Monday, May 30, 2011

Tickle Me Emo

One of the benefits of a job in the ER is that it keeps you up to date with pop culture. So over the past few years I’ve learned what it is to be Goth, and now I’m become familiar with those we call Emo. I’ve even had occasion to write an Emo poem, at the request of one of my finer compatriots in the emergency care system of our fine nation, and thought I’d share it with you here.

(PS: Larned and Chattahooche are the locations of some of our country’s most desirable pieces of psychiatric real estate. Thought you should know.)


I cut my wrist in joy
For the bloodletting is freedom
And death my Valhalla.
If only my girlfriend notices
And I can avoid going to Larned.
Or Chattahooche.

My blood runs black
Black like the despair that fills my soul
Black like the curtain of worldly evil
That shatters the glee even of my pain
Caused by fibromyalgia.

Black like the bile of medieval times
Spawned by malevolence
Causing disease
Pestilence
Death
Black like the smell of melanotic stool.

Black like the color of Snooki’s hair
She of the Jersey Shore
A testament to the unfairness of all
And that I need larger breasts in order to attract media attention.

And what I want to say to you
You who demands my happiness
You who insist I value this pointless existence
This accident of fate
In a universe less a deity;
This struggle for life,
Only to end in inglorious pain,
Going nowhere and leaving nothing behind, is:

Leave Brittney Alone.

Sunday, May 29, 2011

Food Fact

Here’s a thought as to the obesity epidemic, especially among the poor and disadvantaged. I went to a coffee shop the other day. I had something called veggie hash, which was a small bowlful of roasted potatoes mixed with seasoned vegetables and covered with a slice of cheese. I was a bit of a doubter, but actually very tasty. Price for large order: 3.50. Add in my large hot tea for a buck-fifty more, and I’ve got a reasonably healthy 5.00 breakfast.

Breakfast at McDonalds the day before, 2 hash browns and a large soda. 2.00

See a connection?

Saturday, May 28, 2011

Revisiting Breakfast

I owe the Saab dealership $1400 to fix my car, and in order to facilitate collection they sent a driver to fetch me from the Orlando airport. (They call it Customer Service, though I suspect it’s actually a way to make sure I come back to pick up and pay for the vehicle.) I’m talking with the driver, and when he finds out I’m an ER doc he mentions that once upon a time he wanted to be a paramedic. He bailed out on that career because he didn’t think he could stand the sight of blood, and didn’t believe a friend who said he’d get used to it. Personally, I’ve never had a problem with blood, especially when it belongs to someone else. But as I’ve previously noted in these pages, I have a real problem with gastrointestinal fluids (vomitus and feces, or barf and poop.) So I explained to him that he was right, that you never really get used to it. Which is why I’m the guy flying out of the room when the retching starts, ostensibly to find a nurse with a plastic pan or to write some orders for medication to help, but really just to get out of there faster than spit. Granted, there’s probably some therapeutic value in standing by the patent’s side offering words of comfort and a reassuring hand on the shoulder, but I try not to stick around long enough to find out.

That’s why I’m so very grateful that my son is not a barfer. Some kids barf at the slightest provocation, mine has a stomach like iron. He comes by it naturally. I myself have done so maybe eight times in my whole life, and with only two exceptions they’ve all been from the excessive use of alcoholic beverages and therefore eminently preventable. (By way of contrast, The Bride is a barfer, but she does so with such charm and grace that I’ve actually thought about holding her hair back if she needed me to. But because she is wonderful, she knows not to ask.)

So it was quite a surprise last weekend when I was sitting happily at the kitchen table and heard an “urping” sound coming from his room. The fact that he was in his room at 9 AM was curious enough…he’s usually well engrossed in the computer by then… but he had told me he felt tired and wanted to rest, and I just figured it was some of his father finally coming through (weekends are sleep-ins for the ol’ man). I didn’t know what to make of it at first, as the only urping noises I’m used to hearing around the house come from the cat having a personal moment with a hairball. So I didn’t think much of it until I heard the sound of liquid on solid, which sounded suspiciously like…well, like what it was.

I have to hand it to the young man; he really kept his cool. No screaming, no crying. It was Spartan barfing. I waited a few seconds or so to give him his dignity, and then heard this small, embarrassed voice say, “Dad?”

I walked in to his room to find a slide full of blueberries. His bed is up on posts about five feet high, with a military d├ęcor. On the foot end of the bed is a ladder to climb up; just on the right side, next to the head, is a slide which allows for a fun exit in the morning. It’s also an excellent surface for the collection of vomitus, and to direct it away from the bed toward the carpet, where the blueberries currently resided in an intense pool where the slide met the floor.

Here is what I’ve learned by having my son barf a pint of blueberries:

1) Revisited blueberries are a lovely deep blue, and don’t smell bad at all. Therefore, while I would always encourage you not to engage in vomiting, if you must do so I highly recommend that blueberries be involved.

2) Blueberry hulls don’t deteriorate in the stomach. Although the juicy contents have been extracted, the hulls themselves stay relatively intact. (See “corn.”)

3) When you mop up the mess, the blueberry hulls stick to the towels.

4) When you wash the towels, soggy blueberry hulls stick to the fabric during the spin cycle. In the dryer, they will separate from the linens and lodge in the lint trap.

Here’s what my son has learned:

1) Don’t eat a pint of blueberries all by yourself during a single two-minute block of commercials.
2) Be sure to wash the blueberries before you eat them.

3) Don’t wash them down with a warm Coke.

Barfing in the ER is pretty easy to deal with, and it’s actually kind of fun to manage. It’s an instant gratification sort of thing. You can make the barfing go away, the patient feels better, the horrible retching noise stops, and everyone is happy. The process usually involves tossing the patients a few bags of IV fluids to aid in rehydration and to dilute out the ketones that have built up, chemicals which themselves can induce the Technicolor yawn; and giving some antiemetics, medications that work to suppress the Vomiting Center in the brain. (I’ve always wondered how they figure this stuff out…keep poking a rat in the brain until it ralphs, figure out where it landed, and call it the Vomiting Center? And yet science marches on.) The disposition process is pretty easy as well. If the patient keeps vomiting, they get admitted. If they get better and can keep down some Gatorade or juice, they can go home. There are lots of pills for vomiting out there, but I’ll usually prescribe a suppository on the theory that while you can barf up a pill before it has a chance to get absorbed, it’ll take a very special effort to bring up a suppository.

Barfing at home is different. The usual solutions include ginger ale, Seven-Up, and soothing noises uttered to the afflicted while cleaning up, all the while silently praying they never never NEVER make you do this again. And you can also…

(I was going to write more, but even thinking about this makes me feel a bit unwell…I’m breaking into a sweat, and starting to salivate. No, really I’ll be fine. Just leave open the door to the bathroom, and please be sure not to block my way. Can you hand me that Sprite?)

Friday, May 27, 2011

Turf the Bear!

There is a stash of small stuffed animals in the back room of the ER that we give out to young children or physicians who are scared of getting their employer-mandated flu shots. (This is why I have a new giraffe named Bob). So it's not unusual to see these toys floating about the nursing station. But what was strange was finding a stuffed bear with a tear in the joint between its head and neck taped to a clipboard and stuck in the "To Be Seen" rack with a note on the chart that says "Help me, please...I'm losing my head!"

This prompted a discussion of the best plan of care for the small smiling ursine. While we can and do sew up lacerations, the location of the tear and the extrusion of fluff from the rent suggests the possibility of deeper injury that goes beyond my expertise. In fact, as the bear does not react when I talk to it, nor does it have effective movement of its limbs, severe head and spinal injuries might be present. Maybe he needs transfer to a neurosurgeon:

"Hi, Dr. Smock? Hey, it's Howard Rodenberg out here in the ER. I've got a patient I hope you can give me hand with tonight. His name is Theodore Bear...last name's B-E-A-R...and he's an unknown aged male with a large laceration to the back of the head, almost like someone tried to decapitate him. When I first saw him his eyes were open but he was unresponsive, not moving his arms and legs, and not reacting to voice or pain with an overall GCS of 6. So far I've got a CT of the head which shows only a "white-out" homogenous pattern with obliteration of the normal anatomical landmarks that radiology is reading as diffuse cerebral edema with increased intracranial pressure. I've tried to intubate him for airway protection and hyperventilation but I'm unable to get his mouth open to intubate him despite using paralytics...it's like his mouth is sewn up tight. I've tried to get a nasal tube in him instead, but I keep meeting resistance and can't get it placed. That being said, his vitals have been unchanged throughout his ER stay. I'm thinking that because we're having airway problem, it's best to get him there by air. We'll make the arrangements with the helicopter if that's okay with you."

You don't know how much I want to make the call, because I'm nearly positive that if I talk really fast at three in the morning I can probably pull it off. I probably would do it, too, but neurosurgeons generally have the same sense of humor as Newt Gingrich. Oh, wait...that's wrong...heck of a prank he pulled off last week about that whole Presidential thing. Well, played, Mr. Speaker...well played.

Thursday, May 26, 2011

I Write the (Titles of) Songs

It’s often hard to remember that other people outside of The Bride and The Parents actually read this blog. I know this because I was reminded of such by one Katelynn Ralph, an ED tech who hails from the lovely town of Beloit, Kansas. Beloit is not particularly renowned outside of North Central Kansas, but I have been in Beloit during my tenure as a State Health Officer visiting the Mitchell County Health Department. I learned that the people of Beloit are, well, quite Beloitful, but also that they put out a spread of cookies that included the most remarkable pecan tarts. When most places simply open a bag of Oreos and sugar wafers, you remember stuff like that.

(I have done some more research on Beloit and have also discovered that according to the Definitive Authority on All Things…and by that I mean Wikipedia…that “legend has it that the local Indians advised to locate the town at a certain bend of the Solomon River to protect the town from tornadoes. To this date, downtown Beloit has never been hit with a tornado.” I have also discovered that Beloit was once home to Gene Keady, former Purdue Boilermaker head basketball coach who was despised by my parents (both Indiana grads) for decades of coaching against The General and really bad choice of hairpiece.

(You may laugh at the whole Indian thing, but they clearly knew what they were talking about. In Topeka, for instance, city planners were warned not to build a water tower on Burnett’s Mound, long thought by native peoples to protect the city from tornados. They did, and a tornado came right over the top of the mound in 1966, killing 16 and doing over $100 million dollars of damage. I also have it on good authority that Lima, Peru was sited directly in the middle of a malarial swamp, as the Spanish were advised to do by the not-so-savage-and-really-pretty-darn-acute native population.)

Katelynn had asked why I had not blogged in the past few weeks. To be honest, I hadn’t really thought much about it. I blog when I blog, and some weeks I do better than others. I do recall that the last time I blogged I was having problems with line and paragraph spacing on the BlogSpot site, and that whatever I tried to post came out as one long run-on sentence. That’s probably reflective of how I actually talk, but not really good for reading. So I remember thinking that I’d give the system a week or so to figure itself out, and then I’d go on-line again.

Then I made a discovery…or, more accurately, a re-discovery…that steered me away from my writing tasks. This was called Civilization IV, a game where one’s nation starts in the Stone Age and your task is to emerge victorious by “The End of History,” which the game reckons to be the year 2050, a full 39 years after last weekend’s aborted rapture. It’s an older game, and I’ve had it for a couple of years. It had been dropped from the standard repertoire of time-wasters for Age of Empires III, then for Starcraft II, and finally Civilization V. Civilization V, however, was so little fun…and I mean that in a playing sense, not in the sense that I stand no chance above the merest beginner level, nor in the sense that I won’t play on-line because I’m tired of having my butt kicked by teenagers who have no life and can’t spell, because that’s a given…that I decided to give Civ IV another spin in the CD drive.

This was, to put it mildly, a mistake. Civ IV has become an all consuming passion for the past six weeks, and while I’ve done some writing it’s usually started out in with a phrase like “I saw a patient in the ER…” and ends up a sentence or two later with “…and what I really need are a few Giant Bunnies with Chainsaws to take out those stupid Barbarian Axemen.” Needless to say, I like the game. It lets me create people who do whatever I want them to with no regard for themselves. I can name cities after particularly noxious individuals in public life or in my own personal and professional sphere, and then utterly destroy them with nuclear weapons. I can make an entire culture put up monuments to ME. It’s horribly addictive, and to be frank it wasn’t Katelynn’s question, nor the continued urgings of The Bride that brought me back to my keyboard. It was the fact that I’ve been able to win on Warlord level six times running (don’t get too excited for me…it’s still the third easiest out of the eight levels of play) and Amazon.com has yet to send me the next expansion disc. I figure I have a ten day window (standard shipping) to write.

So Katelynn, here is your blog. As you requested, it’s about soundtracks. A few weeks back, a few of us (Katelynn, Aminda and I) were sitting around thinking about the music you hear in the background at stores and when you’re on hold. What if different places in the hospital had their own piped-in music? We came up with a brief list of tunes we thought should be in the background for these many different units. Here’s a sampling, edited for taste:

Intensive Care

“Every Breath You Take” (The Police)
“Breathe” (Faith Hill)
“Knock Knock Knockin’ on Heaven’s Door” (Bob Dylan)
Anything by Air Supply

Urology

“Bridge Over Troubled Waters” (Simon and Garfunkel)
“Goodbye Yellow Brick Road” (Elton John)

Labor and Delivery

“You’re Having My Baby” (Paul Anka…because he had His Way with you)
“Baby, Baby, Baby’ (Justin Bieber)
“Born to Be Wild” (Steppenwolf)

Cardiology

“My Heart Will Go On” (Rene Angelil’s incredibly rich Child Bride)
“Heart of Glass” (Blondie)
“I Can Feel Your Heartbeat” (The Partridge Family)
“Achy Breaky Heart” (Miley Cyrus’ Dad…didn’t he used to be somebody?)
“Heart Attack” (Olivia Newton-John)

Emergency Room

“Urgent” (Foreigner)
“Need You Now” (Lady Antebellum)
“You Can’t Always Get What You Want” (Rolling Stones)
“Alcohol” (Brad Paisley)

Plastic Surgery

“Barbie Girl” (Aqua)
“California Girls” (Katy Perry)
“Baby Got Back” (Sir Mix-A-Lot)

Operating Room

“The First Cut is the Deepest” (Rod Stewart)

Psychiatry

“Crazy” (Patsy Kline)
“Crazy Train” (Ozzie Osborne. FYI, you can get rabies from eating bat heads.)
“Man of Constant Sorrow” (Soggy Bottom Boys…also see Urology songs.)

Pediatrics

Anything by Justin Bieber or Billy Ray Cyrus’ kid (Didn’t she used to be somebody?)

Neurology

“You Shook Me All Night Long” (AC/DC)

Transfer Center

“We’re Not Gonna Take It.” (Twisted Sister)

Radiology

“Underneath Your Clothes“ (Shakira)

Pastoral Care

“Living on a Prayer” (Bon Jovi)
“Don’t Stop Believing” (Journey)
“Jesus Take the Wheel” (Carrie Underwood. I have long thought there should be a song called, “Moses, Invest my IRA,” but no one seems to want to record it.)

Ophthalmology

“Eye of the Tiger” (Survivor)
“Eye in the Sky” (The Alan Parsons Project)

Anesthesia

“High on You” (Survivor)
“Mister Sandman” (The Chordettes)
“Hit Me with your Best Shot” (Pat Benatar)
Anything by Michael Jackson (can you say propofol?)

And a special tune for those with any two or more totally unrelated problems, each encompassing a time span of greater than three months that needed ambulance transport between 1 and 5 AM, asleep upon physician arrival but awakes to find they are still in severe pain, is accompanied by at least three family members or any number of assorted pets, reminds you that they are “not a f…ing prisoner” when you tell them it’s against hospital policy for them to go outside and smoke during their care, and says they know someone in administration:

“Here’s a Quarter. Call Someone Who Cares.” (Travis Tritt)

As always, your contributions are welcome

(Hey, Katelynn…yes, I did write most of this at the Laundromat.)

Wednesday, May 25, 2011

Photo Guy

I will be the first to admit that in I can be a bad tourist. I try very hard not to be an Ugly American, with all the baggage that implies. But I do think I wind up being an Amusing Japanese, as I have this tendency to take pictures of everything I can find. This is especially true of things like animals, as for some reason I believe that stray dogs in Peru are fundamentally unlike stray dogs in the States. Probably has something to do with it’s political ideology, or the fact that it ages siete anos cada ano instead of seven years for each one as our dogs do. And clearly this difference has to be documented for posterity.

Nonetheless, I was startled last week in the Orlando Airport to see what, by all indications and accents, were normal, red-blooded Americans taking pictures of a Starbuck’s. With the possible exception of selling china cups emblazoned with the name of the state of residence, I cannot figure out what unique quality of this particular caffeinated outlet would cause anyone would do such a thing. A Starbuck’s is a Starbuck’s, and they’re all the same, equally good or bad, unless we’re talking the Starbuck on the original Battlestar Galactica who was a much better character, but a lot less hot then the buxom female Starbuck on the 2000’s version who is probably best known for sharing a bathtub with the Big Bang Theory’s Howard Wolowitz. But I try to be understanding, because during my traveling days I was working on a photo montage called “The McDonald’s of the World.” Guess it’s a case of the exposed film calling the photographer black.