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.