My job pays for my food and drink while at work.

That is lovely, just lovely.

Thus I have gotten in the habit of purchasing and experimenting with things that I haven’t ever had before.  Thus, I am now, almost every single time I work, getting one of these:

Let’s go over the nutritional value of said drink, shall we?
Here’s the ingredients:

Glucose, Citric Acid, Taurine, Natural and
Artificial Flavors, Sodium Citrate, Caffeine, Benzoic
Acid, Sorbic Acid, L-Carnitine, Inositol, Niacinamide, Calcium,
Pantothenate, Milk Thistle Extract, Gingko, Biloba Leaf Extract,
Guarana Seed Extract, Riboflavin, Pyridoxine Hydrochloride,
Cyanocobolamin.

I know!  Finally I can get 100% of my much needed Milk Thisle and Cyanocobolamin at the same time!

It has the important ingredient (caffeine) in high quantities, so it does it’s job and tastes better than chugging 4 Mountain Dews, so that’s good.  One ingredient that I think they forgot to list though, is lasix.  That’s right, theres a fair amount of diuretic in every can.  I’m sure on this.  How do I know?

Well, 30 min after drinking a can of the stuff, I will have to pee.  I’m not talking about the typical “ooh, me thinky I gots to tinky” kinda pee.  This is a full blown bladder-busting auto-flushing high-water-pressured typhoon strength piss of champions. 

As I’m sure you know, I love a good pee.  There’s nothing so nice as one of the simple pleasures of a fantastic and satisfying pee.  Ask any guy, he’ll agree.  Thus, I keep on drinking them to keep the flow strong.  However, I think they could also market the stuff to people who really need to pee more than I do. 

ME:  Hi there Mr. OLDenburg, I hear your prostate is the size of a small watermelon
Oldie: Yah young shnazzle-puss, helps out me nickers in my stream is fozzled.
ME: I don’t know what that means, but here, drink this
Oldie: <glug-glug-glug>  aaaah.
ME: wait for it…
                         wait for it…
                                           wait for it…
Oldie:  OH!  OOOH!  I’m pissin’ like a 40 year old!
ME: Woohoo!  Success!  Old pee everywhere!

Man, I’ve had a lot of post lately about pee.  Well, you know what they say.  Write what you know… write what you know.

It has rapidly come to my attention that one of the things that drags down good ER doctors the most is gravity.  It’s consistent downward force always… um, wait, lemme start over.

It has rapidly come to my attention that one of the things that drags down good ER doctors are the angry, uncaring, inebriated and obnoxious patients.  I can usually handle patients that have one or two of these attributes, but when they are all combined together, you get an overwhelmingly loud and painful human that usually has to sit in the hallway (because they are not really sick) and constantly berates staff, sometimes punching or spitting or urinating on staff and themselves.  Sometimes it is hard to be compassionate.  When a person is loudly swearing and screaming racial slurs at anyone and everyone with in shouting range non-stop for hours, that gets annoying.  This is not a rarity, this is common.

I try to be a compassionate and understanding person, but sometimes these people make it hard.  When you see the exact same person over and over and over, for the same reason (drunk), it gets quite taxing.  I don’t really know the answer.  Once an ADJO (angry, drunk, jerk-off) is in the ED, we are required by law to make sure they are ok.  The first drunk guy that fell down and smacked his head while he passed out that you DON’T get a CT scan of the head on will have the biggest intraparenchimal bleed in the history of time.

I am carefully listening to your thoughts right now (aren’t computers amazing) and I hear you thinking that I should just wait until they are sober and not do tests that they aren’t going to pay for… or… just kick them out of the ED as soon as they come in.

Nope.  Sorry.  I’m on the clock and IF they have a subdural hematoma in their skull, and I waited 5 hours (to let them sober up) and they’re still gorked, that’s malpractice.  Welcome to US medicine.

Thus, I have come up with a plan, but I’m not sure if I can enact it.

You ready?

Here’s the plan:

Ask the drunk the answer to life’s most difficult questions.

Me: Excuse me, sir, what do you think we should do to stimulate the economy?  Sir?  SIR??

That’s not really going to help me with my problem of trying to stop the numbers of them from coming in.  But at least I could enjoy the responses.  Some drunk people have surprising insight, who knows.  Scientists and really smart people haven’t found all the answers yet, perhaps the ADJO’s know the answer.

Sir?  As soon as you’re done talking with the statue, could you answer a question or two?

This is where you come in…

Is it mean?  Is it unprofessional?  What questions would YOU want to ask an angry, violent, semi-incoherent drunk person?

I know I won’t do it, but sometimes one has to weigh professionalism vs one’s own sanity.

As pretty much all of you know, I have the body of a Greek god.

Unfortunately, that Greek god is currently the god Adephagia which makes me sad.

Today I woke up and my whole body was very sore.  I do have a little cough, so I was figuring that it might be from the slight cold.  However, that did not account for the aches all over my body.  Then I remembered.  I played some hard core Ping-pong a few days ago.  Hmm.  So yeah, I’m ridiculously sore and in pain after Ping-pong.  PINGPONG!  Sad.  I’m looking into getting the P90x.  Getting Huge, or better yet, at least getting in shape.

Oh, and it’s officially not July anymore.  So that sucks.  This means that I got to start studying for The first Step of the Board exams again.  BOOOOO.  boo.  After that, then the oral boards.  Then and only then, will I be done with the madness.  But, to be realistic, post-residency life rules like no other.  I have more free time and I am seeing friends and family much more than I have in the past… well… decade or so.

You know what this entry needs?  A good tangent.  Lemme check my files… ah, here’s one:

I’m about to go see Batman, finally.  I put a Foley catheter in myself for two reasons.  First, I didn’t want to leave the movie to have to pee.  Second, I am pretty sure I would be peeing my pants anyways since the movie is that awesome.  The only possible problem would be if the Foley bag gets completely filled during the movie, which, more than likely could happen.  Thus, I think we’ll have to get the small popcorn (804 oz size) so that I can use it once the popcorn is done.  Now I know I can hear you grumble about a doctor and cleanliness and infection and blah blah blah your an idiot.  Pee is sterile.  You can drink it.  In fact, you SHOULD drink it.  I’ve seen that crap you slug down day after day.  All of your “Energy Drinks” and “Vitamin Water” and “Coffee” are just water with caffeine and a multivitamin.  And that’s another thing, what’s the deal with “toxins?”  Seriously.  I mean to write about this a year ago after I went on a cruise and during the tour of the ship we visited the spa and the masseuse lectures us about toxins and accumulating toxins and getting out toxins.  What toxins???  Then, more recently, I saw more things about the Kinoiche Foot pads… which suck out toxins.  Where are these Toxins?  How did I get these toxins?  As it turns out, toxins are everywhere and everybody has them and they cause all diseases.  You got a sore neck?  Toxins.  Do you get headaches ever?  Toxins.  Have you ever had diarrhea?  Toxins.  It had nothing to do with the fact that you ate the extra greasy nacho supremes.  No.  Toxins.  If only I could market something that was easy to get so that I could fool people to getting rid of toxins… But where to look for the solution.  Oh, I know, I’ll look in this paragraphs.  AHA!  There’s the answer.  That’s right.  Drink my pee to get rid of your toxins?  Insomnia?  Only my pee can cure it!  Do you ever wake up tired?  Drink my urine!  Have you ever gotten sore after Ping-pong, this urine can help.

Aah.  That’s a good rant.  Now I feel better.  Now let me go Google “Drink my Pee” for the picture… here ya go.

My job is pretty awesome at times.

Seriously, I get to do tons of stuff that I find really cool.  Intubating someone?  You know, rendering them unconscious via medication and then carefully inserting a breathing tube into the trachea to allow them to breathe when otherwise they’d likely die… very cool.  Lumbar puncture?  Obtaining spinal fluid from the area surrounding the actual spinal cord (ok, I know… its after the cord dissipates, but it’s close enough)… quite cool.  The hours are awesome, and, if I’m going to be completely honest, the pay is pretty sweet as well.

However, sometimes it’s the worst job in the world.  How often do you have to tell people that their loved one is not dead.  How often do you have to tell a pregnant lady that she is miscarrying and the potential baby she has been harboring for the last 18 months is not going to slowly come out as a depressing bloody mess.  How often do you have to give rectal exams, pelvic exams, or see people when they are crying after they have been sexually assaulted.

And then you get the days like today.

A rather bazaar mixture of both.  But how best to explain it… I know, via multiple random pics,
                          

GO TEAM GOOGLE IMAGES FOR INSTANT FUN PICS!

One guy has a horrible bleed in his brain (that’s bad),
 

but I got to intubate (that’s fun, and it went well, so good),
 

but I had to talk to family and give the bad news about the brain bleed(that’s bad).

I had another insanely anxious guy with chest pain and everything turned out great (that’s good).
 
I had another quite young guy who has newly diagnosed lung cancer (very very bad).

I also had a delightful drunk guy in the hall who sang songs for the staff (that’s good, and amusing). 

I also had a patient that I admitted a month ago with a severe stroke,
but recovered well (that’s great)
 

but now she had pneumonia (that sucks).

Then I had a friends father who was in a bad fall and broke some bones (that sucks)
,
but I got to see my good friend when he visited (that’s cool, and fun, but bad)

        
Kind of weird, no?  Lots of emotional ups and downs and ups and downs.  Here’s a pain scale that is used to evaluate pain in children (seriously).  I think my emotions kept jumping from “A” to “I” to “A” to “I” and by the end I was so mysteriously melancholy that I ended at “E”.   Not  happy, not sad, just morose.

Actually I guess I’m a little more towards the happy side.  The nurses gave me the nickname “Chunks.”  I thought it was cool to have a nickname.  Unfortunately, I had to earn that nickname… which I did during my intubation when I got a collection of vomit and lung-butter splattered all over myself.  Mmm, just call me chunks.

I don’t know about you, but for me, getting something in the mail that doesn’t suck is a rarity.

Seriously.  The only crap that comes in the mail is bills, junk mail,
and more junk mail.  It is a complete rarity if anything comes that I’m
like “holy crap, how fun!”

Occasionally I order stuff, and then when that comes, it is somewhat
fun, but I am expecting it.  Thus, when you get something nice out of
the blue, that you weren’t expecting, it is the coolest thing ever. 

I give you exhibit A:

This is me sporting a brand new Ren & Stimpy T-shirt from Lisa
Haley.  She rules and rocks the free world to the Nth degree.  This was
made even truer since she sent me this awesome T-shirt with a note
saying she was getting ready to move and thought I would like the T
more than her.  Awesome simply awesome.  Oh, since you don’t feel like
you know her very well, she was one of the graduating seniors, so here
is her video from the project.  Shea also has an encyclopedic knowledge of oldschool trivia (from movies to cartoons (ie Felix the cat to Mel Blanc triva) to just about anything).  She does own a few cats, thus was
dubbed a little bit of the Crazy cat lady.

Well, now you know her a little better.

If you’d like to be featured on the Slicy Blog, please send a fun filled package to my address and you’re sure to be featured right away!  All gifts in all shapes and sizes are accepted.

Batman.

That’s the answer.

I am convinced of this fact, and I have not even seen the movie yet.  In fact, I’m almost scared to, due to the story I am about to tell.  It was a somewhat peaceful day in the Emergency Room…

When a guy came in complaining of chest pain.  Chest pain always gets your attention as an ER doc.  Chest pain can be lots of different things, and none of them are good.  Myocardial Infarction?  Bad.  Pulmonary Embolism?  Bad.  Tension Pneumothorax?  Very bad.

However, most of the time the chest pain turns out to be nothing too serious.  I always approach patients with the thoughts of “worst thing first.”  This means I assume something terrible is going on and I have to prove to myself that it isn’t.  Thus, I approached the patient.

He stated that he had been watching the new Batman movie and 2/3rds of the way through the movie began developing chest pain.  He tried to shake it off, but it continued to worsen and worsen, to the point that he had to come to the Emergency Room even before the movie was over to get it checked out. 

Holy Crap!

Well, to make a long story short, every test came back negative.  Nothing was wrong.  EKG, Chest Xray, blood work, all of it was negative.  Thus, I think I will have to do a case report on the first Batman-induced Angina Thoracicus… or BAT.  I’m sure to get published.  Right after I go watch this movie.

OK… that all being said.  I did some research on batman induced ailments.  I came across this old comic book and than I really started getting worried.  I mean, can I really respect and admire someone with such a shady past?  You be the judge, my friends.

My brother Chris and Laurie had a baby!!!

His name is Noah and he’s supercute.

This is normally the part of the program where I’d show you a picture of him, but since my parents don’t know how to use their camera, and my brother is allergic to the internet, I don’t have any pictures to show you, thus, I’ll try to find a similar picture of him online by googling “Noah awesome” … and here we go:

Well, this is what I got


DOUBLE CIRCLE OF FIRE WITH GROUND FIRE EXTRAS!!!!!  GO GOOGLE “NOAH AWESOME” YOURSELF TO SEE!!!!”

Um, right.  Excellent.  On with the show.

Recently, some random guy I’ve never met (see the link to Edieaeaeusie’s challenge here) threw down the challenge to write passionately endorsing something you are truly against.  I’ll never refuse a writing challenge, so here we go.

Being an Overweight Smoker in American society, a sensitive view on a sensitive subject.

I have been a fat smoker my whole life.  That is how I was born, that is how I grew up, and that is how I am now.  There is nothing neither I nor medical science can do to change that.  Seriously, I have tried literally everything on the market, and yet I do not lose weight.  The real question is, why should I even have to?

First of all, I am an endomorph.  If you don’t know what that means, go look it up since I’m not here to to make you smarter.  Wait.  Nevermind.  It means that I have a heavy-set body type.  That’s what genetics is.  You are born with certain genes and you CAN’T change your genetic make-up short of radioactive spiders biting you.  Fat people stay fat.  That’s life.

I can hear you skinny thin lips flapping in the breeze while you eat your rice cakes, so don’t even go there.  What’s that, you say?  You say that being overweight is unhealthy?  Really, are you sure about that?  Why don’t you go check out this book from your local library then.  It is written by a very knowledgeable LAW professor, so it’s definitely got to be true concerning science.  Oh sure, I hear you saying, it might be ok to be a little overweight, but my BMI is 48.  Yeah, I turn heads, but I’m happy and healthier than ever.  Do I have health problems?  Sure, everyone does.  But I have the exact same health problems that all the other people my age have.  Who, I ask you, at age 51 does NOT have chronic back pain?  Who has knees that don’t hurt?  Who doesn’t have a little bit of a cough every morning?  No one, that’s who.  You get aches and pains when you get older.  That’s life.  It isn’t being fat and it isn’t smoking, deal with it.  Speaking of which, don’t get me started on smoking.  You wanna open that door? well then get out of the way cause I’m coming through.  Here’s a freebee for you to start… fat people DON’T GET OSTEOPOROSIS!  You little brittle boned crybaby whiners might get it, but I’m not worried.  Suck on that.  Now on to smoking, since “it’s so bad for you.”

Fact 1: No one has ever conclusively proven in a double-blinded randomized control trial that smoking causes cancer.  Surprised?  I thought you skinny bastards might be.  And PAH-leease don’t get me started on second hand smoking.  There have been trends and associations, never scientific proof. 

Fact 2: Smoking after heart surgery decreases the level of restenosis of the arteries.  Here’s the proof!  I’m sure your little skinny, pearly clean lungs couldn’t understand all that, so I’ll explain.  If I ever need heart surgery, and you need heart surgery, I’ll get better faster and have less complications, since the carbon monoxide levels in my lungs will be higher.  Carbon monoxide dilates blood vessels.  Hell, I think I’ll light up right now… ooh, that’s smooth.  But I can hear you whining “but you’ll only get heart disease if you keep smoking in the first place.”  You, my tooth pick friend are an idiot, so I’m not even going to answer that argument.  Instead I’ll prove that I’m smarter than you with…

Fact 3: Smoking make you think gooder that non-smokers.  That’s right.  Here’s the proof.  Did you get that?  YOU may have to read it again, but I’ll remember it, since I’m smart.

Fact 4: This is for you granola loving, tree hugging hippies… Even Disney’s Goofy smoked, and he couldn’t stop either.  Seriously.  Check this out!

Now quit bitching, eat and smoke!

So I’ve actually worked a few shifts now.

Scary.  Pretty scary.  Here’s some highlights from my first 2 shifts as an attending

Third degree heart blocks (people who have a heart rate in the low 20′s… that’s not a good thing)

Really bad Afib with RVR (people who have a heart rate in the high 180′s… also not a good thing)

A transfer from the outlying facility with a patient who is “slightly short of breath.”  This turned out to be a really really old guy with TONS of problems who wasn’t really able to talk since he was breathing so fast.  You try breathing 60 times per minute for several minutes… that’ll wear anyone out.  He got intubated…by me…without the safety net.  Go team go!

So that was all fun.

However, tonight, July 4, I get to work and take care of all the 4th of July crowd… bring on the Drunkies!  What’s that sir?  Ah I see.  You wanted to see how close the wick could get to the base of the M-80 with out it going off.  Hmm that seemed like a good idea at the time.  Is that bag of hamburger the rest of your fingers?  Good.

Thanks for the outpouring of support.  As it turns out, pretty much my
entire first day was training and tomorrow I will really have my first
day.  Thanks though

I thought that since I made this ridiculous video for the graduating
seniors, the least I could do
for my fellow residents would be to put some of the highlights up from
it.  The whole video is about 35+ minutes long, so I’m not gonna post
the whole thing, but I think Tracy’s was pretty much my favorite
individual one so I’ll post that one and the Intro.  If I get any of
the other residents want theirs put up, just tell me and I’ll be happy
to add them on (I don’t know if any of the residents ever read this
anydangway, but if you do, and you want it up, lemme know).  That gives
the
flavor for the video.  Go team NINJA RESIDENT!  Ok. 
So I think I have too many memories from residency to post at one time,
so I’ll just start with the videos for today.  First one is the intro. 
It’s 44MB long, so those of you with a dial up might take a while
longer to download.

INTRO:

The next video is Tracy as “NINJA RESIDENT.”  I’m kinda proud of this
one since it took quite a bit of editing and re-editing and then even
more fine tuning to get it to come out like it did.  I thought it was
pretty funny though.  Go Kick some patient booty Tracy (and the rest of
us as well  )!

Heh, I think I like the last 1 second of Tracy’s vid the best wha-tcha!!

Tomorrow is the first day of the rest of my life.

I start my first day as an attending.

The safety net is gone.

I’m flying solo.

Alone.

Me.

I.

Hmm.

I guess so.

I’m sure I’ll get help.

I mean, other’s will still be there.

I won’t be the only one working, and yet…

I am responsible now for all of the choices, all decisions.

Well, enough of that.  I’ll try not to drag out the point anymore that I’m a frightened little 7 year old girl in a 31 year-olds hairy, nearly wookie-like body.  But tomorrow I have my first real shift.  I’ve been waiting forever for it, and now that it’s here I’m scared.  The Shel Silverstein’s whispering “Whatifs” are coming at me from all sides.  What if I make the wrong diagnosis?  What if I miss a fracture?  What if I start someone on the wrong antibiotics?  What if I forget to dictate?  What if I act to slowly?  What if I forget all that I’ve learned in residency?  What if?  What if!  What if?!?!? 

I know I’m ready, but I don’t know what the future holds.  I’ve trained my whole life for tomorrow to start, I suppose I should be a little scared, and excited, and nervous.  Thank goodness I can put in a Foley for when I want to wet myself and I already got the 50 pack of Depends, so I think I’ll be fine