Paul Broun

Paul Broun, The doctor turned Congressman from Athens, GA who allowed rhetoric about assasinating Obama to go unchallenged at his own rally is a disgrace to both of the professions he represents. His inaction and complacence is no better than that of Sarah Palin or the silent under Hitler. Let me say, he does not represent all doctors. Unfortunatly, he does likely represent the majority, but definetly not the majority of ED docs. or is it spelled Paul braun?

Primum non what?

Primum non nocerem (sp?) What about first do nothing, primoris, operor nusquam? I think that was the fat man's motto, and it served those guys well enough, not doing bad for me either.

Difficult Family

A particularly difficult family member was my problem recently. a real pain in my ass. His mother, an 89 year old bed bound nursing home pt, was dying. Shitting blood and bleeding out through the gut. She looked like a picture of death when she rolled through the door, and my first move was to look for a code status, which I fully expected should have been "Do not Resuscitate." It was not. We all began to mutter under our breaths and slowly began to work on the unfortunate woman. Torture her, we said. We were just preparing to intubate when they brought her son back. He was in tears. Didn't he expect this? Despite pointed questions and multiple attempts, he was adamant that the woman should be full code. We intubated her, put in a central line, and began dumping in fluids and uncrossed blood. Her initial hemoglobin was 4.4. She coded multiple times, and we collapsed her chest wall with our compressions. I made repeated visits to the son in the family room; updating, and occasionally pleading the case to withdraw support. He had family members on the way, could we just keep her going until they arrived? He was crying constantly. We worked for three hours, diverting care from younger, healthier patients who just had to wait. Finally, the grandchildren arrived, and slowly, after much talk with the chaplain, the nurses, and myself, the man decided to withdraw support. The woman went quietly, in a darkened room, surrounded by family. When it was over the man hugged me, thanking me repeatedly. He cried some more, and this time I cried as well. I had bought him the time he needed to come to grips with his mother's death. Maybe I still resented him a little for what I felt was prolonging her misery, but at that moment I felt understanding for his point of view, and I realized that often we feel family members are "difficult" or hard to deal with, largely because they just dont agree with exactly what we think should happen, and the decision does not rest solely with us.

darkness

The trauma service amd its 100 hour weeks is even worse in the winter. You miss all the short day light hours and find yourself inside all day, in only the faded glow of the flourescent lights. depression descends quickly under these conditions, amongst the death and mayhem.

Interesting Shift

The most interesting shift Ive had in a while had its ups and downs. I had a homicidal maniac who the cops had to taze after he threatened to kill me and the cop and was screaming, shaking and flipped the bed over. It was also a night of nasty pelvics. Started with 210 kg pregnant lady with vag bleeding, then there was a girl who hid a pouch of tobacco in her vagina when going into jail and lost it for two weeks and I had to go digging. it was the second time she had done the same thing in a month. didnt she learn? The whole room stunk before she ever took her clothes off and pus was flowwing out. first case of fitz hugh curtis ive seen. whats worse this thanksgiving day was like a hospital frequent flyer all stars day. all of our frequent flying psych pts were in, some multiple times. I think they were lonely on the holidays and we are reallly like their family. the higghlight of the shift was the save i made in the nursery, the one day old who was dropped on her head and had an epidural. the pediatrician was sitting on his hands, wanting an mri, etc. what the kid needed was a peds neurosurgeon and i pushed until we got it...saved maybe my first life that shift

A case in point

on the local news yesterday, an apartment used as a meth cooking house (in some brand new low income apartments which look very nice), in a nearby town caught fire. One man was burned on 60% of his body and another injured as well. luckily, the people's two kids were at a grandparent's. the two neighboring apartments suffered smoke damage and are considered contaminated and have to be totaly evacuated and cleaned. The newscaster said that police say there has been a dramatic resurgence of meth with the recent crack down on prescription drugs.

The Prescription Drug Problem

I have thought a lot about the prescription narcotic problem. I have experienced it every day I have worked in the er, and I have seen friends and family members consumed by it. I have hated it. every day I see the crimes and blights on society produced by it, my car was even stolen from my driveway. I am ashamed that educated "professionals" contribute to the drug problem. However, recently, I have been thinking a little different lately. There has always been a drug problem, throughout history, and will always be. The only thing that changes is the drug abused most commonly. Right now, in my region, and in most of America, the drug of choice is prescription opiates. Is this the worst drug that we could have as our drug of choice for users? Maybe not. Unlike cocaine, heroin, or the like, these drugs are not furnished by large cartels in other countries. Organized crime has less opportunity to become involved. The manufacturers of these drugs are legitamate companies that provide jobs for legitamate american workers, unlike the slaves in the fields of south america. Even the people who make money from dealing these drugs are middle and upper class Americans who likely pump this money back into the US economy. Maybe this system is not the worst possible way our drug abusers could get their drugs. At least this way provides more income to our country and even to some innocent people (such as those drug factory workers). This is probably the wrong way to think, and I am going to continue to fight against this thing every day in the ED, but at least it is a small way to look on the bright side of the problem. On a related note, do you know that the street price for oxycontin is a dollar a milligram? So the average monthly prescription of say, 90 pills, 80 milligram oxys, the street value is 7200 dollars! Wow! Think of the people who just drive around all day, obtaining prescriptions for these things! More on this next time.

The wild wild south?

The town is in an uproar and the hospital has been on lockdown two nights this week. Killings and reprimands have shaken the city. It started with a guy who was stabbed, but survived, then somebody stabbed the first stabber and he came in as a full trauma code, with thoracotamy. the families spilled into the waiting room and fights broke out there and in the parking lot. this went on for an hour before we were able to get the police to even respond to our calls. The guy who was accused of killing this guy then had his house burned down the next day, then, three days later another man was shot in the stomach and killed in his yard. Online community message boards are filled with posts, supposedly from atlanta and houston gang members who threaten coming to town and carrying out revenge killings.