My provost

So the OUHSC provost, while in the process of developing a swine influenza task force for the zero swine influenza in Oklahoma, sent out an email to the entire OUHSC community which included the following list "basic personal steps" to stop flu transmission:
1. Wash your hands thoroughly and often with soap and warm water for 15 to 20 seconds, especially after you cough or sneeze.
2. When soap and water are not available, alcohol-based hand gels are effective.
3. Cover your nose and mouth with a tissue when you cough or sneeze, and throw the used tissue in the trash. If you don’t have a tissue, cover your cough or sneeze with your shirt sleeve.
4. Suspend courtesy hand-shakes and kisses for the time being.
5. Avoid touching you eyes, nose or mouth. Try not to touch surfaces that may be contaminated with the virus.
6. Avoid close contact with people who are sick.
7. If you get sick with flu, stay home from work or school and limit contact with others

So now I can no longer give my patients courtesy kisses, nor can I touch my eyes, nose, or mouth. I must also be careful not to touch any surfaces that could have the virus on it- not a problem in a hospital. And my personal favorite, I, as a consciousness medical professional, need to avoid close contact with sick people.

Did I mention there are no documented cases of the swine flu in Oklahoma?

My Train Wreck

When I got into the ED yesterday, they tell me that the Electronic Medical Records system is down. Since the health care field is moving toward using this, there are whole sections of the hospital that use only electronic records. The ED is one of those. So when they say that the computers are down, what they're really saying is that we have to write all our lab/x-ray/CT/consult orders by hand, and have couriers deliver them where they're supposed to go. And we have no way of knowing what the results are unless a courier brings them back. Take x-rays for example. The image is taken digitally, read on the computer, and the report is sent back to the ED in an e-mail-like fashion. When the system crashes, they have to find x-ray film, the radiologist has to do the old fashioned holding up to to a big light thing to read it, and then they have to send a hand written report back to us. The result of all this is chaos and everything taking hours instead of minutes.
On top of this, one of our three CT scanners broke earlier this week, and has not yet been repaired. Since three is barely more than enough, we've been making do with just the two, it's just slowing us down a little.
A few hours into the shift, the computers finally come back online. We all rejoice, and everyone goes into overdrive trying to re-enter everything in the computer systems. We're doing alright when, twenty minuted after the computers come back, the power goes out. Yes, we were sitting in pitch black in the hospital for a little bit. Of course, the hospital has generators that come online quickly, so people didn't die.
Now, this power outage did two things. First, it took the computers back offline. Not only did this mean we were back in our previous predicament, it meant that all those bajillion orders we were frantically entering just disappeared. The best part is, we weren't sure what made it through and what didn't. So for the rest of the shift we were getting half our labs back, or discovering that no labs had been done at all. Second, when the power went out, it scrambled one of the two remaining CT scanners. When I left, there was a 5-6 hour delay for anyone needing a CT, and the low-priority section of the ED had discharged only one patient in the last four hours because they couldn't get CTs.
The ED was a disaster. Since everything was going so slowly, our patient load backed up out of control. There were people laying and sitting wherever there was an empty space in the hallways. People were being treated wherever they were. It was like a war movie or something.
Hopefully today will be better.

My procrastination

I realized yesterday that I haven't really done any of the extra work for ER. So, now I'm doing doing a month's worth of reading, quizzes, and case presentations in the next three days.

And I just spilled coffee on my crotch.

This is going to be great.

My time in the ER

or "ED" if you keep up with fashionable new medical terminology.

Anyway, I haven't blogged in a while, so I'm combingin all my recent happenings in one convenient post.

Why I Love America
Guy has average/mediocre job in America.
Guy can't afford good health insurance in America.
Guy develops Schizophrenia.
Guy can't get adequate medical treatment in America.
Guy loses job.
Guy still can't get adequate medical treatment in America.
Guy becomes an alcoholic because the voices in his head aren't as loud when he's drunk.
Guy becomes homeless.
Guy gets jumped under a bridge.
Guy comes to the ER, gets stitched up, and still can't get adequate medical treatment because there's no one to pay for psychiatric therapy.
Guy gets kicked out of ER two hours later.

I love it.

ER Quote of the Day (For Jen)
"There's not that much that Percocet and Valium can't fix."
-my attending physician

I'm not going into ER
When I came to medical school I figured I'd go into ER. I thought I'd love the shift work, and love never being on call. I remember thinking the last thing on earth I'd want to go into was Family Medicine. I thought it'd be the crappiest, most boring field in medicine. Well, once I actually did Family Medicine, I freaking loved it. I loved being in the clinic, I loved keeping up with patients that I was treating, and I loved having a regular schedule. Still, though, I hadn't given up on ER.
All that changed on Tuesday. I was presenting a patient to my attending, and this guy was on insulin and four different diabetes medications. That's absolutely ridiculous. So, I bring this up to my attending, and he just looks at me for a little bit, and then says, "Oh, I was waiting for you to get to the part that I'm supposed to care about." Now, to be fair, he wasn't being a jerk, he was just pointing out that in the ED, we can't manage every aspect of a patient's health care because we don't have the time or the resources. That's just not what the ED is for. Anyway, right then it hit me- I want to manage this guy's medications. I cared about what would happen to him after I left, and the next day, and a year from now. I liked talking to my patients, and I liked looking at the big picture of their care. And I really don't care about doing some awesome procedure or managing a trauma patient.
Also, I really hate being in hospitals.
So all this to say that at that moment I realized that I am going into Family Practice, and I'll be probably be poor, and I'll probably take it up the butt from Medicare, but I will be happy.

My Life Really is Like the TV Shows
Keith came to town today. He starts his ER rotation tomorrow. Being the kind, even saint-like, friend that I am, I told him to come up while I was working tonight and I'd show him around. Right, so I do, and Keith leaves to go home and I walk back into the ED. As I walk in the door, paramedics blow through the outside doors with a guy on a stretcher getting CPR. The attending looks at me and goes, "Josh! Get some gloves on take over. Now." and so I rip off my white coat, grab some gloves, jump on this guy's chest, and start doing compressions. Unfortunately, the guy dies in the middle of this. So then we're backed up, and I turn right around and start seeing a new patient while my attending goes to break the news to the family. All in a day's work, I guess.

ER quote of the day

Guy rushes into our section-
"Hey, is this the place with the ruptured orb? No? Oh, okay."
-rushes back out.

["orb" is in reference to someone's eyeball]