Sunday, May 31, 2009
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
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
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
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
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.
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."
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
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.
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
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 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
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
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.