My dream car

This was parked next to the hospital yesterday.

My Poor Patients

What not to say to the new mom who brought her 2 month old in for a checkup:

"Her name's Adelaide? That's a great name. It's what I named my dog."

My Clinical Example

I've been studying for taking test #2 of 4 for my medical license. I'm pretty sure it's like 10 times harder than taking the Bar exam.
Anyway, this is an excerpt from a clinical example they gave for a lung abscess:
In fact, the most striking feature of his presentation is not his physical exam, but the fact that as soon as you enter the room, there is such a powerful, bad odor that you look under the bed in the drawers to see if a decomposing, dead animal can be found when suddenly you realize it's your patient's breath. No dead animals are found.

My New Chart

For Zach.

This is posted on the wall of the residents' station in the hospital.
No joke.

My Garden

Here's a few pics of my garden these days.

My Lunch Lady

The lunch lady at the hospital had this nametag:

"Patricia Titsworth"

My amazing niece

Yesterday we hung out at my brother's house for a Terminator marathon. When we got there, my adorable niece

asks if "Keesh" is coming. By "Keesh" she meant "Keith." She had met Keith the week before when we babysat her for a while. Anyway, we told her that he wasn't coming, and she goes, "Okay good, 'cause he was scary."
After we stopped laughing, Laura tried to explain that Keith wasn't scary. It went something like, "Keith isn't scary. He's just tall and really skinny. Kind of like a bean."
To which my niece replies, "Like a scary bean!"

Also, this is her making her Zoolander face:

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]

My first night in the ER

Within the first hour I'm there, two people come come in with heart attacks.
A while later, this tiny Vietnamese lady comes in who speaks no English and hates doctors. She has this huge bleeding lump on her head that the family says has been there all day. The family swears she didn't fall, but as I'm sewing up wound, the CT comes back showing a significant subdural hematoma.
At the same time, this huge guy is brought in because he was found lying in the street, unresponsive, with white powder all around his nose. The rest of the shift was spent making sure this guy stayed very "relaxed" in a quiet room. With two police officers outside just in case we failed at relaxing him.
The rest of the shift was pretty laid back, until the end, when a really nice old lady comes in with all these crazy wounds. What happened? She was out with her tiny little old lady (or Zach Herbert) dog, and these two Great Dane mutts run and go after her little dog. What does this lady do? She grabs her dog and holds it above her head while these two dogs maul her. She had bites that seriously went to the bone. When neighbors came out and chased the dogs off, she was still holding her dog up. That's legit.

Quote of the day

"Have you ever known a fat person who didn't like yellow?"
-Laura Reese

And so it begins...

Sunday was a very busy day for me. First, I moved my home-brewed beer over to a secondary fermenter. I had this idea of brewing beer a couple of months ago, and it went something like this: "Well, I've made wine and I'm aging some whiskey, what other alcohol can I make?" and of course beer was next on the list. Since I've never brewed beer before, and it seemed like a fairly complicated process (which equals a high likelihood I'll screw it up), I decided to scale down the operation. A typical recipe makes 6 gallons of beer. That's a heck of a lot of beer, especially if it's messed up and makes you go blind. So I decided to scale it down to a single gallon and test it out. There are two problems already with this idea- first, it reduces the ingredients to an obscenely small scale, and second, I didn't have Laura double check my math. Nevertheless, I persevered and will have about ten bottles of beer just in time for the Crawfish Boil.

Second, and more the reason for the title, I also started a new batch of wine. This current batch is Pinot Noir. I'm excited, because this is our favorite wine, and it's normally pretty expensive in the stores. My fermenting it myself, it comes out to about 3 bucks a bottle. I'm also excited because I got to use smoked oak chips in the fermentation, which should be mind-blowing. Anyway, the thing about making your own wine is that it gets better with age. With our Reisling that we made before, it had to age at least three months. With a red like this Pinot, it has to age a minimum of six months, and should be aged about nine months. So, we'll probably break out our first bottle around Christmas. Be there. It'll be awesome.

My crazy mondays

I'll start with last Monday. Last Monday was awesome because 1) Somebody died on our service, but I missed because 2) I got free sushi. So, basically, we have this chump of a Residency Director who wants to have weekly meetings just so we can listen to him pontificate for hours on end. Well, this rotation, he met with us only once, and thus felt obliged to take us out to eat. Since, he had to cancel this meeting as well, he told us to go out and the department would foot the bill. We all were craving sushi, and so we go this place where you sit an ovoid bar, and a train circles on top of the bar carrying various types of sushi. It was awesome. And while I enjoyed this delicious meal, a 40 year old guy died because nobody figured out his potassium was out of control.
So, this past Monday, I started my geriatrics rotation. I go in to see this sweet 86 year old lady who I met in the ER the month before. So, it was kind of weird seeing this lady so long afterwords and on a completely different rotation. Well, it was great, because we were like old friends, and come to find out, she's been having 2-4 glasses of wine each night. Since this constitutes alcoholism, it was my job to talk her out of drinking. When I started to talk to her about it, she goes, "Oh honey, this isn't bad. I finally gave up my Jim Beam last month." Needless to say, this lady is awesome. So, it all ended up with me getting her to drink 1-2 glasses per night, and me convincing my attending that a nice 86 year old lady who's stuck in her room all day deserves a few glasses of wine each day. I actually wrote an order for this lady to have a glass of wine at night.
I'm also going to count this morning as Monday, allowing its craziness to fall under this blog's title. Today I went to a nursing home/psych facility to talk to people with dementia and such. My first patient is some elderly guy who's bipolar. During the course of our interview, we get to talking about his roommate. Guess who his roommate was. It was the guy from this day. Yes, Mr. Anti-Christ himself was living there. Unbelievable. Well, I of course ask him what happened to the guy, and it turns out he left over the weekend, got on a bus, and took off for Canada. Of course. Where else would the Anti-Christ go?

Bad Case of the Mondays

Saturday I was on call, which consists of me hanging out in the ER admitting patients to the hospital. One of the patients I admitted came in because she had abdominal pain and pancreatitis, which x-ray showed to be from gall stones. "No big deal," we tell her, "We'll just admit you, get pancreas to cool off, and then we'll take your gall bladder out. You'll be out in a few days."
Sunday I came in to check on her, and her labs are screwy. She definitely has gall stones, but it looks like something else might be going on. "Probably not a big deal," we say, "but it's better to be safe than sorry." So we order a CT scan, and call it a day.
Yesterday we come in and take a look at the CT scan. Turns out that instead of a liver, this nice lady a huge blob of cancer. "Hey, remember how we thought we'd just take out your gall bladder?" we say to her, "Well, it turns out you're actually going to die. Soon." So instead of surgery, we're giving her medication to try and make her comfortable, and sending her home to enjoy what little time she has left.

I really hate Mondays.

Adelaide at 5 months

We've finally taken more pictures of Adelaide. We're kind of failing at this whole obsessive dog owners thing. To make up for it, I think we'll get some custom t-shirts made with Ada's picture on them. Anyway, here are some before and after shots of Adelaide at 2 mo. and 5 mo.
For the rest of the new pictures, you can look on Facebook.

Overheard in the Hospital

Last night in the doctors' work area:

-Resident talking on the phone stops suddenly, and after a long pause-
"Is that my patient coding in the background?"

I love this place.

Have a cold one for Jesus

I don't talk much about our church, but this is a great story I can't leave untold. Actually, it's two stories.

First, just before Thanksgiving, our pastor told a story in one of his sermons. This is the gist of it: A guy's wife's family likes to drink beer. This guy has always been told that alcohol is of the devil, so he doesn't drink, and so becomes the odd man out during Thanksgiving. He tells the pastor, who asks if he's a recovering alcoholic and if he likes beer. The guy answers no and yes, and so the pastor tell him to have a beer and Thanksgiving and see what happens. The guy comes back and tells a great story about how he had a single beer, and the whole family instantly warmed up to him because they no longer saw him as being "holier than thou." So that's an unbelievable story to hear from the pulpit in the first place, but here's the benediction at the end of the service: Go in His peace, and have a cold one for Jesus. Amazing.

Second, today our pastor goes off on a tangent about drinking. He says, "Listen, I'm from Wisconsin, and I like beer. I like wine too, but I like beer." He goes on to talk about how crazy the South is about alcohol. He says, "You know, the same verses that talk about drunkenness also talk about gluttony, but nobody here ever talks about how bad it is to throw back a ton of fried chicken. And on top of that, no person's solution to gluttony has ever been to stop eating. The solution is moderation. And that is why I'll still drink beer."

It's so great to hear stuff like this come from the pulpit. At the same time, though, I'm disappointed that the church (at least here in the Bible Belt) is so ridiculous, and that I get so excited to hear a pastor endorse drinking in moderation. It seems so adolescent sometimes. Nevertheless, I appreciate so much that my pastor has the balls to say this stuff. It makes Sundays okay again.

The greatest niece ever

This is why my niece is the greatest:
1. She gets excited about watching old 60's Godzilla movies with me.
2. When she sits at the piano, she always sings this song: "Josh, Josh, Joooooooooosssshhh!"
3. She ends that song with "Ta-da!"
4. She's smaller than my dog, but still makes Adelaide sit.
5. She's the only person who makes a bigger mess than me when she eats.
6. She has a doll that she named Baby Naked Butt.

AIDS is so lame

So this guy comes in with AIDS, and it's to the point where he has no immune system. Now, sometimes I exaggerate, but in this case I am not. He seriously had no immune system. When you don't have an immune system, you get all kinds of really crazy diseases, and this guy had some crazy kind of pneumonia. Also, when you don't have an immune system, antibiotics are, as my resident explained, like "pissing in the wind." So, we basically watch this guy slowly die over the past few days, and we can't do anything about it. And that is why AIDS is so lame.

On a brighter note, Adelaide is nearing 50 pounds already. Hopefully we'll have some new pictures up pretty soon.