Thursday, December 31, 2009

The lounge

I did forget to mention the one improvement I have contributed to the lounge. I stuck a random picture of bisphosphonate related osteonecrosis similar to this on the bulletin board right above the lunch table. This is a totally rare and irrelevant disorder as EM is concerned, but the pic is so nasty I had to hang it.

Sunday, December 27, 2009

Christmas Muzak

The Muzak that is piped into our floors, much like in the house of god is noramally very annoying, but it was even more so this christmas. For one thing, it had been turned off for nearly six months after the "Highway to Hell" by ACDC was playing overhead during a nasty ED code. When they did turn it back on it was christmas music. When the same christmas songs are looped through an average of 4 times during the course of a 12 hour internal medicine shift, it can be very annoying, to say the least. It starts to be very depressing as well. Particularly when you see a 90 yr old parkinsonian gomer lying in bed, Q sign on face, staring at the ceiling, and twitching, seeminly to the beat of deck the halls.

Monday, December 21, 2009

The residency lounge update

I went in to work early this am to find a neatly made mattress lying on the floor, its frame shattered into a shambles. The vandals strike again!!

Sunday, December 20, 2009

Resident Lounge

The lounge, as I have said, has been a special project for my friend Cade. Now he has had his set backs, but, he has done a great deal to improve it. Miss Ann Thrope, and others have put time into making the place feel more comfortable and home like as well. Now, Darshita, one of the new first year residents has decided to take a collection to put in a video gaming system. Everyone has agreed and it sounds like a great idea. I have refused to contribute the first red penny, even after Darshita had to inform everyone that the price per person would be rising just because I was the one person who would not pitch in. I feel like Yossarian when he refused to contribute to the building of the officer's club. "Actually there were many officer's clubs that Yossarian had not helped to build, but he was proudest of the one on Pianosa. It was a sturdy and complex monument to his powers of determination. Yossarian never went there to help until it was finished; then he went there often, so pleased was he with the fine, large, rambling shingled building. It was truly a splendid structure, and Yossarian throbbed with a mighty sense of accomplishment each time he gazed at it and reflected that none ofthe work that had gone into it was his. " Actually, as my residency experience drags on, I begin to relate to Yossarian, trapped on Pianosa, more and more. And I see the awful similarities between the military beurocracy described in the book and the sphere of academic medicine. I think the infamous hang up is actually written into our own by laws somewhere, or evrywhere. At least nobody is trying to kill me, at least that I know of.

Thursday, December 17, 2009

The Penis Surprise

I Gave a lecture today, and as a policy I always try to sneak a Nasty Penis picture into every presentation. I always spring it when people least suspect, like right in the middle of a series of slides depicting all the images of the FAST exam. This picture of circumate balanitis (for those who wish to know) was the one I snuck in today. Just as I moved from ACute mountain sickness with High Altitude Pulmanary Edema and transitioned to High Altitude Cerebral Edema, I flashed the picture. I should start offering bonus points for the first person to name the various penis pathologies.

Wednesday, December 16, 2009

The Hiney shot

A patient told me today they had had a fever ever since they recieved the hiney shot. The hiney shot? I thought about this a second and realized they meant the H1N1 shot!

Monday, December 7, 2009

Unintended consequences of Swine Flu Scare

So much morbidity and mortality has been incured from the swine flu scare itself, probably more so than from the actuall flu. All this hospital overcrowding and resultant medical errors and increased infections and complications, etc. Then the scare has caused a shortage in the seasonal flu vaccine as well. my 90 yr old grandparents have been unable to get a dose of seasonal flu vaccine because of this. And I don't even want to get into all the costs we have racked up during this scare.

Thursday, November 26, 2009

Macy's Parade and Football

Watching the Macy's parade. I can't believe it is actually ending this early. Growing p it seemed like it went on all day, and as far back as I can remember I HATED it! it was so boring and my mom always made us watch it, or at least have it on. I always wanted to watch cartoons, or, later on, the lions play football. I have to admit I had a little thing for the lions there for a time. Not sure why. I hate detroit, and every other sports team from michigan. I guess because they always played on thanksgiving, and I always enjoyed watching football on that day, and they were the underdogs. I realize now that they will never improve. In fact, I don't really care for the NFL at all. Maybe because we don't really have a team here in arkansas. Anyway, it seems that the NFL is a rather blue-collar sport. The league came into bieng in the days when all the majority of the country had never been to college and worked in factories and couldn't feel an attachment to a college team, so they followed the city team instead. Today, the majority of americans have been to college, and it is also much more accepted to follow a team even if you didn't go to college there. So, why do we need the NFL? The drama associated with it seems to be the only thing people follow now anyway. After the long, unintended digression, I will say that I do enjoy the parade now, and I watched the whole thing, and now I'm watching the dog show.

Saturday, November 21, 2009


Freda is an interesting name. I tend to have a lot of patients with that name. Who would name a girl freda now? Nobody right? It was in the 200's until 1942. didn't drop out of top 1000 until 1975.

Friday, November 20, 2009

The Death of Ivan Ilych

The Death of Ivan Ilych should be required reading for all who wish to go into medicine in any form. For that matter it should be required reading for all of humanity. No one who reads it carefully will ever be quite the same inside again. Try it out. ........ Saw somebody pass out in person for the first time ever the other night. I was putting in a femoral line during a near code, and a pharmacy student just kind of drifted backwards, like in slow motion as soon as I got a flash of blood. Crazy! Luckily all the spectators caught her.

Wednesday, November 18, 2009


One of many large decubs on a man whos wife and daughter allowed him to lay in his own feces for weeks. Seasoned ED nurses vomited, some say for the first time in career.

Tuesday, November 17, 2009

Go Razorbacks

Well, I didnt make the game, but those damn trojans went down hard, and Mallett and the whole team were amazing! Now we get to see the razorbacks back in Little Rock, and They truly are hitting a stride.

Saturday, November 14, 2009

This is too much!

I don't mind working my ass off in the ICU for weeks, but when I am forced into call on Saturday night when the Hogs are at home, after I have already worked 14 out of the last 15 is too much! My dad and brother were both going to the game with me, and it was going to be awesome! Sure, we are just playing Troy, but I really dislike Troy. I typically have a ton of respect for strong mid - major schools, and I hate the BCS and think everyone should be on a more level field (playoff), but those Bastards from Troy, I don't care for. I think it is just because I have known some people from the town that I didn't care for. When I think of it, I don't remember ever meeting anyone from Alabama that I liked.

Friday, November 13, 2009

In "The House of God", Shem tells of the "Rose Room". This is the room where all the old gomeres name Rose are housed. They sometimes die, only to be replaced by another rose. When Shem was writing, in the late 70's, a large percent of the elderly women were named Rose. When you look back at the social security administration list of names, the years 1895 - 1900 ten rose was solidly in the top 20 most popular women's names. These women would have been becoming "gomeres" in the time that "The House of God" is set. I reflect on this because I had three elderly women named Opal in one day. I had an Opal ward. Opal came into the top 100 in 1905. It stayed near there through 1922. Between 22 and 35, doris was top 10. I see a lot of Dorises. Barbara is another. It was top 10 from 27 through 59. We will see a lot of gomeres named barbara for years to come. I will add to these "new" gomere names as new ones occur to me.

Wednesday, November 11, 2009


Rotating in the ICU and, like roy basch, it is about to become the breaking point for me. Our patients die every day. From the 47 year old breast cancer, to the 34 yr old lung cancer patient, yes 34. The asphyxiated elderly man who layed two weeks brain dead because the family was too guilty to pull the plug, they all die. It is one big swarm of death. The only thing I haven't seen kill anybody yet in our ICU is the swine flu. Cade is taking it the hardest. I think he really thinks ghosts are following him around the hospital. He talks about them all the time. which ones might be present, and why. In the elevator he tries to decide if all the people he has killled can fit in there with him. He says they follow him down the halls at night, and bang on the door of his call room. He sees glimpses of them from the corners of his eyes. He is crazy. But......I would be scared too if I had stolen the big screen from the hospice house!

Monday, November 2, 2009


Working like 120 weeks, so not much time to post, but gathering tons of material.

Thursday, October 29, 2009

New Clue in Residency Lounge case

As hard as this may be to believe, I have stumbled onto an astonishing new clue in the lounge vandalism case. I went in, late last night, to use the restroom and heard voices and laughing from the back. When I looked further I found a few of the staff in there, with a complete hair cutting operation going on! I mean the entire bed had this big fancy kit spread out on it, the person getting their hair cut was on a stool, with a drape around their neck and everything looked super professional. There were hair cuttings all on the floor, which they assured me they would be vacuuming up after they finished. They also assured me they were all either off duty or on lunch break. I couldn't believe it! This could explain how the hair got in the drains, in fact I'm pretty sure it does. However, they asked me how the beds got broken, so they must not have been involved in that...or were they? Now the big question is should I mention this to anybody, at least just to convince them to change the locks or something. I would never reveal any names, because I like all these people, but to say the least, I was shocked. Note: The actual details and circumstances of this encounter were significantly altered for the purpose of this blog. The encounter actually occurred several weeks ago and I actually only heard about it second hand, rather than witness it myself. Remember, this blog in no way reflects actual occurrences, it simply tells a story about the residency experience. Again, as the disclaimer states, the reader would do better to spend his / her time looking into their own hearts and souls than to try to place real people to these fictional events. Do I make this point very clear? lol.

Wednesday, October 28, 2009

Residency candidates

Going out to dinner tonight with some residency candidates. The best I can say about this is it will be a free meal. We have really had some duds at times. Like the guy that kept telling me to check out the female candidates ass while on the tour of the hospital. And the guy who thought he was the next thing to god, and said that he left his wife at the hotel for dinner, because he didn't care what she thought. And so many more. It is really hard to believe what some people actually say and do.

Tuesday, October 27, 2009


The afghan war dead total 55 so far this month, the deadliest since we entered the war in a place I can't even spell. On another note, the word for the day at work has been felching, or felcher. I don't even dare to define this word on this website....

Monday, October 26, 2009

Do I Have Swine Flu?

I have a fever, runny nose, myalgias, I feel like shit! Do I have the Swine Flu? I think so....lbut I don't have a cough or anything. Who knows.

Bad Luck

Just back from the Ozarks and a big weekend of trout fishing, during which I caught absolutely zero trout! At least my friend caught two good sized brooks and we had trout for dinner once anyway. Oh well. I am always bad luck when I fish.

Friday, October 23, 2009

Swine Flu

The number of swine flu deaths topped 1,000 on the year in the US today. Sounds scary? An average of 36, 000 die per year from seasonal flu related complications in this country. A high year since 92 has seen 56,000. So it isnt time to panic (oh, its too late for that, huh?). However, the traditional seasonal flu will likely also strike later this year, and bring many more deaths, particularly amongst the elderly, with it.

Thursday, October 22, 2009


A 19 year old girl came to our ED today, complaining that she had a AAA (abdominal aortic aneurysm). She was smiling and laughing and said that she thinks it is ruptured. Her cousin, a nurse, had told her that she had a pulsating mass in her belly and that she needed checked out. She sent her with a list of tests that we should perform to diagnose the aneurysm. I was so glad. The girl certainly did not have an aneurysm, but I attempted to calmly reassure her. However she insisted and seemed terrified so I ordered a few of the desired tests. No aneurysm. Ridiculous.... She was kind of nice though, and I think her cousin the nurse had just really scared her.

Tuesday, October 20, 2009

Dental Residents

Allow me to start by saying I love my dentist. He is one of the most intelligent men I have had the privilege of speaking too. He has far more general medical knowledge than I. The only problem I have with him is that he always starts conversations that are dependent on me answering 100 questions while I have my mouth open wide and full of instruments. Anyway, the dental residents here at our hospital, I don't love quite so much. Today, they sent over a lady from the dental clinic because of bleeding gums. I mean minor bleeding gums. They requested that she be evaluated for a bleeding disorder. I did a CBC to check platelets and Hgb, and informed the pt that any further workup would need to be coordinated by her family doctor, because these are not the kind of things we do in the ER. She was unhappy and took it upon herself to page the dental resident from her room phone. The resident came down and chewed me out for 5 minutes. She wanted something done, and done know. She had intended for me to diagnose the problem, and send the pt back to complete her dental work, before the dental office closed at five. She wanted to know why her critical patient had set in the waiting room six hours before even being evaluated. This changed nothing that I planned to do, and it made it obvious how little she understood about medicine in general. I stayed calm, and attacked her instead with the use of big words like Idiopathic Thrombocytopenic purpura and diathesis. We parted on fairly good terms, and hopefully she has the point that we don't need her bogus referrals, particularly in the midst of the swine flu crises.

Monday, October 19, 2009

The Resident Lounge Revisited

Who Are the suspects in the residency lounge vandalisms? First, lets consider the possibility; could it all be a series of accidents? The beds are the cheapest of cheap, maybe somebody just sat on them to heavily. But twice? Maybe the hair in the drain is just old, built up over tim. But why was it all long and one color? The busted mirror? Maybe bad luck. Who knows. And who attempted to Jimmy the lock? Wouldn't the perpetrator know the code? But, who are the suspects? Cade? Probably number one in some minds. He did "steal" the flat screen TV from the hospice lounge. Who could be more heartless and lawless? Does that man know no limits or have no morals? Me? I am certainly not above suspicion. I have never been known as the strictest rule abider. There are some in the hospital who probably think I am capable of this. What about the EM / IM resident who I will refer to as our own version of "The Fat Man", except she is "The Fat Woman" And the name is well earned. While she lacks the flare and intelligence of the original, she at least lives up to the name. Maybe she sat too hard on the super cheap beds, and they went down. She has to sleep somewhere, after all. What about the aforementioned Peds resident. With the drug habit and the paranoid schizophrenia, I still put her at the top of the list, and she has the long hair. The butch fat woman does not. What about Lyle? The freaky resident with the wife in the GI fellowship? Did they practice colonoscopies on each other in the sleeping area and get too frisky on the beds? Is that all ass hair in those pipes? Who knows. I am certain the investigation continues, and I will be sure to keep you posted.

A new Name

Anshawnalakiesha. How about that to add to the collection of names?

Sunday, October 18, 2009

Hogs Nearly pulll Major Upset

The season has already had its highs and lows for the hogs, but a superlative high nearly came yesterday with an upset of Florida. The hogs were thwarted at the last second by a field goal, to put the gators up 23-20. Oh well. Mallet played well anyway, and I am really starting to like this team.

Friday, October 16, 2009

Swine Flu

43 kids have died this year so far from swine flu, and it is not even time for "true flu season". In an average flu season only 50 die. That's for the entire year. As I have said, Hospitals that I know of personally are putting into action emergency plans for overflow tents. Is this thing going to be that bad? It is certainly going downhill right now.

Wednesday, October 14, 2009

Watching a recent sunrise, I was reminded of the bathroom at one of my favorite beach bars. There is a painting on the wall, of the Enola Gay, against a beautiful morning sky. The caption reads; "Dawn, The World Forever Changed". For me, on that more recent day at dawn, the world was forever changed. The previous night I had seen my first child abuse death. The kid was bruised all over, including around genitalia and rectum, and was a total mess. We worked it for some time, but we knew when they rolled in what the outcome would be. All faith I ever had in humanity was destroyed when I saw this up close.

Monday, October 5, 2009

Swine Flu

The Swine Flu is heating up. Where are those vaccines? Several people in our area have died, who I believe probably wouldn't have died from traditional seasonal flu. It seems like, when you look at our ED board, 75% of the complaints are fever, cough, flu-like symptoms, or exposure to flu, or positive flu test. All the pts wear masks, and things are crazy. wait times are through the roof. What will we do for room in the hospital if things get a little worse? Back to the vaccines, I guarantee these same people who rush thekids in for every little sniffle and demand testing and treatment for the swine flu are the same ones who will refuse the vaccine, and we will have to spend just as much time convincing them it is safe.

Sunday, October 4, 2009

My Blog

I have to admit I started this blog, at least in part, because I thought maybe it could help support my meager residents income, but, several months in, nobody clicks on adds, and I don't make any money, and I have lost all illusions that it ever will. However, I continue to write, I think it is somewhat therapeutic for me, and also it allows me to get all these thoughts and experiences recorded, so I won't forget them. This blog is semi-anonymous at best, but it is still a nice outlet, where I feel like I can say atleast almost everything I want. So I continue, for my own enjoyment if nothing else.

Friday, October 2, 2009

Unusual Names

Along with repeat offenders, I think I will start a regular feature on unusual names that I have heard about or directly encountered in the ED. How about Candy Disch? Or twins Unique and Dunique? I think Dunique got the raw deal there. Another fabled set of twins is Orangello and lemonjello. Spelling orange jello and lemon jello! More to come I hope.

Thursday, October 1, 2009

Stop The Skid Hogs!

Ok, so we aren't looking too great in conference play. We had a tough couple of weeks, and our championship hopes look slim at best. Time to buckle down this week in Arlington and take care of business. We can still make a good bowl, and its time to get some wins under our belts!

Wednesday, September 30, 2009

Strange Happenings

An investigation is ongoing into recent vandalism in and around the resident lounge. Two beds have been broken, and someone with long hair either washed or cut their hair in the sink, stopping it up, overflowing the toilet, and a hole had to be cut in the wall to fix the pipes! There are various suspects, including more than one of our own residents, but the prime suspect, in my mind, is one of the female peds residents who is very strange, to say the least. She may be on drugs, and I think she lives full time in the hospital. She even told me she does have an apartment, but that she is afraid to go there because there are "too many stairs", and she has a bad fear of steps! BAD paranoia! Once, I walked into the surgery lounge at two in the morning, to steal a soda, and there she was when I opened the door, just standing there, staring at the wall!

Tuesday, September 15, 2009

Swine Flu Strikes

The Swine Flu has hit our emergency department hard already and the flu season is very, very young. The Hospital is staying full and Holds are filling up the Emergency Room. The waiting room is a madhouse, people are in arguements, fist fights, and half the people are wearing masks. Things are very, very crazy!

Monday, September 14, 2009

A couple More

Found two who were in the 90's over 4 years, and one with 130 in 14 months! The unfortunate part about that last pt is they tried to die on my shift recently.

Wednesday, September 9, 2009

An update on The Repeat offenders

Thus far, just by searching the patients I personally know, I have found some interesting results. One pt has been in this single ER 320 times over four years! During that time the pt has amassed an amazing 100 CTs! Think of the radiation exposure! This patients Mother has visited us 70 times as well during the same period. The average cost of a CT is something like $1500 (although some numbers I saw were closer to $3000. So this pt. has cost medicaid 150,000 in cat scans alone. ER visits run between $100 and 5000. lets assume an average of 500. There is and additional $160,000! so at least $310,000 for this one patient in the last 4 years, not counting the mother. I found another patient with 80 visits in two years, ad another with 47 in 8 months. This is ridiculous, to say the least.

Sunday, September 6, 2009

Swine Flu

Do you realize there have been 595 swine flu deaths in the US already? Second only to Brazil. 2,000 cases have been reported on the campus of washington state alone. I heard on the news about an ER nurse who died recently as well....
Mallet and The Hogs Cruise to easy victory over Missouri St. ! Go Hogs!

Saturday, September 5, 2009


Get ready for the HOGS!! See you at War Memorial Stadium!

Thursday, September 3, 2009

Repeat Offenders

Check out this news story! It is old, but I just remembered it. It details how 9 people accounted for 2700 ER visits in the Austin, TX area over a six year period. I am sure that we have some similar people at our hospital, and I aim to find out. I know a few names and I'm going to ask my attendings for a few more and see if I can find similar results. I will let you know. I think we only have EMR back 5 or 6 years from right now, but should be enough to see the big offenders, and it shouldn't be hard to think of who they are. I'm not sure if we have people that are THAT bad, that averages out to 300 visits per person, and this article talks about visits to all area hospitals total, while I only have access to our records, but I think the numbers will still be impressive.

Wednesday, September 2, 2009

Go Hogs

Can't wait to see the Hogs back in Little Rock at War Memorial Stadium! Petrino is orchestrating the "Razor Rock" week and things couldn't be better in Hog Country. The Razorbacks are such a common ground amonst all residents of the state, and when they come to Central Arkansas, I couldn't be happier. Go Hogs!

Tuesday, September 1, 2009

Razor Rock

An exciting week is under way as Bobby Petrino orchestrates Razor Rock Week in Little Rock. Can't wait for the home opener against Missouri State! Go Hogs!

Sunday, August 30, 2009

Does the estimate of 90,000 deaths mean there will be that many in addition to the 60,000 who will die from the seasonal flu? certainly the people the flus will kill will overlap? I guess if the swine flu ONLY killed the young then it would be different than the ones who would die from seasonal flu, but it wont ONLY kill the young, right?

Saturday, August 29, 2009

New Swine Flu Reports Trigger New Post

Recently released estimates say that the swine flu could infect half of all americans and kill as many as 90,000. The typical annual number from seasonal flu is about 60,000. Also The CDC dogedly stands by the statements that young people and children will be heavily affected.

Saturday, August 15, 2009

Drive Through Emergency Room

Stanford Medical center has been experimenting with a drive through emergency room. Admittedly the plan is only designed as a back up for major events such as a swine flu outbreak. However, they are actually using it so they can see how it runs, and it is easy to see that it won't be long before these things are in wide spread use. The drive through society will soon accept no less.

Tuesday, August 11, 2009

ATV vs. Car

This lady rolled in last night after a DUI on an ATV, in which she and her husband pulled directly out in front of a car going about thirty.... She had gone up and over and into the windshield and was combative on arrival. She had leaves, glass, and whatever else in her hair. She was pulling wildly at the hair. "Just take it off, it comes off, get it off my head". She was pullling huge chunks of hair out. The policeman who brought her in calmly said to her: "Ma'am, your wig is stilll in the back of the ambulance" Her husband was dead at the scene.

Tuesday, August 4, 2009

Pneumonic Plague

An outbreak of plague has struck in northwest china among tibetan villagers, who probably first contracted the highly contagious and deadly form of plague from skinning wild marmots. Pneumonic plague is the most rare form of the black death, but the most deadly.

Monday, August 3, 2009

Fat Doctors, Fat Patients

There has been some discussion recently in news outlets, and on other medical blogs regarding Fat doctors, and their lack of efficacy when instructing pts to lose weight. They should be a better example some say, and they cant tell people to do something that they themselves do not do. The same arguement could be applied to doctors who smoke, or drink, or ride motorcycles without a helmet. The thing is, if a stock broker tells you what stocks to buy, it dopesn't have to mean he is buying them as well, he is just doing his job. This should apply to doctors, but when it comes to unhealthy habits, people want to look for any excuse they can find to not have to break them.

Friday, July 31, 2009

Man Fucks Horse, Woman Eats Baby

On a single newspaper page I found these stories, as well as one about a woman who let rats eat the toes off her baby. A woman in Texas has decapitated her three and a half week old son, and eaten his toes and part of his brains. Meanwhile, a man in South Carolina has been sneaking into a horse stable to have sex with a mare he is particularly fond of, named sugar. He was arrested for Buggery with the same horse three years ago, and now his old lover has lured him back. The horses owner became suspicious when she found bales of hay stacked up in the horses stall, apparently so the man could get in a position to access the horse. Also, she had noticed that the horse had suffered from repeat vaginal and anal infections. She set up a video and caught the man in the act. She then waited in the barn with a shotgun and apprehended the man. Her picture is above. The photo features Sugar as well. Anyway, the combo of these stories just goes to show that the human race cannot be trusted, ever. Nothing has ever or will ever change about the way we behave. Genghis Kahn's men complained that women didn't have enough orifices to service enough of them at one time, so they would simply cut extra ones to fuck. The world is fucked, and has been since people have been on it.

Thursday, July 30, 2009

Cash for Clunkers

What is all this about Cash for Clunkers all over the net?It is all the rage. It sounds like a good program, but i don't have a vehicle that gets 18 mpg. The only thing I see wrong is they are destroying all these cars when there are people who cant afford any car who would be happy to have one of those instead of destroying the motors. I do applaud getting rid of all those gas guzzlers, but like I said, maybe some of them could be put to better use.

Saturday, July 25, 2009

Steven Wells

Steven wells, a British Journalist who recently died from enteropathy-associated T-cell lymphoma wrote of his experiences in a Philadelphia Emergency Room a few months before his death. Following is an excerpt.... “I’m writing these notes in the ER blitzed off my tits on Vicodin and synthetic heroin. Outside in the corridor some poor bastard who got crushed by a bowling ball stacking machine is screaming like a baby with Tourette’s. I should be experiencing compassion but instead I’m feeling disappointed. I’ve been brought up by American TV to expect the stabbed, the gut-shot and the Mafia-kneecapped to be fistfighting with the gangbangers, the crack addicts and the self-mutilating anorexic Goth chicks in ER waiting rooms. Instead there’s just lots of very fat people feeding McDonald’s to even fatter children." Nice description, except I do see a lot of self mutilating Goths, or "Emos" as I have recently learned most of them are called.

Tuesday, July 21, 2009


As promised, updates have been added to the middle finger post of a few days ago.

Thursday, July 16, 2009

Fuck em all.

Two things. First, I think that may be the only catfish in foot pic I'm gonna get. The others are just too blury. I did get a different cool pic today, but I am starting a new policy of waiting a month or so before posting pics, just to add an extra layer of identity protection for the patient. Secondly, if you notice the films I put up of the finger dislocation, check back at that post in a few days because I plan to write a little about it. I am just too exhausted to get into the kind of heavy handed philosophy that the discussion will require. Tonight, I think for the first time, I got a glimpse into why the burn out rate is so high among emergency physicians. The bastards just ask too much from us. You finish your shift everyday completely exhausted, feeling that you have been pushed to the absolute limit of physical, emotional, and mental ability. At first this is the best feeling on earth. You leave feeling like you did your job, the description may be shitty at times, but you did that job, and probably did the right thing for a few people as well, and you really feel good about yourself, and maybe even life in general. However, this high eventually wears off, and you realize that you are grinding yourself to exhaustion every single day, and the only reward is a little sleep before you just start all over, and there comes a point when you just can't continue to lay everything you have out on the line in a public forum day after day after day. And who cares what you do really? Most of the patients don't even really care. Tonight, at the culmination of one of these hideous, stinking shifts full of wrongs and terrible abuses from the patients and to the patients, I walked out of the department, straight through the lobby, and right out the main doors, just for the hell of it. Subconciously daring someone in the waiting area or out front to fuck with me. When I came out the doors to the private auto drop off ramp I noticed the strangest detail of an insignificant scene. A lady had pulled up and was getting her son, about 10, from the back seat. He was in no apparant distress. The thing that struck me was the smell of fries. Mcdonalds fries. I glanced to the front passenger seat and noticed an older daughter cramming her fat mouth full. I thought about that and all I could picture was them out, on the way to the hospital for an "emergency" at 2am, and they decided to just run through the mcdonalds drive through on the way. My blood boiled. I really considered dragging somebody, anybody, out of that car and strangling the fuck out of them! This scene, in one split second image, captures the whole essence of the way I felt about Emergency Medicine right then at that moment.

Digitus impudicus

THESE FILMS, OF A DISLOCATED MIDDLE FINGER, PROVOKED MUCH DISCUSSION AND HEATED DEBATE AMONG THE PHYSICIANS IN OUR ED RECENTLY. Jokes were made about the middle finger, and then a statement was made that the origin of the obscene gesture is from the battle of agincourt during the hundred year's war. It was said that the french had threatened the feared english archers, saying that after they won the battle they would cut off all their middle fingers so they would no longer be able to draw a bow. After the English won the battle, they showed the still attached middle fingers to the french. Some of us doubted the truth of this story, so we looked it up on wiki. Turns out that the agincourt story is just one of many myths in regards to the origins of the "fuck you" gesture. In truth, references are found as far back as ancient rome, byzantium, and egypt. The gestures popularity in the roman empire would explain the widespread prevalence of it and similar gestures. In many older writings it was associated with such other superstitions as the evil eye as well. Regardless, this guy will have trouble flipping the digitus impudicus with that hand for a while.

Wednesday, July 8, 2009

Pulled From the Claws of Defeat!

Here is the first picture of hopefully three total. I asked around and found that one of our awesome techs had taken some phone photos of the infamous catfish. Here is the first one he sent me. It shows the shoe with the fish sticking out. The shoe is off the foot here, but part of the spine is still in the foot.

Monday, July 6, 2009


Tonight was a tough evening. We had an attending call off at the last minute, and we were swamped. Tons of minor emergencies, on top of lots of serious and complicated patients. One of the minor emergencies was a guy who had gotten a three pronged fish hook in his thumb and then decided it would be a good idea to cut it off down to skin level. What could have been a simple extraction turned into an incision and lots of digging around. The strangest part of his story was that he said he was home alone and would have been stuck in his building if he hadn't have cut the hook. This makes no sense at all, but all patients are lying about something, for some reason. The low point of the evening was this 87 yr old guy who was fairly lucid, but who was on his last leg and who i had to change from full code to DNR and ship back to the nursing home to die. I had to explain all this plan to him, even though his daughter was the power of attorney and he didn't really make the decision. He cried a little, but then seemed ok and just wanted some water, on which he nearly aspirated and died right there soon after I had revoked his full code status! At least he was not totally aware of the situation.

Sunday, July 5, 2009

The 4th

My patients last night were a steady stream of drunks and weirdos, and drunk weirdos, interspersed with this strange rash of "stomach flus", although as has been said by I believe Greg Henry on EMRAP, you won't ever find the "stomach flu" in any medical textbook. I guess just a summer bug going around, the "24 hr flu", but damn if Im not scared I'm going to miss something serious in the middle of all of them. The parade of weirdos and drunks was highlighted by a guy who called the squad for himself, after he wrecked his bicycle. Once he got here though, he spent the next five hours trying to get out. His story was that he got drunk and got with a prostitute, who he was trying to fuck on the bicycle, while riding down the street. This seems unlikely, but would explain the accident.

Friday, July 3, 2009


Cade and I went to see some fireworks in this small town about an hour from the center tonight. The show was small, but we got to be really close to the action. We both work tomorrow night and will miss the big show in the city. As the evening wore on,waiting for the show, Cade became rather drunk. He started talking to all the people around us, and we heard of how during the previous year's show a canister had tipped over and sent a mortar screaming through the crowd! Supposedly nobody was hit, but the shell hit a nearby house and started a small fire. .... At home now, going to have a hard time sleeping because m dog barks at all the fireworks that go off around the area.

Thursday, July 2, 2009

A Response

"Norgi" left a comment on my 5 june post; "Call Night Under The Full Moon", I appreciate the interest, but you pastafarians are all the same. You have no concept of the principles of Capitalism and The American Dream. As some asshole once said, you have no faith in the essential decency of the white man's culture. Besides, You are breaking one of the "Eight I'd Really Rather You Didn'ts" by Using FSMs Existence As A Means To Oppress, Subjugate, Punish, Eviscerate, And/Or, You Know, Be Mean To Others. Ok, have to go to bed, I'll be out at the Alotian early in the morning, so I can catch the greens while they're fresh.


Forgetting my camera at work today was a huge mistake! A guy was fishing and caught a small (about 10 inch) catfish. When he tried to remove it from the hook he was stung. This really pissed him off, so he threw the fish on the ground and stomped it. The dorsal spine went through his sandle and into his foot! He came into the department with a fish still hanging off his foot! The thing was still alive! After much effort it was removed, and I lost possibly the greatest photo opportunity of my life! You can't even find a picture of anything similar to these on google images or anywhere else I looked on the web. Missed a chance to contribute to medical literature I guess, or at least the "darwin awards" or something like that.

Tuesday, June 23, 2009

Sunday, June 21, 2009

Busy, Busy

Just got to Dauphin island yesterday to start a few days of vacation. Things have been very busy lately!

Friday, June 12, 2009

Swine Again

Swine flu is flying through the northeast at an accelerating rate. 5,000 new cases have been reported this week, bringing the total to 18000, and meaning the cases have grown by about 35% this week alone. Scary.

Wednesday, June 10, 2009

Monday, June 8, 2009

Friday, June 5, 2009

Call night under the full moon

I'm sitting here, in the call room, deep in the bowels of the hospital, where all the shit collects, getting ready to try and get an hour of sleep. I doubt it will happen. The Center has been alive on this full moon night, writhing around like some tortured monster. There has been a steady stream of comatose overdose patients, jacked up on the first friday night of the month, getting high on our money, and being bailed out with our money when they push it too far. There was the cocaine man, our fucked up version of the rainman. All he would say was "I take Xanax TID," "I need you to give me my Xanax." "TID." "Xanax TID." Then came the hip fractures. There have been more little old ladies with hip fractures tonight than I have seen in two months. The bulk of them were the result of a head on motor vehicle accident, several miles from The Center. Six passengers were involved, one was life flighted directly here, the others rolled in slowly with less serious injuries. However, two of these "less serious" injuries were little old ladies with hip fractures. A hip fracture for a little old lady is a health event every bit as significant as a heart attack or stroke, and one of these ladies was 93. furthermore, a church service or graduation ceremony of some sort happened to be taking place near the accident scene, and when the life flight landed in the church lot, all the people inside apparently came running out to see what the stir was all about. During the chaos, two more little old ladies became entangled in each other's feet and fell on the concrete. Two more hip fractures for Doc Hog! ... I think I hear the pager getting ready to go off now...

Too many Twinkies

When you can smell the stink from thirty feet outside the room you know your in trouble. In the case of Mrs. Ima Cowell I figured the stench was coming from multiple areas of her 400 lb plus body. I figured I could also guess where. On that point I was wrong because I never would have predicted that the triage nurses would find a nasty mold covered twinky smuched inside one of her abdominal fat rolls. You realize a twinky never completely rots, so its hard to say how long the thing had been in there. Mrs. Cowell went on to explain that her husband (who weighed about 135) and her would play a sexual game where she would hide snacks in various body crevices and folds, and he would try to find them and eat them during foreplay. I guess he missed that one.

Thursday, June 4, 2009

TV Detectives Crack Case, Break down Residency Lounge Door

A senior resident, Ms. Ann Thrope, discovered that Cade had actually stolen our new LCD TV from the family grieving room in the Hospice Center, and she promptly reported him to the authorities. We were just chilling, watching The Notebook, when I thought I could hear "Bad Boys", or "The Theme From Cops," playing in the hallway. Soon after, the door blew off its hinges and crashed to the floor. Several hospital security guards swarmed in, SWAT style, flashlights drawn. The TV was removed and we are back to a small 20 inch, circa 1990 model, and a sheet hanging over the lounge door.

Sunday, May 31, 2009

Compound Arm Fracture After Motorcycle Accident

The Improved Intern Lounge

My friend Cade is an opportunist, and he has worked all year, by various means, to improve the resident lounge/call room. He convinced the maintenance people to repaint the battleship grey walls to a sunflower color. He stole inspirational posters from the Hospice house and hung them all over the walls. He got the old recliners from the physician lounge he brought in an X-Box that he bought on black Friday, and today, we had a 42 inch LCD tv on the wall. I don't know yet how it got there, all mounted and everything, but I know it wasn't the hospital that furnished it. The nuns are too cheap. I'm sure Cade is behind the TV, but I haven't seen him today, and I don't know for sure how he got it.

Thursday, May 28, 2009

Spanish Influenza Graph

In the top graph you can see the bathtub curve of deaths from the 1918 Spanish Influenza. The flu behaved typicaly by killing largely the very young and old, but also note the peak in 20-40 year olds. The bottom graph shows the impact the influenza had on the overall life expectancy. Impressive.

Wednesday, May 27, 2009

Leg Fracture

Flu Update

Swine flu death toll in United States hit fifteen today, with at least 12,000 confirmed cases worldwide. The flu continues to spread, even as summer approaches. Will it continue through the summer months, and then explode in the fall? The panic in our Emergency Department, at least, seems to have subsided for the time anyway. Now we only have ten or so people a day who think they may be infected with the virus, down from probably fifty.

Tuesday, May 26, 2009

Crack Whore

Saw a twenty year old with an abscess in her antecubital fossa. She admitted it originated from IV drug abuse. She said she injected Xanax, which I never even knew people injected, but stated that it was her first time injecting anything. I naturally would have seen this as the biggest lie on the face of the planet, but she went on to say "I just don't enjoy it, my drug of choice is smoking crack!" She was very matter of fact and even a little stand offish. She also admitted to prostitution for crack, and in her recent history was infection with gonorrhea, chlamydia, and hepatitis C. I asked her if she ever thought about quitting crack, and she said, "why should I? It doesn't affect me at all, I can do it and not have any problems."

Monday, May 25, 2009

The House of God

I Just started reading "The House of God". We were all given a copy last July when we started our internship year. I figure that every intern should read it, particularly one who wants to blog about experiences in residency. The first interesting term I came across was "Gomer". I have never actually heard this used in real life, and I didn't care for it until I learned that it was an acronym for "Get Out Of My Emergency Room". The term is used to describe old, helplessly sick patients who frequent the ER from nursing homes, etc. and have incurable illnesses, and who should be allowed to die peacefully.

A messed up leg!

Sunday, May 24, 2009

Just finished a 36 hour shift and I am still too wired from coffee and Rockstar energy drinks to even think about sleep. Most of my shift was spent on house call for the hospital medical floors, but also in the ED some as well. The shift started, almost two days ago now, with an admission of a young achondroplasiac, or midget (little person may be the current runner on the euphemism treadmill), who was also afflicted with several other unfortunate disorders that had left her, although fairly sound of mind, essentially bed ridden. She did have a boyfriend, however, and when I arrived the nurses informed me that she had been on the phone with him all morning, and talking rather dirty about what they were going to do when he arrived, in the bathroom. I immediately began cursing him as a scumbag who was no doubt taking advantage of this poor girl, but when he arrived he was a little person as well, who had met the girl at a convention for little people, like you may have seen on "little people big world". I felt bad for the bad thoughts I had had about him so, when he came to the desk, asking for a nurse to transport him down to the ED to visit his grandmother, who was also a pt., I quickly volunteered. All the nurses were busy, so I thought I would help out. To make a long story short, I dropped him off at his grandmother's room in the ED. An hour or so later, I learned from the security guards that he had been removed from the department a short time after arriving because they had caught him in bed with his grandmother, snapping the radish (masturbating)!
Later that day I was relaxing in the department when a group of EMS personnel and civilians came quickly into the department yelling and in a state of general chaos. They had a big piilowcase with them that was writhing about. There was a snake inside, and it wasn't quite dead yet. A man had been biten in his garage by a rattlesnake, and they had brought it with them for identification by us. After clubbing the squirming mass a few times with Tintinalli's Emergency Medicine text, we were able to remove it safely from the pillowcase and see that it was, in fact, an eastern diamondback rattler. The man was elderly, and walked with a walker. As he told the story, he had come into his garage and the snake had been hiding in some corner, from where it struck. He fell to the ground and turned with his walker and knocked the snake from his leg. He whacked it with the walker a second time and then, as he put it, "it crawled off one way and I crawled off the other."

Sunday, May 17, 2009

Friday, May 15, 2009

Another swine flu death has occurred, and an entire NYC school is shut down with a massive outbreak. Are we out of the woods yet? It seems clear that we likely are not, and things will probably be worse in the fall. A public service announcement on the radio today told of how when a pandemic strikes there will likely be a break down in public services, and you should have water, medications, etc. stockpiled in your home. This is exactly what happened in 1918. Philadelphia, for one place, was swept by near total anarchy. This was fueled, in no small part, by the government telling the citizens there was no epidemic while 5,000 people were dying in the city each day. Cade, My friend and fellow resident says he will defend his home with massive amounts of firepower when the pandemic arrives. He will feed his dogs from the flesh of those that he executes on his property, and himself as well if need be.

Friday, May 8, 2009

Sad Cases of the Week

There are sad cases everywhere, everyday. In fact, most of them are sad in some way. A few that were particularly bad this week will be discussed here. We had two infant deaths, one from suspected abuse. We had a lady with a first diagnosis of metastatic Colon cancer made in the ED. She was about 70, but told me she was raising her 7 month old grandchild because the mom was on heroin, and the kid would be in foster care otherwise. We had a second lady with metastatic Colon cancer, whom the psychiatrist told me was abused by her husband, who wouldn't let her agree to any treatment because he wanted her money. She said the same lady was raped by her father as a child because, he said, his wife wasn't a virgin when he married her, so he was going to raise some virgins of his own (his daughters). Then, worst of all, was the swine flu death.... just kidding about that one.

Swine Flu Blown Out of Proportion?

The Patients in our Emergency Room still don't think so. The visits continue to overwhelm. The CDC now says they may have over called the severity of this flu, but that 2 billion may still become infected worldwide this fall. It is a watch and wait now. There is always the possibility of a major antigenic shift this summer as the virus simmers in the human host, and comes back with a vengeance in the fall.

Wednesday, May 6, 2009

A Resurgence

With the second US death from swine flu a second wave of patients have flooded the emergency Department. The Hospital press release states that there have been no "confirmed" cases of swine flu, seemingly implying that there are unconfirmed cases. I don't know of any we even suspect. I mean, we have had sick people, with colds and such, but nothing out of the ordinary. Meanwhile, the CDC has raised the possibility that this outbreak is merely the herald wave before a more severe pandemic in the fall, such as was seen with the Spanish and Hong Kong flus. This is what I suspect we may see. At that point I think the best thing we will be able to provide is a little two wheeled cart to pull along and shout "Bring out your dead"!

Monday, May 4, 2009

The Pig Party

The Swine Flu panic seems to continue, and maybe with good reason, Mexico has prematurely called a return to normalcy, allowing people back out into crowds when the pandemic may yet be in its infancy, and the number of cases and states affected grows daily here in the US. The winter flu season is just gearing up in the southern hemisphere, and the WHO may declare a pandemic any day this week. They say the virus is going to continue to spread, and there will be more deaths in the US. For the most part things have started to calm down in our Emergency Room. If the hospital would stop making daily press releases, things would go a lot better. I think they like drumming up the business.

Sunday, May 3, 2009

The Old Man and The Slut

In our EM program, we ride on an ambulance for one EMS shift every month. You can see some crazy stuff on these runs, to say the least. Today I rode along with one of our inner city squads. Most of the day was slow. One old man DOA, not much else. Then, we were called to a little run down house in a not so good part of the city. We had been called by the police to take in an eighty-two year old man who had been assaulted by a prostitute, that he had invited into his house. He wasn't hurt very bad, but she had robbed him, and busted up the house. The man was demented, and needed to come in so that social services could obtain a nursing home placement for him. He, however, did not feel that he needed a nursing home. He was rather belligerent, and said that he refused to leave, and that he could take care of himself. Furthermore, he had a little beagle that he was concerned no one would be able to take care of if he left. With much effort we reassured him that the dog would be well taken care of him, and the police firmly showed him to the ambulance. As we were bringing him through the gate of his chain link fence, the dog squeezed out and took off down the street. The cops chased it, but weren't able to catch it, and soon gave up. The old man cried about the dog all the way to the hospital, I'm sure he will never see it again.

Friday, May 1, 2009

The Maldives and The Snows of Kilimanjaro

This is, possibly, the most beautiful picture on the web today. It is The Maldives, a tiny chain of islands in The Indian Ocean. A story I read on Yahoo news said the islands and their 380,000 residents are threatened by rising sea levels. A breaker wall built in the 1990s is failing, and the government is considering moving the entire population to Australia or somewhere. The same article goes on to describe the melting glaciers on Kilimanjaro. They are 80% decreased since 1912. The Hemingway Story entitled "The Snows of Kilimanjaro" describes the frozen carcass of a snow leopard about halfway up the peak. Upon reading the story, I wonder, is that leopard still there? I won't get into the underlying discussion inherent to this topic, I just like the picture.

Thursday, April 30, 2009

The Year of The Swine

The Swine Flu panic is in full swing in our ED. Visits have increased 40% over the past two weeks. Everyone with a sniffle feels that they need an evaluation. Combine that with the fact that the past weekend was the worst in a decade for pollen and allergens in the area, and you can see the situation we are in. The director held a public news conference urging people not to come to the ED if at all possible. This statement was probably an EMTALA violation of some sort, but extraordinary times, I suppose. The media sensation is reaching fever pitch, but the flu itself seems to be reaching some sort of plateau at least. The only thing that worries me at this time is the fact that the 1918 Spanish flu appeared first in the spring, and was relatively mild. However, it reappeared in a more virulent form in the fall / winter of 1918 / 1919. It is interesting to note that world war one killed approximately 16 million people, and the flu epidemic that followed killed 40 million. The announcement today by the WHO that the flu would no longer be called "swine", despite the fact that the majority of the genes are indeed porcine, was ridiculous to say the least. I understand the honorable attempt to prevent senseless slaughter of pigs and further economic damage, but scientific authorities should act above the ignorance of other elements of society, rather than join them. To call the flu simply H1N1, is just like calling a Portuguese water dog simply a dog. It is a correct label, but not properly descriptive. Many Influenza viruses can be called H1N1.