give some pain meds, and never complain about having to unhook the patient from the monitor or having to put them back on the monitor when they are back.

That said, I have two questions for you:

1.  Why is it that not a single one of y'all is capable of parking the stretcher straight.  At first I just thought that maybe I happened to get the drunk DI tech, but no: it seems like every single time a patient comes back from DI, the stretcher is parked at some kind of diagonal angle.  What gives?

2.  Okay, so this isn't so much a question as just a complaint:  some DI techs are okay at this, but others will bring the patient back, get them all hooked back up, maybe even park the stretcher straight, and then walk out without giving the patient their call light.  This happens all the time.  Often I catch it quickly, because I always try to go in the room when a patient comes back just to make sure they are doing well and vitals are stable and all that jazz, but sometimes I'm swamped with things to do and can't get in for a while and only find out that the patient doesn't have a call light until someone hears the patient calling out and then yells at me about not giving my patient a call light.

The first point is just a humorous observation.  I don't really care if a stretcher is parked straight or not.  But the second point is a genuine safety concern.

So to all you thousands - nay, millions - of DI techs that read my blog on a daily basis (okay, maybe there are 2 of you...), what can I do without stepping out of bounds to help the DI techs remember to give the patient a call light when they come back?  I don't want to become the DI police, and I'm not much for confrontation, but I do get concerned about patient safety issues.  I think DI is great for the most part and I really love the techs I work with, so I don't want to alienate anybody.

So, Dear Abby, what do I do?

Saturday, December 20, 2008

Villainous Bacteria

These killer bugs are getting worse and worse!

Said one nurse, who was obviously fighting a whopper of a URI, when asked what was wrong:

"Streptococcus are ravaging my bronchioles."

And there you have it: your nursing diagnosis of the day.

Favorite Medical Word of the Day

Someone once told me that the reason Doctors use fancy words is because people will pay a lot more if you treat pharyngitis than if you treat a sore throat.

Whatever the reason, medicine has some pretty outlandish words.

In this new series of blog posts, Braden highlights some of the more interesting medical words that make him happy and help life continue in its sunny course of awesomeness.  All this because he likes you (and because it is a really easy way to pad his post count).

Today's word:
Ischemic Penumbra

an area peripheral to one of ischemia where metabolism is active but blood flow is diminished.

This is really what we are fighting to save when we talk about the golden hour in stroke care.  Also when we talk about door to balloon time for an acute MI.  This is not to be confused with the famous "balloon to anaphylaxis due to latex allergy" time commonly talked about in pediatric wards.

To understand the penumbra, you need to understand what happens with ischemia.  When blood flow is interrupted to an area of the brain or heart, there is an area that is dead and aint coming back.  This is referred to as "screwed tissue."  Then there is the ischemic penumbra, which is still salvagable, but is a lot like any show that Bob Saget has ever participated in: right on the edge of being worthless.  Hope this helps.

So now, huddled masses, go to and find an excuse to use the term Ischemic Penumbra today.  Share your experiences in the comments.

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Friday, December 19, 2008

Yeah I Want A Break, But Not From You

I'm sure I'm not alone in rarely getting more than my 30 minute lunch break and maybe one of my 15 minute breaks.  We are supposed to get three 15 minute breaks and two 30 minute lunch breaks according to the union contract, but I've never done it and I don't know anyone who has.

That said, I love it when the float nurse comes up to me and says, "hey Braden, do you want a break?".

At least, most of the time I love it.

There are some float nurses that I really don't want covering me for a break.  One time in particular, I was swamped with things to do.  It seemed like each patient had a perpetual list of three tasks needing to be done and no matter how hard I worked I couldn't catch up.  I had been going nonstop for several hours and was starving of starvatious starvation.  The charge nurse came up to me and said "I'll give you a break if you want."  Boy did I want.

30 minutes later I came back out, hoping that I would at least find myself no further behind.  But this was a charge nurse with many years of experience and skill under her belt.  Maybe I'd find that she had made real progress on my patients.

I went to the nurses' station, but she was nowhere to be found, so I grabbed the first chart to see what was done.  Nothing.  Oh well, she's probably been busy on the second room.  Here's the rack, there's the chart... and: nothing.  Third chart: nothing.  That's right, I left for thirty minutes and put my faith in this nurse to cover me and more importantly to cover my patients, and I come back to find that absolutely nothing at all has been done.  No meds, no procedures, no vital signs, no walk by the room and wave.  Nothing.

If I wanted to abandon my patients for 30 minutes, I could have just left a couple hours ago and enjoyed lunch back when I was hungry rather than waiting until the ravenous bugblatter beasts of traal invaded my stomach and commenced an internal devouring.

I know that 30 minutes isn't a lot of time to do everything that needs doing, and I expect to come back from break to find that there are still things to do, but please, if you go through the motions of listening to report and what needs to be done for each patient, at least try to tackle a couple of those things.

Thursday, December 18, 2008

Electronic Medical Records

One thing that Mr. Obama and I agree on regarding healthcare is that it is very important that our records go digital.  We are never going to maintain the best healthcare in the world (yes, we have the best healthcare in the world... access may be limited, but technology, skill, and delivery are still in our corner) if we can't come up with some way to maintain consistant, accurate patient histories and medication records.

From that point on, we disagree about almost everything else, including how to implement the system and who should pay for it.  But it is always nice to see areas where you agree.

Anyway, this isn't a political post, but rather a chance to spout off a few random thoughts about EMR systems.  There are a lot of systems out there, and many of them I've never used, so I'm not exactly an expert in the field, but here are a few that I have played with:

Where I am working now, we use the FirstNet program from the Cerner Millenium suite.  It is alternately called ACIS, which I think refers to the whole hospital group of programs where FirstNet is the ER part or some such drivel.  I can't speak on the nurse charting or physician order entry aspects of this software, as we only use it for the tracking board, secondary assessment capability, and lab interface.  I suppose this is not the worst software out there, but I'm not overwhelmed by it.  I appreciate how it interfaces with the rest of the hospital, and the medication reconciliation, while frustratingly slow, is actually fairly decent.  But beyond that there are literally dozens of madening aspects to it, ranging from small to homicidal-ideation-inciting points that seem like they would be such no-brainer fixes (like why do we have to have a character limit in the free-text box for each system - so when I'm talking about abdominal tenderness and last oral intake and bowel tones and which shade of green that vomit was, I run out of room and have to start cutting things out or abbreviating or eliminating spaces after periods.  Seriously, people, what's up with that?).  Another thing that really frustrates me is trying to chart pain.  When I chart on a paper chart, I can write

O - sudden
P - movement, pressure.  no palliation.
Q - throbbing, burning
R - L arm
S - 8/10
T - 3 hours, intermittent pain

This takes me about 30 seconds to do, if that.  But in Cerner, each field brings up its own individual pop-up window with checkboxes that rarely satisfy what I want to say (probably 80 percent of patients descibe their pain with throbbing or stabbing but neither of them are in the "quality" checkbox, for instance).  Why I can't type in where the pain is located and then have 1 box pop up where I can simply enter the details all at the same time is beyond me.  I know that this only takes an extra couple of minutes, but when I'm seeing anywhere from 5 to 30 patients in a shift, and stupid stuff like this takes an extra 5 or 10 minutes for each patient, it really adds up - especially when I have the doctor who writes for Dilaudid "every 15 minutes" on every patient who walks in the door (praise be for carpujects).

I have used a couple other EMRs as well, including EPIC from Epic Systems, which has a number of really great features, and no huge drawbacks that I can remember, although I do remember being frustrated from time to time at a few things.  I used it mainly in Peds and Family Practice as an LPN at a huge (40 or so doctors) comprehensive health clinic, and I really liked the way that everything was integrated into one fairly easy to use system with lots of automation and patient-friendly graphs.  Patients could send e-mail messages through the system and doctors could reply and have the whole exchange automatically entered as part of the medical record.  Messages could be sent electronically to different staff members.  Medication refills could be sent straight to the doctor for approval and then sent back electronically.  And a whole host of other really nifty features.  I also spent a good amount of time in the same organization working in the Urgent Care Center.  I found this system to be a little less intuitive for this use.  Mainly, I think, because the triage entry seemed less intelligent and the nurses' notes came out in a reader-unfriendly format.  although because physician order entry was electronic, to chart giving a medication involved checking a box for PO meds, and for IM or IV meds you just had to fill in a couple details.  Also, you could see the tracking board either as a standard list, or as a layout of the department with rooms colored based on status, which made it easy to see at a glance what was going on.

Far and away the best feature, though - and the one that I miss sorely - is the "dot phrase" that Epic allows you to use.  In medicine, we are constantly using the same or very similar phrases over and over, whether it be in charting or patient instructions or whatever.  With Epic's dot phrases, you can enter a phrase one time (or choose from a large library of pre-entered phrases) and save it with a keyword.  Then whenever you type a dot and then the keyword, such as .sleep the computer replaces that with your pre-determined phrase, such as:

patient resting quietly with eyes closed and even unlabored breathing

because everybody knows that nurses aren't qualified to determine if a patient is actually sleeping or not.  Even cooler, is that if you include three asterixes in your original phrase, then this becomes an easily-editable part of the phrase.  For instance, I could put *** after resting quietly, and then when it pops up in the charting, I can quickly go through the text and any time there is a *** it will highlight it and ask me what to replace it with, so I could put "on his back" or "on his right side" or "in the sink" and then move on.  Even cooler, is that a lot of data from the patient's medical record can be called up in a similar fashion, so if I made a phrase such as:

.name is a .age .gender who complains of .cc for *** days.  .he has allergies to .allergies and regularly takes .meds.

and saved it under the keyword .triage, then when I type that keyword, I will get something like this:

Braden is a 72 year old male who complains of nausea and vomitting for *** days.  He (this phrase calls up the gender and puts the appropriate pronoun in place) has allergies to aspirin, ibuprofen, tylenol, and tramadol and regularly takes vitamin b12.

At that point, I hit the tab key (if I remember correctly) and it highlights my free text spot (the ***) and I can type what I want.  And of course the whole thing can be edited, so if anything doesn't apply I can delete it or add what I want.

Needless to say (but I'm saying it anyway), this saves immense amounts of time, and makes it so that you can write all the lawyer friendly stuff (patient tolerate procedure well, for instance) without having to wear out your hands and take the time to write the same thing over and over again.  I could chart a very thorough summary of crutch teaching, for instance, including documenting return demonstration, height of crutches and everything else, by just typing .crutch and then editing a detail or two.  Boom, 15 seconds spent on what would otherwise take a minute.  Multiply that times every patient encounter of the day, and perhaps you can understand why I miss this feature so much.

Okay, enough free advertisement for EPIC.  Are you still reading?  Good.

The other system that I have used is Ibex PulseCheck from Picis.  I remember being impressed with it because it was so simple and straightforward.  That said, there are very few specifics that I can remember to either praise or denegrate the program.  One thing that I do remember liking, however, was that the background color of the screen could be modified based on conditions, so when there was a blue screen, that meant that things were going well and you could bring your own patients back, but when there was a red screen it meant that we were getting busy or had a lot of ambulances on the way, so only the charge nurse could assign patients to rooms.  At the time I used this, I was an ER Tech, so most of my documentation consisted of charting blood draws, splints, EKGs and patient transports, so I really can't speak too much for how easy it is to do nursing assessments or med documentation on this system, though it seems that most of the nurses seemed to like it once they got used to it.

Another hospital I did clinical rotations at in nursing school used a DOS based system from the 1600s.  I would rather engrave the medical record in stone tablets than go back to that hospital.

Anyway, each of these systems has really nice features and each has features that just make me scratch my head and wonder if anybody is really thinking this through.  This gave me the crazy idea that I could come up with a good EMR, and since my brother is a computer programmer (who brings in almost 2.5 times my salary), maybe we could get something started and strike it rich.  So I've been jotting down notes every time I think of something that I want in my EMR, and although I know deep down that it is an impossible dream, I keep getting excited at the idea of solving all of the worlds medical records woes.

So I told him about the idea the other day and he said that not only is it a bigger project than I realize, but it involves a school of programming that he is not interested in, and besides, a clause in his contract states that anything he works on while employed by Software Giant, Inc, becomes their property.

Oh well.  Nice dream anyway.

So for all you intrepid souls who have followed me this far, what EMR do you use and what do you think of it?

Monday, December 15, 2008

Flirting With Jay O Sanders

So I have a facebook account mainly just to be able to stay in contact with friends (and because my wife forced me to at gunpoint), but I have taken advantage of a couple of features, such as the book list and I joined a bunch of groups that I thought were funny.  One of the groups was fans of audiobooks (I loves me a good audiobook), and that got me wondering if there was a group for fans of Jay O Sanders, seeing as how he is far and away my favorite audiobook reader.  I stumbled accross him while listening to a book by an author that I really like, and since then, I have found myself going out of the way to find books read by him even if I wouldn't otherwise be interested in it.
Turns out there is no group for fans of Jay O Sanders, but he does have a facebook account, so I requested to add him to my friends list with a message that I really like his books blah blah blah.

Imagine my surprise when the next day I get a message back from him thanking me and telling me about some of the audiobooks he has enjoyed reading.  So I respond telling him about which books I liked (Dragon Tears by Dean Koontz is not only an excellent book, but Sanders knocks it out of the park), and politely offered to take good care of him should he ever get in a traffic accident.  He responded again telling me about the books I mentioned (turns out Dragon Tears was his first...) and politely declining the traffic accident offer.

By this time I'm delighted to see a real human behind a (semi) famous face, and not wanting to push my luck/look like a stalker, I told him that he rocks and wished him best of luck.  Then I quickly posted another message asking him why he was responding to my comment at an ungodly hour.  Turns out it was a time zone difference that made it look ungodly.

Anyway, the whole point is that I think it is great that he is willing to take the time to personally respond to a fan and show his human side.  It makes me even more desirous to go out and get more of his audiobooks.  And if you haven't ever heard of him (his acting career seems to be mainly smaller parts in movies and a few TV shows, but nothing that I remember seeing him in), please go check out one of the audiobooks that he has narrated.  Give yourself time to get used to his style, which is a little different than the average narrator, and I think you will agree that he rocks the hizouse.

"Thanks for getting in touch and for your kind words. It's great to hear directly from people who listen. It's time spent with all these people we rarely meet, despite the intimacy of having privately told them a story."

 - Jay O Sanders (personal correspondence to unidentified nobody schmuck - December 15, 2008)

Incidentally, he never did accept me as a friend, but that is understandable... I probably wouldn't accept a stranger as a friend on my facebook page either.

Saturday, December 13, 2008

Heartbeat Ring

COI Titanium Heartbeat Ring - JT493

This ring is actually pretty cool.  Hey Ker, if I ever lose my wedding ring, (and when I'm done sleeping on the couch and receiving my lashes) let's replace it with one of these.

Friday, December 12, 2008

I Can Name That Rhythm In 3 Complexes

ER Murse directed me over to the CNA website (am I the only one who has a hard time seeing the abbreviation CNA as anything other than certified nursing assistant?), and when I got there, I was greeted with their logo, which was conveniently placed next to three EKG tracings... or at least I 'm going to assume that these are three separate EKG tracings, because if this is the same patient, then not only does he have a rate of like 40, but he is experiencing several serious problems simultaneously.

Obviously, they have taken the P waves and the T waves out so as to avoid distracting us with anything other than the QRS complexes.  That's good, because I didn't want to try to figure out what kind of heart block these patients are in.

But we can still try to figure out just what we are looking at, right?

The first patient has significant ST segment depression which would make me be a little concerned about a possible heart attack.  I think I would have to confirm this on another lead.

The second patient has a good flat isoelectric line, but the marked RSR' would have me wondering about a Right Bundle Branch Block.

The third patient also has an RSR' but this one appears to be more in line with a Left Bundle Branch Block.

In any case, I think that all of these patients need cardiac enzymes, a cardiology consult, and a life-saving 81 milligram aspirin, STAT.

Also, is it just me or is that an innapropriate use of a tilde?  I think that they really wanted a semi-colon here, but somebody said, "hey, wouldn't that squiggly line look a lot better there?  Kinda trendy, doncha think?"

Is There a Right Union for RNs?

Change of Shift is up over at Marijke: Nurse Turned Writer and one of the interesting links is over to ER Murse's blog, where he opines on what union is right for RNs.  I hate unions, which makes me fall into the group that he considers "hopelessly naive".

If there must be a union then I agree with him that RNs should be in a separate union, but I hate unions.  Did I mention that I don't like being in a union?  Because I don't.

Anyway, in an effort to get mileage out of my comment on the blog, here it is, reproduced in it's unabridged beauty for your visual degustation: I am at, most hospitals are unionized and you really don't have a choice about which union because if you want to work for that hospital, you have to work for that hospital's union.

One hospital in my system is a non-union hospital. Their salary is a tiny bit higher as a base, but when you consider that they do not pay union dues, the salary jumps up a lot more. As far as I can tell there are no significant differences between the way their nurses are treated and the way that I am treated, with the exception of the fact that at their hospital nurses are treated as individuals and when individual circumstances come up they don't have to pretend that everybody is exactly the same with no exceptions.

My wife and I are considering the possibility of a move in the coming months and among the places we are looking is Arizona. In doing research, Arizona has no unions at all. But based on information I have gathered so far, salary is higher, benefits are better, staffing ratios are similar or better, and from the anecdotal evidence that I have collected in talking with a few nurses, general satisfaction is very high. Another hospital system about 100 miles away from me is also non-union, and the salary is significantly higher, and again, in talking with several RNs from that system, they are delighted to be non-union.

So I guess you can tell where I fall on your scale. Yep, I'm the hopelessly naive third group. I recognize that unions can do some important things, but I think that every major union I have run into (I have been a member of SEIU and my state branch of the ANA) has become bloated and impersonal and has lost focus of actually caring for the individual in favor of seeming to care for the individual. What they actually do is extract large sums of money from my paycheck and dictate to me what I can and can't do. They throw massive weight behind political causes that I do not agree with, though they use me as ammunition in doing so. They try to "protect" thier workers in such a way that my individuality is completely wiped out, and in such a way that I cannot be rewarded for good work or punished for sloppy or lazy work.

If I could be part of a very small local union consisting of a few dozen or maybe even a few hundred employees where I actually had access to leadership, and where individuals could still be individuals and where they weren't encouraging me to strike over a 1 percent raise so that they can get more money for their political ambitions, then maybe I would be interested.

But forcing me to be in a union, extorting me for union dues, misrepresenting me to the public, and not advocating for my individual needs makes me resent being a union member.

And yes, I know that I can join the union blah blah committee and get into nasty arguments and long and unneccessary unpaid meetings.  Maybe one day I will get frustrated enough to do that just to spite some union officials.  Unfortunately, unions don't generally appreciate the "loyal opposition" so much.  Don't believe me?  Go check out the Employee Free Choice Act.

Sunday, December 7, 2008


While reading a comment on Crusty Ambulance Driver's blog, I came across the term CAOx3.  I've never seen this term before, so a quick google search came up with conscious, alert and oriented times 3.

Of course I'm familiar with A&Ox3, but I've never seen conscious added to the equation.  Is this something that is commonly used and I just haven't seen it, or maybe is used frequently in other parts of the country?  It doesn't make sense to me, because to my concrete reasoning, if you are alert or oriented, then by definition, you are conscious.

So my question to anyone who uses this term:  Do you use it because it conveys something that I'm not understanding that is not already contained in A&O or do you use it because that is the way that you learned or the way that others around you do it?

And lest anyone think I'm being snarky here, I'm not.  I really want to know so I'm not caught flat-footed if I see this in the less-virtual world.

Also I have nothing else to post right now.

Saturday, December 6, 2008

All the Manipulation That's Fit To Print

Elizabeth Cohen needs to lose her "medical correspondent" status STAT.  Your ER Doc pointed to this article on CNN's website about how to manipulate your way in to see the doctor.

Starting with some heartstring tugging story - complete with photograph - of a woman who hit her head and was told by the ER to see her PCP, but she couldn't get in for a week, it goes on to list some ideas for getting in faster:

1. Harrassment is a great way to make your doctor slink further away from the community.  Because lawyers haven't done enough of that already.

2. It's not really a lie if it's sort of true.  Right?  Like, you remember that boy who cried wolf?  Well maybe there was sort of a wolf.  Right?

3. Make friends and influence people.

4. This one is actually good advice... as long as you are considerate with how you use cancellations.

5. Are you kidding me?  Are you freaking kidding me?  No, seriously, are you kidding me?  Please see number 3... multiplied times 50.

I love it when our illustrious news media tries to help out by encouraging deception, manipulation and harrassment.

Here are a few random thoughts:
  • If your throat really does feel like it is closing, then please get to the nearest phone and call 911.  That is a true emergency and you shouldn't be seeing your doctor anyway.
  • Your manipulation may get you in to be seen sooner, but at what cost to your future credibility?
  • Note that the woman in the article is bemoaning not being able to get in to see an internist.  Perhaps she could have tried to see a general practitioner.  I don't know about where she lives, but the family practice clinic I go to has several doctors in the office and almost without fail I can get an appointment to be seen within a day or sometimes two.
  • Group practices are great.  I used to work in a very large group practice as an LPN, and while it certainly had its flaws, I think we delivered good care, and as a patient in that practice, I received good and timely care.
  • As an ER nurse, believe me that I don't want all these patients spilling out the door of the doctor's office and into my back yard, but if your ailment is so serious that you need to be seen right away, then you may need an Urgent Care or ER visit.  If it is the result of not planning ahead on your part, then suck it up.
  • If your doctor really is that busy, then find another doctor.  Nobody is forcing you to go to that one.  This is the beauty of the free market system.
  • If you think this is bad, just wait until you are assigned to a doctor and that doctor is allotted a certain amount of money and no more.
A few gems from the comment section.  These are the ones who really get it - the people who have their finger on the proverbial pulse of true entitlement thinking:
  • "I am tired of hearing how "busy" the doctor's are. They should behave in a more professional manner and never make the consumer feel like a "bother" or a "nusiance"."
  • "When patients (an apt term) need to be their own advocates because a physician, hospital, or other healthcare provider can't be bothered, something is definitely wrong."  That's right.  How dare they make me advocate for myself! Something is seriously wrong when the doctor can't even care enough to squeeze me in on his lunch break.  What's he doing taking a lunch
    break, anyway?  How can he even think about food when there are sick people out there?
  • "there is no reason I have to walk around for weeks with coughs, pains, dizziness or other minor ailments, feeling miserable and troubling the people around me."
And finally the commenter that just doesn't seem to understand.  Hey guy, these patients are entitled, and how dare you suggest that they might need to accept that there are other people on the planet:
  • "If you 'exaggerate' and say your throat is closing when you have a regular sore throat and get in sooner, what happens to the people who really are having a true emergency?"
In the end, I understand that there really is a growing problem with access to doctors, and it is one that needs to be addressed, and I think is being addressed in many ways.  It can be frustrating when you are in pain and need to get in and are having a hard time finding an appointment.  My heart goes out to you, it really does (despite my sarcasm earlier in the post), but lying and manipulation and other dangerous and antisocial behaviors are not the solution, and shame on you, Ms Cohen, for being willing to spread such ideas.

Saturday, November 29, 2008

I Said Height and Weight

It amazes me how eighty percent of the time when I ask for height and weight I get weight and height.  This is not a huge deal, it's just interesting that almost everybody, even when asked for ht and wt (in that order) feel compelled to give me their weight first.  What's up with that?

Thursday, November 27, 2008

Getting Into the Thanksgiving Spirit

I try my best to live a life of gratitude every day, but I do appreciate having at least one day that is set aside to really ponder what I am grateful for.  I've been thinking about this for a couple weeks and planning what to write in my head, but a killer cold of lung-coughing-outness and sleepless nights of babyal awakeness have left me a wide-eyed zombie, so I have kept putting off this post until now.  But hey, what a way to start out a gratitude post with things that I'm not thankful for...  let's get onto the big show:

I love my wife.  She is rocking cool of friggin coolness and I love her coolness of awesomation.  She is a trooper when it comes to taking care of the baby, especially on the nights before I have to work.  She is a great Mom to both of our daughters, and she stands by me even when I sometimes let my winter blues keep me from actually doing anything helpful.  K, I love you forever and even if you look like a 16 year old, you carry your teenage presence with grace.  Or something.

I love my kids.  My older daughter is the light of my life and it is so satisfying to see her growing and learning every day.  She is the smartest kid I've ever seen for her age and I know that she is going to do great things.  My younger daughter can be trying at times, what with the grunting all day and night, but she is growing more and more beautiful, and I can already see that she is going to be just as smart.  She is amazingly alert for a one month old and has a neck made of steel, and now she is gaining weight like a champ!

My parents and siblings are awesome.  Even though we don't see each other as often as I'd like, I still enjoy living within reasonable driving distance to all of them, and it is one of the biggest reservations I have about the idea of moving somewhere else.  My parents will drop everything to help others and give literaly dozens of hours every week in volunteer service, and my brothers are all great people and happy husbands and fathers with wonderful, supportive wives and smart children.  I am really grateful to have a brother that works in the ER just down the road.  It's nice to be able to comiserate over a lively game of ping pong.

I love my job.  I really like going to work knowing that I'm going to make a difference in some lives.  Sometimes it gets stressful and a little overwhelming, but it is so worth it for those moments when the patient tells me "thank you, you have been so kind."  That is why I got into nursing in the first place, and it means a lot to me to have a job where I can bring some kindness and joy into the lives of others while at the same time being challenged every day.

I am grateful for those who work with me.  My fellow nurses in the ER are always willing to stop and help me when I have a question (which is all too often), my ER Techs, for the most part, are very helpful and will anticipate what needs to be done and get it taken care of without me even having to ask, and the group of Docs and PAs that work at my ER are all great.  With just one or two exceptions, they all carry themselves as coworkers and friends rather than holier-than-thou bosses, and I feel that I can come up to them with questions or concerns and they are receptive and act as part of the team trying to help each patient feel better.  The medics that come to our ER are incredibly smart and capable, and the two that I rode along with for a day 8 months ago still greet me by name when they see me.  I feel confident with the information that I get from them (except for the medication lists, but that is a story for another day), and I generally find that what information they are able to gather in the back of a speeding ambulance is acurate and largely complete.  It takes a huge load off of my shoulders when I can put such confidence in what I get from the EMTs.

I love my patients.  Yeah, there are the bad apples, and those are often the ones who make it onto this and other blogs, but for the most part, I deal with patients who are coming to get help because they really feel that they need it, and I find them to be kind and gracious on the whole.  I try to show respect for them, and I usually get back a good experience as well as we work together to try to ease concerns and heal wounds.  It is very satisfying.

I am grateful for this blog.  It has given me the chance to vent frustrations, share interests, rant about politics, and gain great insight.  I've never met epijunky, but I feel like I have a friend, and that's pretty cool.  when I started the blog, I wondered if I would be able to get more than the couple hundred visitors a month that our old family blog got.  Now I get several hundred visitors a day, not to mention the hundresds that subscribe through various feed readers.  It is humbling and satisfying, and the majority of comments I have heard back from readers have been positive and supportive.  Thank you so much for coming out to my corner of the web!

Oh goodness, I always get to this point and realize that I have listed tons of stuff but still have tons more to say, so I'll just go into zippidy doo dah mode and list off some other things that keep me sane and happy:

Church - yeah, I'm religious and I love it.
Football - I've always liked a game here and there, but this year I've been following it closely and have enjoyed it tremendously.  Here's to hoping that USC can get into the BCS championship and that Detroit can maybe win a game somewhere.
The mall - wandering aimlessly around the mall is the best date for me and my daughter, and she loves loves loves the slide in the play area.
Wendy's Chili - yummy.
Mario Kart - words cannot describe...
Thanksgiving Dinner - the best meal of the year.
Provigil - miracle drug.
Classical Music - I love me some James Taylor and Garth Brooks, but nothing is quite like a Rachmaninov Piano Concerto or a Beethoven Symphony.
My Pocket PC - Telephone, calculator, drug guide, game repository, calendar, mp3 player, camera... it is rarely not right at my side.
Good Authors - Michael Crichton, Dean Koontz, Orson Scott Card, Brad Meltzer, Piers Anthony, Michael Connelly, John Grisham, Vince Flynn, Timothy Zahn, Dave Barry.  Others.
DVR - Now that I can pause and rewind TV and fast-forward through the comercials, I never watch live television anymore.  If I really want to watch it live, I just record it and start 20 minutes late so that by the time the show is done I've caught up to it and I still don't have to watch the commercials.  Oh blessed day!
Webcams - We just spent 30 minutes talking to family members from all over the country thanks to Skype and my webcam.  My parents got to see my youngest daughter and I didn't even have to take her out of the swing or even wake her up.
Wii - Wheeeeeee!
Humor in all it's forms - I cannot live my life without humor.  It is always present around me.  No, seriously.  I've tried sprays and creams and pills and nothing seems to be able to get rid of it... maybe that's not humor after all...
Great Examples - The other day I went down to visit my parents on a Sunday and when I took my daughter to the nursery, one of the nursery workers was a man who just months before was the leader of a whole region and 2500 church members (in our church we have no paid clergy, so members serve in varying capacities for a short time and then move on to different jobs).  Most people would scoff at going from top dog to a lowly nursery worker, but he delighted in the chance to serve his fellow man however he could.  Truly one of the best examples I have ever known.  And while I'm getting sappy, his daughter was a huge example for me many years ago when I was a teenager and she was the epitome of what a friend should be.  Hi M!
Other stuff - I'm forgetting a lot of stuff, but you've probably stopped reading by now anyway.  I love all y'all and keep it real, yo.  Peace out!

Bat Thumb

A comment I was leaving on another blog reminded me of a scene from Bat Thumb.

Warning: if you do not like crazy stupid humor, then you will probably not like any of the Thumb movies, so just skip it and move on.  There is nothing to see here, people.

Otherwise, enjoy this clip of some of the funny moments from the Bat Thumb movie (really it's only a 30 minute movie, so this clip is nearly a third of the whole thing, but it really is that funny... if you are weird and nerdy like me)

Wednesday, November 26, 2008

Calling All Travel Nurses

Right now I have a good job at a good hospital and I'm pretty happy with it.  I'm getting great experience and I enjoy living near (but not too near) my parents and three married siblings.  That said, I have a few problems:
  • I want to do some travel nursing before the kids are in school.
  • My wife hates the weather here (like she can talk... she's from Ohio)(okay okay, I don't like it either)(my wife made me put that)(okay, so she didn't force me to, but she strongly encouraged it)(if you can call a butcher's knife encouragement)(no, I don't need to speak to your social worker about domestic violence concerns.  I have a butcher's knife, too)(my wife's is sharper, though).
  • I want to go back to school and get at least my BSN and more likely my MSN (I have an AA right now - all 12 steps of it!), and I don't like the options around where I am living now.
  • Both meself and me misses get wanderlust and the idea of going someplace else attracts us.
  • I hate the politics of my blue, blue state.
I've already chatted with one kind fellow blogger who helped me with some information about one possible location that we are considering that solves all of our problems (except the weather one), but I would like to see if there are any other intrepid souls out there that would like to extoll the virtues and warn of the pitfalls of Travel Nursing.  What are the best agencies?  What are the traps to avoid?  How do we know we are getting a good deal?  How easy is it to come and go from an agency? 

And even more, I would like to see if any of the 509 Arizonians that have stopped by my blog would like to help me with some information about living in the Phoenix area and what hospitals are good and which ones to avoid at all costs.  We have done some research over the past few days and have found a couple that really interest us and a few that grab our attention.

Other places that we have considered include Colorado Springs, San Antonio, San Diego and Santa Cruz (as you can tell, we are most interested in the Southwest).  All of these places violate one or more criteria that we are looking for, but I think that if you want to live in the perfect place you need to live a life of service and gratitude and mostly a life of avoiding killing men in Vegas just to watch them die.  But I digress.  Anyone from these areas have any input?  You can leave a comment, or even better, send me an e-mail to

You're Number 25,000 (and 6)! I'm at it, I just checked my Google Analytics report and as of midnight, I have now had 25,006 visitors.  I can hardly believe that this many people are really interested in reading my drivel, but please, read on!

Incidentally, despite two individual posts about the state, Wyoming has still only sent 4 people to see me.  4.  What did I do wrong?  I wear deodorant, I promise!

Even more incidentally, and while I'm at my nerdy best, California and Texas are my most common visitors, but in a somewhat surprising turn, Pennsylvania, Illinois, and Michigan are also visiting me at alarming rates.  What kind of goodness have I offered these states to merit such wonderful rates of visitation?  The world may never know.

Somewhat less incidentally, the reason that I am looking up these stats is for a post that I will write as soon as I finish this one.  Stay tuned.  (or more likely you will have already read the next post since my site puts the most recent entries on the top...)

I'm number 1!

I just looked myself up on Alexa, and it turns out that I'm number (six hundred and seventy one thousand, nine hundred and fifty...)


That's right!  You just read my page rank for all US traffic.  Jealous much?

Tuesday, November 25, 2008

Crouching Tiger, Hidden Baby

I try not to post too many photos of my children - internet stalkers and all - but sometimes they are just so gosh darn cute that I can't help myself.

Here is El Grunto* in full Chinese Action Movie mode:

My wife suggested I go into photoshop and take out the blanket and paste her** on a forest background.  The problem is that we got a new computer several months ago and I don't know where the photoshop CD is, so I've never installed it;*** so you'll just have to use your imagination.  I've included a picture from the movie**** to aid you.

* For those of you that do not speak Spanish, that means "The Grunteous One"
** The baby, not the blanket... a blanket pasted over a picture of a forest would just be dumb.

*** And even if I had, I'm lazy.
**** What movie, you ask?  If you really need to ask, then you probably didn't read the title of this blog post.  Go read it now.  I'll wait.  Are you back?  Do you still need to ask?  Please address your inquiries to 1-900-555-I'mmovieousllychallenged.

Monday, November 24, 2008

Poor Nurse Ratched

Over the months that I've been around, Nurse Ratched's blog has been my 7th leading referrer (and fourth among blogs), sending nearly 1000 people my way.
Nurse Ratched
I just found out that I'm not exactly returning the favor.  I was editing Epijunky's link to direct to her new blog site and realized that nobody has yet mentioned my referring to Mother Jones as a "psycho nurse" (I can justify this because my Dad is a psycho doctor - the PhD kind, that is - and so I know all about psychoology).

Anyway, to make a medium length story short, I clicked the link just for fun and realized that it goes to the old Nurse Ratched's place which has been out of comission for 3 months.  Oops.  Sorry Mother Jones.  Problem solved now, so expect thousands and thousands* to come flooding to your site, eager to sit at the feet of the psychoiatric master as I do every day.

*or maybe ones and twos.

How to Win Friends...

We got an e-mail the other day reminding us to have patients stop by the checkout desk.

...PLEASE notify the reg staff that the patient is about to be discharged and we will come to them since it is such a burden for them to escort the patient to the discharge desk.

Well if it wasn't a burden before, maybe now I'll make it one so that this self-fulfilling prophecy can become reality.

Sunday, November 23, 2008


I'm considering signing up for feedburner to increase my ability to be a stat nerd, but I've heard from some people that when you sign up for feedburner, it makes you commited to use the service because people then have to sign up for the RSS feed through their service and not through your native page anymore, but the reports seem to be conflicting.

Does anybody out there in Blog heaven have any experience and advice?

Saturday, November 22, 2008

Going, Going, Gone

In my last post, I talked about a transfer I had yesterday.  Interestingly, this was the third patient in a row for me that needed to be transferred, making for quite a busy afternoon.  I guess there is no better way to see the limitations of our smallish community hospital than to get a retinal detachment that can't be seen there (no opthamologist on call) followed by an SI* that wanted to go to inpatient psych (no mental health at this hospital) followed by the mandibular fracture (no maxillofacial surgeons).

Other cases that we have to transfer out: any seemingly imminent pregnancy (no L&D), bladders that can't be cathed (no Urologist), STEMIs (no cath lab), Renal Failures (no dialysis), high-level traumas (We are level 4), head bleeds (no neurosurgeon).  Probably others.

We certainly aren't huge (I recently toured an 80 bed ER that just kept going and going and going), but at the same time, it isn't that we are some podunk ER.  In fact, our department is fairly moderately sized (25 beds) and stays pretty busy with a good inflow of patients.  I think it is more that fact that the hospital that we are attached to has less than 100 beds (one ortho unit, one med/surg unit, one PCU/stepdown unit, and a 12 bed CCU).  This kind of hospital, with no surgical specialty unit, no pediatric unit, no renal unit, no oncology unit, no neuro unit, no mother-baby, and a cafeteria that only serves hot food for a couple hours at a time three times a day is not likely to attract the best and brightest specialists around.

The upshoot, I suppose is that I get really good at this end of the ambulance transfer system, and the EMTs get really good at standing around watching me frantically finish up last minute details so that I can get the patient out the door.

* by SI I mean suicidal ideation, and not, as you may assume, Sports Illustrated. I think our hospital would do just fine in taking care of Sports Illustrated, thank you very much.

Spinal? Really?

We had a patient come in yesterday on full spinal precautions after falling down some stairs.  The doctor came in the room pretty quickly and did his assessment and determined that she could come off of the backboard and c-collar.  We did so.

20 minutes later he wanted her "road tested" so we got her up and walked around the ER and everything was going ok.  She had escaped, it seemed, with some facial lacs and a couple of loose teeth.

Then the CT results came back: mandibular fracture.  This means a transfer up to a higher level ER with the proper medical staff for this fracture.  Okay.  That makes sense.

Except the part about having to send her out in full spinal immobilization.  After we have cleared her and proved that she can walk and has no neck or back pain?  Are we trying to give her back pain?  And she has a fractured mandible.  Is it really the best idea to then put a c-collar on her.  Protect the neck, sure, but have you ever noticed where the collar pushes against?  I'll give you three guesses.

So this woman who has been getting beaucoup dilaudid, which is just now barely catching up to her pain is going to be forced to be on a hard backboard with a cervical collar pushing against her broken face for a 45 minute ambulance ride?  I know that protocol is protocol, but come on, peeps!

Perhaps somebody out there in cyberland can help me understand why this is a good idea, because I just don't get it.

In the end, all I can say is thank goodness for medics who are more proficient with this task than I will ever hope to be.  I went to give the paperwork to the unit secretary and by the time I came back, she was all set to go.

Thursday, November 20, 2008

The Castle Aaaugh

Public Service Announcement:

For all you high-minded intellectuals out there, you should be aware that the scholarly group known as "Monty Python" has launched their own YouTube Channel, thereby deftly thwarting the would-be imposters and their crappy videos by offering higher-quality videos of their own.

Capitalism at it's finest.

Hat Tip: Lowering the Bar

Wednesday, November 19, 2008

Wordpress Pet Peeve

One feature that I love about blogger is that when I leave a comment on a blog entry, I can check the "e-mail follow-up comments" box and forget about it, and then when someone else comes along and adds thier own comment, I will get an e-mail message.  This is great for the times when I make a comment and want to know if anybody else responded to my comment.  I bloviate all over the blogosphere and can never keep track of what nonsense I'm spouting on who's blog, so this feature is really nice.

Wordpress seems to be a great blog engine except for the lack of this feature.  There are several blogs I subscribe to that use Wordpress and I either have to keep a tab open with the original post and check it from time to time or bookmark it and try to remember to come back to it.  I suppose there are worse evils in the world, but it is still an annoyance, especially when I know that the technology is out there to allow me to know of responses without any effort on my or the blog admin's part.

So to all you Wordpressers out there: defend yourself.  Is this feature not available, or are you just not availing yourself of it?

This I-just-got-done-with-a-late-night-baby-feeding-and-I'm-tired-and-frustrated-and-will-probably-think-this-looks-foolish-in-the-morning rant brought to you by Walmart brand baby formula:  It's Enfamil, really.  No, really - compare the two and you will understand. 1/3 the cost; same product.

Infant Tylenol and the Mystery Dose

ERP has a little rant up about parents waiting to give Tylenol or Motrin for their children.  It is a frustration that I think all ER workers can understand, especially when a child is very febrile.  Go read his post.  Here is my response (also left as a comment on the original post):

To play a little bit of devil's advocate: When we had our first baby and we realized that she needed Tylenol, we pulled out the bottle and looked at the instructions: "for children under 2, ask a doctor"

This, of course, is ironic, because they are "infant" drops, designed, presumably, for "infants" (by definition, I believe, under 2 years old - confirmed by the fact that "children's" Tylenol starts at age 2).  Nonetheless the fact remains that for laypeople or those who do not often deal with infant dosing - or just people who don't fully understand medications and are understandably a little scared when the packaging wont even give them instructions on how to dispense the product - it can be a little scary to try to properly dose the child.

Add to that the confusion about what 10-15 mg/kg means when you are a layperson and may not know your child's weight in kilograms (or for that matter you may not even have an acurate weight in pounds), and even if you do, it can be confusing about when you give 10 and when you give 15.

Also, those droppers have lines for 0.8 ml but they are incredibly hard to get precise measurements on.

Now all that said, I'm big on personal responsibility and as a parent I took it upon myself to learn all I could about these meds and how and when to use them.  It was easier for me, being a nurse to get the information and to understand it, but it is out there and should be an important thing for all parents to know.  I just have a little sympathy for the parents who are confused and a little frustration at the drug company who is willing to put a product out there at outrageous cost (compare the per-mg cost of infant Tylenol with adult Tylenol) and not even provide instructions for the target age-range beyond "ask a doctor".  No wonder they show up at my ER with the bottle in hand not knowing what to do.

UPDATE: Link to original post added. Oops.


If it is good enough for Epi and Keepbreathing, it is good enough for me: says I'm a Cool Nerd.  What are you?  Click here!

I'm actually kind of amazed that I scored that high.

Where's the Motivation?

Friday, November 14, 2008

One Step Closer to Supporting National Healthcare

I just got off the phone from a very long and emotional phone call to my insurance company.  The literature that I used to base my insurance selection from led me to believe that the baby costs were 100 percent covered.

They aren't.

It turns out that we owe thousands of dollars, and the insurance company was unwilling to budge.  So it looks as though my insurance will cost me many many thousands of dollars this year when copays, deductibles, and bimonthly payments are taken into account.  And this is supposed to be a good plan.

And to make the sting worse, my brother (who works for a software company) was telling me today about his health insurance - no copays, no deductibles, no monthly payments.  I should have been a computer programmer.

Thursday, November 13, 2008

What Disease Department?

My Father recently took a trip to China and sent me some pictures when he got back.  This one he took during a visit to a hospital.  Tell me how much discomfort you would need to be in to actually show up to a place with this name:

Wednesday, November 12, 2008

Public Service Announcement

It has come to my attention that the world is in need of an important announcement, since people just don't seem to understand the following important fact:

30 Rock is not funny.

You're Welcome.

Tuesday, November 11, 2008

Daddy-Daughter Date

I was planning on taking most of yesterday to really get some things done.  I have bills that are collecting and insurance companies to yell at (deliveries 100% covered my royal booty) and kitchens to clean up and... yeah, all kinds of stuff.

But mostly I have a toddler that needs some attention, so we went out for a little date.  She had her first Happy Meal and we walked around the mall.  And around the mall.  And around the mall.  I think we walked more yesterday than my wife and I did a few weeks ago when we were trying to induce labor.

And J is so cute that everybody always stops and mentions how cute she is (the glasses don't hurt, either - what baby doesn't look cute with glasses?).  Today one of the workers at Hallmark gave her a couple of balloons that I tied around her wrist and she walked along bobbing her arm to make the balloons float all around her.  This just made her cuter and got her even more attention.

Then we went to a baby superstore and looked around for some needed items.  We paused in the toy aisle and I gave her a few toys to look at to gage her interest vis-a-vis Christmas gifts.  One of them was silly little toy that sings the alphabet when you press a button.  I didn't expect her to show any interest because she has had several alphabet-y toys in the past, but when I gave it to her, she pressed the button over and over and over and over and over and over for about 20 minutes.

Daddy-daughter time?  Check.  Christmas Shopping? Check.  Bills and boring stuff?  Well, in the words of Ruth Hulburt Hamilton:

The cleaning and scrubbing will wait till tomorrow,

for children grow up, as I've learned to my sorrow.

So quiet down, cobwebs. Dust go to sleep.

I'm rocking my baby and babies don't keep.

Sunday, November 9, 2008

Don't Get Messed Up

Epijunky put up a picture from post secret in her last entry that says, "I would rather be a messed up person, fixed, than to be a regretless person wondering how "messed up" would feel."

I commented, "The problem is, sometimes you get so messed up that there is no "fixing" that can bring you back.

I think we see some of these people frequently in our profession."

And as I've thought further about it I want to add that the more I think about that idea, the more I think it is a dangerous view to have.  It sounds very much like a declaration of somebody who is trying to justify why they are now serving 10-15 for drug possession or someone who is now serving McDonald's food to make rent because they now can't find a job that pays more than minimum.

The fact of the matter is that through a lot of love and grace and work, it is possible to come back from messed up, and if you go into it with the right attitude, then that journey from messed up can teach you big lessons and in some ways make you stronger.  Repentance is a miracle.  But I think that never messed up is almost always a stronger position for you and for those around you than the pain, suffering, and possibility of going too far into messed up.

So don't rely on the fixing. Instead just do the right thing to begin with.

Sorry about the post-nap Sunday philosophy.  I now return you to your regularly scheduled silliness.

Friday, November 7, 2008

Playing Around With Google Stats

Google Reader has recently updated the "details" provided for each blog when you click the "show details" link in the upper right part of the screen.  It used to tell you how many posts per week and how many subscribers there are to the blog, but now they have added graphs.


To a statistics-loving nerd like me, that is like putting up a free beer sign outside an ER on Saturday morning.

So beyond seeing that I have way more regular readers than I ever expected (and certainly more than I deserve), I see some interesting patterns in the way that I post, and because it is my blog, you now have to read about it (or you could just move on to the next blog on your list...)

1.  I seem to post in clusters.  Over the past month or so, I have had 9 posts that had a day all to themselves, but 25 more posts that were posted en masse, with one day in particular seeing 5 posts.  Now I subscribe to the Happy Hospitalist, where less than 8 posts is a slow day, so I know that I'm small fries when it comes to clusters of posts.  I just find it interesting, since most of the blogs I read tend to be pretty consistently one per day, or in Nurse K's case, two at a time.  The only med blog that I could find that was similar to mine is epijunky's, which probably shouldn't surprise me, since she is the one who introduced me to the concept of ADOBSO.

2.  I'm not sure what time zone Google uses for their "time of day" feature, but it would appear that I blog mostly at noon and from 9pm to midnight.  I will take this at face value as here I am at 12:53 am writing this post (though I will probably not publish it until after the election is over.  Update: now it is three days after the election and I'm just posting it now because Michael Crichton takes precedence over stupid statistics.).  It is interesting to me that I have not published a post in the 7 am hour or the 2, 4, or 7 pm hours.  But that is getting so nit-picky that even I don't care, so let's move on and look at some other blogs:  Girlvet seems to be completely allergic to posting in the morning.  Over whatever period this records, she has posted a couple times at 11 am but never before then.  Scalpel, on the other hand, doesn't like the afternoon.  His posts are clusterd mostly between 7 and 11 am and then 7 and 11 pm.  So that means that his blog is mostly about 7-11 and am/pm.  Now he just needs to find a way to work Chevron in there and he could solicit a pretty lucrative advertising package.  Whitecoat seems to post mainly in the early morning from 3-6 am.  Night shift doc?

3.  I don't seem to post on Friday or Wednesday, but Thursday is my day.  I don't know why.  Mother Jones hasn't posted on Thursday or Saturday throughout the entire time (probably a month) that Google has been watching.  Wanderer posts on Monday, Nurse K posts .  NewGradNurse posts a lot on Friday and also some on Tuesday, but leave her alone on the weekend - only one post total between Saturday, Sunday, and Monday.  Keep Breathing likes Monday and Wednesday but not much else.

Are you still reading this?  Congratulations, you are now a member of the Braden's Gold Star Devoted Reader Club.  Contact me for your bumper sticker.

Wednesday, November 5, 2008

A Tribute to Michael Crichton

When I was a teenager and was just coming into my own as far as reading long and complex novels, Jurassic Park came out.

I fell in love.  I read the book.  Seven times.  Once in French.  I watched the movie thirty some times.  In fact, I skipped out of school to ride my bike to the movie store where I had pre-ordered the VHS tape and raced back home to watch it (why did my parents allow that?).  I loved Jurassic Park so much that as a 14 year old I started my own sequel, complete with a map of a new island, and borrowing many of the same characters.  It ended up being almost 30 pages long by the time I felt like I had a good start to it.  I mailed it to Michael Crichton to show him that there was a great opportunity to put a sequel together.  Unfortunately his production company mailed it back with a letter to the effect that he could not accept unsolicited works or something like that, and I never worked any more on it.

Michael CrichtonBut my love for all things Michael Crichton could not be satiated.  I devoured each of his novels - many of them more than once - and watched all of the movies based on the novels.  I waited with great anticipation each time for the next book to come out so that I could relish the masterful way that he mixes fascinating and strong characterizations with gripping story lines and compelling scientific thought.  With enthousiasm, I read Airframe, The Great Train Robery, Prey, State of Fear, Timeline, Jurassic Park, The Andromeda Strain, Five Patients, A Case of Need, Sphere, The Terminal Man, Congo, Disclosure, The Lost World, and Rising Sun.  I still have most of these novels sitting on my bookshelf at home, with well-worn corners and tattered covers from the many perusals.  The only book I have not read was his last, and it is on my list of must-reads.

It seemed as though everything he touched turned to gold.  Westworld remains one of my earliest memories when I think of movies.  ER (the early seasons) will always be among my favorite shows.  In fact my wife and I own the first six seasons on DVD.  I have seen Youtube videos of Michael Crichton speaking on a variety of subjects ranging from scientific to literary, and he always comes across as poised, intelligent and well-read.

It was with great distress, then, and a large amount of sadness that I read of his death yesterday at the age of 66.  Apparently he has been battling cancer for some time and has kept it a quiet and personal matter.  Class and honor, even in death.

A truly great American, and one of my personal heroes, Michael Crichton will be sorely missed.

Tuesday, November 4, 2008

Congratulations to Our New President regular reader of my blog is aware of my support for John McCain for president and my fears of an Obama administration.  It was obviously with some disappointment, therefore, that I watched the election results come in this evening.  And now the moment that I have been fearing but expecting has arrived.

Senator Obama is now officially President-elect Obama.

The battle is over now.  The mud can stop slinging, the wounds can start healing.  I have heard many people declare that "Obama will not be my president."

I can't speak for anybody else, but for myself, I can declare that fears and differences aside, Barack Obama will be my President.

I did not feel from the beginning that Senator McCain was the best candidate that the Republican party could have fielded, but I have always felt him to be a man of honor, and his classy and gracious concession speech tonight was perhaps his finest moment.  May we all make his pledge our pledge also:

These are difficult times for our country, and I pledge to him tonight to do all in my power to help him lead us through the many challenges we face.  I urge all Americans who supported me to join me in not just congratulating him, but offering our next President our good will and earnest effort to find ways to come together, to find the necessary compromises, to bridge our differences, and help restore our prosperity, defend our security in a dangerous world, and leave our children and grandchildren a stronger, better country than we inherited.  Whatever our differences, we are fellow Americans.

Election Day Plea

Today is election day here in the United States and the course of our country for the next several years will be charted as people go to the ballots all over the nation.  I have made no mistake of my support for Senator McCain for President, and as we go into the final hours, it looks like there is a path to victory for him, but it looks even more likely that we will soon be swearing in Senator Obama as our 44th President.

To all 15 of you who read my blog: go out tomorrow and exercise what is without a doubt your most sacred duty as citizens of this country.  No matter who you support, please go vote.

Every four years we get into long, drawn out election cycles.  Opinions are shared - sometimes forcefully - emotions run deep, and occasionally angers flare up.  People come up with lists of reasons why they do not like the opposing candidate and warn of doom and gloom should that person be elected.  On November 4th, we go to the polling place and cast our ballot for the individual who we feel best represents us and what direction we are looking for in our country.  And then we wait for the results.

For half of the country, those results will be exciting news.  For the other half, those results will be disappointing.  Elections are very good at dividing us along partisan lines, and in some respects that is a healthy part of the electing contest, but come November 5th and for the next several years we are going to have to do our best to put away those divisions and come together to work with whomever was chosen as our leader so that our country can progress.  Blame who you will, the fact stands that the last several years have been marked by increasing and deepening ideological chasms that have been to the detriment of our culture and our society.

In mid-January, we are going to swear in a new President, and that man will need our support if we are to move forward as a country.

My plea, then, is to prepare yourself for accepting the winner of this election with grace and class.  It may be hard to think of supporting the opponent (I have real fears about an Obama administration; girlvet has real fears about a McCain administration), but it is necessary - not to become robots or rubber stampers, but to agree to sustain the man chosen as our leader and do what we can to see that our country keeps moving.

I have spent years in Europe and the South Pacific and I have traveled to several other countries, and every single time I am excited to come home.  I love this country.  I love our people.  I love our culture.  I love our diversity.  I love our freedom.  I love that no matter who is elected, we will be breaking down senseless barriers.  And I love that even in my deep blue state, my voice will still be heard tomorrow, and that no matter what, I will always have the unique opportunities that come from being a citizen of this great land.

God bless our country, and God bless us to do our best to keep it a land worthy of blessing.

Monday, November 3, 2008

EKG What?

Our ER is trying out new disposable monitor leads.  Great idea if you ask me.  But what's up with the name:

Thursday, October 30, 2008

New Change of Shift

Amanda over at this crazy miracle called LIFE has the newest Change of Shift and it is a sort of spooky ride on the medical train, baby! (this last sentence brought to you by sleep deprivation.  Babies: have one today!)

And in other news, I'm linkedTwice.  It must be my overwhelming talent and all the lovestruck hordes rushing madly like packs of wild, ravenous cheerleading fools to submit my entries in desperate attempts to win my affection.

Or maybe I e-mailed Amanda and said, "hey you can post these if you want."

Either way, I'm published.  Baby.

(This entire post brought to you by q2 hour baby feedings.  All day.  All night.  Without cease.)

They Aren't Dead Until They are Informed and Dead

Tex has a post up about funny nursing school stories.  This one made me spit my coffee all over my computer*:

While working the afternoon shift on a busy medical ward a patient
passed away, something that isn't new. An "older" nurse asked this
student to go and make the patient look comfortable for the relatives
to say good-bye to. Off this student goes and sets the patient up
complete with reading glasses and newspaper. Before anyone saw this set
up, rigormortis had set in and so they had a dead gentleman reading a

If you didn't just laugh out loud (or at least gasp in horror), then you need to take a minute and picture that scene when the poor family members come in to the room.

* Actually I don't drink coffee, and I wasn't drinking anything at the time.  But if I did and if I were, then I might have.

Musical Interlude

I need a break from the political posts and the medical mayhem.  So lets enjoy some beautiful music courtesy of our friends at American Idol and America's Got Talent:

Eli Mattson - Walking in Memphis and Nobody Knows and Against All Odds and All I'll Be.  How did this guy not win?

David Archuleta - Imagine and The Long and Winding Road and Smoky Mountain Memories and Sweet Caroline and Longer.  How did this guy not win?

David Cook - Billie Jean and Music of the Night.

Brooke White - You're So Vain and Love is a Battlefield and You Must Love Me.

Jason Castro - I Don't Wanna Cry and Memory and Travelin Through.

And since I can't seem to get away from controversy, compare the singing ability of Neal E. Freaking Boyd and Eli Mattson in this duet.  How did NEFB win?

* Yes, I know that Imagine is stupid communist garbage, but it is so beautiful when Archuleta sings it.  I just don't listen to the insipid lyrics and I get through just fine.

Wednesday, October 29, 2008

Hatin' on the Disabled

I've already talked about hatin' on the drug companies, now it is time to bemoan those who be hatin' on the disabled.

And by disabled, I mean me.

Okay, so I'm not technically disabled in the park-in-the-handicapped-spot (legally, at least) kind of disabled, but I do have this recurrent OCD kind of behavior that only pops up every once in a while...

like when I walk down the halls at my hospital.

Please excuse the blurry picture, but at least you can see the mental anguish and torture that I go through every day as I walk to the cafeteria for lunch and find myself zigzagging aimlessly down the halls following the randomness of lackopattern that some id on the design team came up with.  I can deal with having to zigzag down the hall as I follow the green line to safety, but exactly what do they expect me to do when I come to the crossroads and have to choose one of two branching paths?  I suppose that I could take one branch and then follow it back around, but I am afraid that I would get stuck in a lunch-break-eating loop of incessant green-line-following.  And we all know the famous adage: "Where loopy green-line-following occurs, mumbling-to-oneself cannot be far off."

That is why I rarely venture outside the safety of my department.

Tuesday, October 28, 2008

Political Humor - Or Laughing at Dumb People

I know I said i would try to make my Obama post my last political one (though I'm mulling over a McCain post after girlvet's last comment), but I couldn't resist this one.

I've seen this idea before where an email gets sent around telling people of one party to vote the day after the election, but never before on official letterhead.  I think it is supremely funny satire in its more innocent form, but I do question the use of official paper to send it around - this borders on fraud in my mind.

Anyway, my opinion is that anybody so uninformed as to not recognize this as fraud should probably not be allowed to vote anyway.

Here is the flyer

Here is the snopes

So to reiterate:  This is a joke and everybody should show up on November 4th to vote.

peace out.