Recently, Michigan repealed the helmet law. It is now legal to drive your motorcycle around without a helmet. The argument went something like this…

“I’m allowed to make bad decisions, don’t force your views on me!”

-OR-

“I’ll be dead if I crash and that’s a chance I’m willing to take.”

The problem with this is that you don’t usually die if you crash your motorcycle. Usually you just get very badly hurt. I don’t care how good of a motorcyclist you happen to be, unexpected things happen. Deer run into the road, other drivers might be terrible and cut you off, it can happen. It does happen. As an ER doctor, when it does, I become responsible for your bad decision not to use a helmet.

We have already taken care of several individuals with intracranial bleeds that would have been prevented if the driver had been wearing a helmet. These individuals have looooong roads of recovery in front of them which will cost thousands of dollars. Often these individual end up in long term nursing facilities with various levels of return of functionality.  All of this could have been prevented by wearing a helmet.

Seat belts are required while driving cars.

Life jackets are required in boats.

Should Helmets Be Required by Law? What do you think?

Should Helmets Be Required by Law? What do you think?

It recently came to my attention that while I’m at work I have many of the characteristics of a super villain.

1.  I walk around dressed in black (scrubs).

2.  I continuously rub my hands together (granted this is due to the hand cleaning gel, but I still do it).

3.  I often have a fleet of minions to do my dastardly deeds (med students, residents, etc).

4.  I often have to jab sharp objects into people I have just met and barely know without any sense of guilt.

5.  I am often working in the middle of the night.

I just took the Super Villain Quiz and found out I would be the Joker.  Not bad, always liked the guy, had a good maniacal laugh.

Which Super Villain are you??

My job as and Emergency Department physician is basically giving advice.  

People come to me with a problem, I suggest tests to discover what is causing said problem and propose a solution.

Technically, I work in an ER (or an Emergency Room (or Emergency Department (ED))).  However, like so many acronyms current out there, people have began ignoring the actual words.  It’s sad to say, but when something gets initialized, it loses its meaning.  Never has this been more true than on the internet.

What does “lol” mean?  If you are an slightly educated dolt, you might say “laughing out loud.”  However, this is not true.  You don’t type lol when you laugh out loud.  You type lol whenever you find something mildly amusing.  Or perhaps you put it at the end of a mean statement to take away a little of the sting.

Text: “I saw you at the gym today, Janet, you looked like a warthog puked on you, lol”

Similarly, the ED has lost it’s meaning.  Emergency.  That’s the first letter, but people often go for pretty trivial issues; or they go when they have learned just enough from the internet to become insane.

Don’t get me wrong, people love the internet.  I love the internet. Its just painful when I’m caught in the whiplash of people freaking out over a chain letter.

So.

I enter the room to find a fine (read gullible) young man who appears anxious, but otherwise fine.  Upon interviewing, he immediately demands that I run a “NutraSweet” level on him.  I smile and nod and then try to determine his actual reason for  being in the ED.  However, he is serious.  He starts listing off a series of vague complaints that he KNOWS is caused by high levels in his blood.  I do my normal exam, and excuse myself.

I’ll be honest.  We don’t have a NutraSweet level detector in the ED.  What happened is that one of his friends, or possibly a chain letter, convinced him that he had lupus.  Now I was stuck with this healthy guy freaking out.  He had all sorts of stuff that he had printed out for me that he wanted to read.  I’m talking multiple pages.  It would have taken longer than my shift to read all of this.  

Aspartame is in everything.  Is it great for you?  No.  But it has been studied EXTENSIVELY and found to be safe.  But this did pique my curiosity.  So I went here and found that several chain letters had been made.  I tried to convince my patient that he was fine.  I also tried to convince him that this was not an emergency.  I failed on both parts.  I subsequently discharged him with a diagnosis of “come back when you are sick” and went on to my next patient.  

…

This fine young man had his phone on him.  On his phone he had looked up something on the most noted and respected Medical journal ever made… Yahoo! Answers.  Yes, that’s right, Yahoo answers.  If you are unfamiliar with this site, it is a site where you can pose a question to the population as a whole and whoever happens to be looking at your question (read as people with waaaay to much time on their hands) will spout out a made up answer.

So I found out that this guy had already been seen and evaluated.  Earlier.  The.  Same.  Day.  Every possible bad diagnosis had been ruled out (thoroughly).

After this, instead of going home and following the discharge instructions, he went home and went online.  The online community responded with furious vehemence.  The random people online gave many possible reasons for his problems… all of which had already been ruled out.  

He continued to scroll through his phone and click on different links for me.  With saint-like calm, I allowed him to show me several things.  Then I explained that there were literally no more tests for me to do.  Everything had been ruled out.  He was fine.  After realizing he was fine, he felt much better.  

Another emergency solved… by telling him he was fine.

I have a saying.

“Glark, book-ook, munganga-ka dee!!!”

That is not my saying.  Those are the noises I made when I learned how to barefoot water-ski for the first time and 2000 gallons of water rushed into my crotch at 38 miles per hour.

As I sat, floating on the water, the life jacket, trying it’s darnedest to keep me afloat despite my desire to empty my stomach into the already slime and Swan filled waters, I realized that sometimes things don’t always go as planned.  You see, despite many years of being the youngest in the family, I somehow maintain the attitude (or delusion) that optimism is still the way to go.

I know, all you realists, and pessimists, and conservationists out there may disagree… but that’s your nature, right?  I actually find that even if being an optimist doesn’t really help me in everyday circumstances, it can help others.  People think being a pessimist is edgy.  Hah, get real.

You want to confuse people?  You want people to really think you’re nuts?  Have a few bad days and STILL have a positive attitude.  Nothing makes a pessimist cringe like having a bad day and being able to shrug it off.  We’ve ALL had bad days.  All of us.  Every single person reading this can rattle off 5 things in under a minute that gets them down.  Likely 5things that happened just today.  Now list 5things you have to be happy about.  

I’ll wait.

…

You want me to still wait?  Cause it’s actually easier than you might think…  Look at the first 10 you listed that are bad things… they are all behind you.  They are over (well, unless you listed chronic pain or 2000 gallons in your crotch, cause that takes longer than a few seconds to go away (especially if swans are in the water (little know fact, swans are friggin’ jerks (seriously, I hate swans (you would too if after 2000 crotch-gallons one came hunting you for no reason!))))).

Let me pretend I’m you for a minute (ooh, don’t I feel so sexy all of a sudden).

1.  I stubbed my toe when I woke up (you list as bad thing, I list as “hey, now it doesn’t hurt anymore and I’m over it)

2.  I woke up late for work and had to rush (I list as whew, though a crazy rushed morning, I still made it in time, who rules, I do!)

3.  Had to make coffee b/c Janice (friggin’ Janice!) took the last cup (I list as meh, no big, fresh coffee is  better any ways)

4.  Had to poop at work (I have the advantage here, I can poop like a ninja and be in and out in less time than you can pee, so, sorry, I’m just better at this than you, don’t take it personally, (we all have our superpowers <–click))

5.  Forgot the to-go breakfast you left on the counter (but now it’s later, and you got to eat whereas thousands today did not (feel guilty yet?  check out Mr. Wet Owl, he also had a bad day)

So, to recap…

Everyone has reasons to be pessimistic or optimistic.  I think the world might just be a happier place with more optimists, but again, that’s just my opinion 

I  took care of several wonderful caring, hard working people who happened to unfortunately be sick.  I’m sure they’re all getting better… but who cares about them, I want to vent about the chaos!

One of my wonderful nurses came up to me and stated she was a little frustrated.  The reason she was frustrated was that she and a family member were arguing about the pain scale.  You see, the nurse explained that, on a level of 0 to 10, 0 being no pain and 10 being the worst possible pain anyone can have, where was her pain level.  The The patients family member explained that this scale simply was wrong.

Him: “Pain can get much worse than a 10/10,”

Her: Um, the scale only goes up to 10.  10 IS the worst possible pain.  10 is the max.

Him: Yeah, but pain can get worse than that, so the scale is wrong.

Her: What?

And it was at that time, both people were confused that the other one was not getting it.

I think maybe we need to change it from a 1-10 scale to something more abstract.  

Me:  Sir on a scale of purple to the letter M, where would rate your pain?  Would you call it a light chocolate, or a glib button?

Him:  Huh?

Me: Great, I’ll just write a 2, thanks.

I’ll give this guy at least a 7.

I normally (on any given day) get pretty excited about a good dump.

However, when my daughter pooped in the toilet for the first time, that was time to celebrate.  

She pooped!

She dumped!

She crapped!

She dropped her very first load!  

She pinched her first loaf!  

She plopped her first squat!  

She gave Fozzy bear the old Wacka-Wacka

She dunked some stinky oreos!

She liquidated some Snickers!

She submerged her first colon submarine!

She released the bowel hounds!

She relaxed her anal sphincter in order to expel solid liquid waste residing in her colon!

She sent the muddy pigs to the abattoir 

She parked the brown car at the splashmart

She released Pooh Bear back into the Wild

She told the wicked monkeys to go home

She shot Chewbacca out of the cannon

She paddled the stank-canoe out of the tunnel

She gave the Tazmanian Devil the slip

She threw wood chips down the Slip-N-Slide

K, that’s all I can come up with for now.  Yay!

In other news, it was not the normal bribes to get your kid to poop that did it.  Nope, she did it so she could play with mom’s computer (that’s my girl!).

She’s finally out of this stage, moving to the next…

Next phase… fun shapes!!!

I think I have a contender for one of my roughest shifts ever.

1.  Emergent Priority 1 with a patient who inhaled toxic gas… subsequently needing and open trach in the ER (rough start)

2.  Emergent Priority 1 with COPD & crashing

3.  Emergent Priority 1 with heart rate in the low 20′s

4.  Emergent Priority 1 baby in cardiopulmonary arrest who subsequently died.

I could give more details, but look again at #4 up there and ask yourself if you really need/want them.  This pretty much took the wind out of my sails.  When something like that happens, everyone in the ER collapses a bit mentally.  Then, after trying to comprehend that, I get to relive it by telling the parents that their little baby died.  I’m sure there’s worse things to do than this, but off the top of my head I can’t think of a single one.  

It has been a little bit since this happened, yet I can still (quite clearly) see the child’s mother rocking her dead child back and fourth, over and over in my mind.  There definitely was nothing I could have done to save the baby.  It doesn’t matter. 

Ever had a day at work that made you rethink what you do for a living?  

There are certain things in life that go up and down at very high rates of speed.  Sometimes these things make you nauseated and sometimes terrified, but often, you can enjoy them.  These things are called roller-coasters, and that is not what this entry is all about.

This entry is about gravity.  I have made a breakthrough discovery which will likely change the world as we know it, and possibly save humankind.  You’re welcome.  Let me explain.

For those of you who currently live on earth, or who have put down the meth long enough at least to visit for a bit, you likely know two things about gravity.

1st factor: Gravity is directly proportional to the mass of an object.  Thus if we are on the moon, it has a much smaller mass, and Neil Armstrong can jump much farther and hit a golf ball 700 yards.

2nd factor: Gravity is INVERSELY proportional to the distance of the objects squared.  Thus, as something gets farther away from the planet, the gravitational pull decreases quickly.

These are facts based in science which you may or may not chose to believe.  If not, please test your own gravity theory by jumping off the nearest 50 story building and willing yourself to float around.  

For many years, these two facts served as the basis for how gravity worked.  Some of the aggressively dorky in the class may point out the quantum theory of gravity as well, to which I say shut up, no one cares about graviton particles but you.  

Back to my theory.

Assuming point 1 and 2 above are true, there is also a third factor which can drastically effect the magnitude of gravity.  That, of course, is alcohol.

You see, as one consumes alcohol, the power of gravity directly on the brain increases with every drink.  Now when I say gravity on the brain, I mean exactly that.  Though some so-called “doctors” might tell you that alcohol is absorbed in the GI system and acts as a central nervous system depressant.  This is of course idiocy.  Alcohol has multiple magical food demons that hide inside while you drink them and make you temporarily feel awesome, until they die, at which time you also feel like you wish you were draped over a boat and left to sea, or “hung-over.”

The formula goes something like this:

Gravity (3rd factor) = brain x (D x 10%) x (TT>5 + T<20)

For every drink >1 that you consume, the earths gravitational pull on your brain increases by 10%.  Thus after a few drinks, you  might feel a little heavy, but, after 10 or more drinks, trying to keep your head from colliding with the pavement at exponentially increasing rates of speed becomes an impossibility.  Also, the TT>5 is the fact that for each tattoo on your body more than 5, added to the amount of Teeth you currently possess less than 20, can greatly increase your chances of having the gravity pull your face into the ground with drinking.

I site exhibits a,b,c,d below as just a few examples of my theory.

Have you ever had excessive gravity attack you before??

Time to vent.

How many times have you taken an ambulance?  If you are like most people, the number is less than 5.

Before I became a physician, whenever I saw an ambulance what I imagined inside was a person struggling to stay alive just long enough to get to the hospital to be resuscitated.  I imagined some poor soul on the edge of death, minutes away from the great check out.  

Now lets recap a few friends I’ve had lately.

One is a lady who I’m pretty sure every ER doctor within 100 miles knows very well.  She comes in about every two days for her anxiety.  She complains she is short of breath, when clearly she is not.  She gets seen and discharged over and over and over again.  This is frustrating especially because we have tried multiple counselors and case workers and interventions to help her.  She continues to call 911 and come in.

This is not as bad as the guy who comes in for his cold.  He had a runny nose and a cough.  No fever, no productive sputum, no shortness of breath.  He pretty much called it a cold.  He also came in by ambulance.  What made this especially irritating was that this fine gentleman had already been seen earlier in the day, he was prescribed different medicines to help with his symptoms, he tried none of them and came back to the ER 7 hours later.  I checked up on him days later and everything was fine, as we all had figured it would be.

But the most frustrating was the young guy who came in for his sore throat… by ambulance of course.  Now, don’t get me wrong, there actually ARE reasons to come into the ER by ambulance for a sore throat; this guy had none of those reasons.  I’m not convinced he actually had a sore throat… or a soul.

What he did have was a VERY pissed off attitude that he did not get seen immediately.  Then he became irate that I did not treat his sore throat with heavy duty narcotics (“the only thing that helps!”).  Then he became enraged when I told him I was not prescribing Vicodin for his alleged sore throat.  Then I showed him his MAPS report (which shows the last years worth of narcotic prescriptions he had obtained from different pharmacies across the entire state).  Apparently our fine friend had been very busy going from place to place to get narcotic prescriptions.

It was at this time he miraculously got much better and left.

Mmm… that’s your tax dollars hard at work. 

What have you taken an ambulance for?

“Hmm, I think I’ll break my leg today, they do have cable in the ER, and after that, maybe I’ll see if I can juggle running chainsaws.”  No one does this.  No one actively chooses to come into the ER.  Well, usually they don’t.  

Let me tell you a story.

It’s a story about someone who can chose his customers.

A friend of mine owns his own business.  He washes windows for a living.  

He works hard.  Very hard.  He is ridiculously hard working.  You know when you come home from work, and say, ‘man, that was a hard days work.’  He will not be there to hear you because he has not gotten home yet.  Also he left earlier than you did this morning.

He told me about a potential customer of his.  The person called and demanded that he come over and wash his windows.  My friend saw where the potential customers house was and pretty much denied him on that.  He said that he had been mugged in that neighborhood before and he no longer worked in that area.  

Now this is where it gets interesting.  He owns his own business.  In my mind, he should be able to say:

“Nope, not going to wash your windows, sorry.”

He is the owner.  He can do that, right?

Well it turns out that the person who lived in that house happened to be an angry man.  He thus tried to sue my friend for discriminating against him.  My friend refused to pay him money based on discriminating against him.  It ultimately went to court.  The judge, who apparently knew this slime-ball person suing my friend told him to “get the hell out of my courtroom and stop bothering hard working people!”  

Apparently this guy had done this type of thing multiple times before.  This was his living.  He made money by suing people.  Despite my friend “winning” the case, he had still accumulated $30,000 in legal fees in order to protect his business and his name.  Cost to the other guy… $0.  

Thus, even when you can chose your customers, it can be harsh.

I can’t chose my customers (they are not patients any more, they are customers, as if they are coming into the Emergency Department to buy a gallon of milk and some Listerine (though one of the drunkest patients I have ever seen did get blitzed off Listerine (cool mint Listerine no less (such fresh breath for a drunk! (though it didn’t mask the feet)))) though I really would like to.

There are certain draw backs to my job.  No one comes to me on a good day.  The simple fact that you are going to the ER to be seen means something went wrong, unless you are insane.  

There are times (oh so many) where I wish I could pick my clients.  But, what most people don’t realize is that it’s not the sick ones most ER docs dread.  Oh no, not at all.  Give me a patient having a big heart attack any day.  I can help them and get them to the cath lab and make a difference.  You got a patient with horrible pneumonia?  Bring it on!

However, if you have a 22 year-old patient with chronic back pain, and been feeling ‘off’ for the last 6 months, and also has eyelash pain as well as chronic fatigue syndrome with a side order of fibromyalgia?   I’m sorry, ma’am, I’ll be in to help you as soon as I’m done juggling these chainsaws.