slicy's Xanga

So much craziness

Mon, 23 Nov 2009 18:32:07 GMT

So many things going on all at the same time...

Here's the short list:

- I did a lecture all about inappropriate use of the Emergency Department. Highlights included coming into the ER via ambulance, twice, for the same urinary tract infection (yes, those antibiotics ARE free, just go and pick them up!).

- I apparently won the costume contest at the Halloween party I went to. Slicy is officially retired from Halloween, which is kinda sad, but it is time to move on. I already have my idea for next years costume.

- Gwen got really sick and admitted to the hospital. She's getting an ERCP tomorrow, so that's fun.

- Samantha got her first haircut. I feel sad, since I really kind of liked the 7 month old with a mullet look.

- I got yelled at in the ER by a patient when I would not give him narcotics for his sore back. He is very young and appeared to be in zero pain. Yet somehow he has chronic back pain. Despite this he could jump around the room, walk all over the place without difficulty and spent the entirety of his time in the ER on the phone and pacing. Sorry, I'm just not buying it, no narcs for you, go see your primary care doc.

- Poop

- 3 deer continue to run around my back yard and a flock of turkeys keeps running by, don't they know Thanksgiving is right around the corner?

My Kryptonite

Thu, 05 Nov 2009 02:26:35 GMT

Yes, yet again I will list my main super-power for those of you who may have missed it.

Super-pooping (I know your jealous, but it has its downfalls, see here). I can crap faster than any human I know. I am not sure how long it takes you to pee, but I can poop in less time than that. I know, it's not as good as super-strength, or teleportation, but hey, I'll take it.

However, I do unfortunately also have a weakness. I know my weakness, yet I remain completely powerless against it. Those who know me closely already know my weakness. Like any good human, I have gone through my 12 steps and finally come to the last... acceptance. Now by accepting my weakness, and embracing it as my own, I can hopefully use it to my benefit to make me a stronger person.

Sigh. Enough drama.

I am, <sniff> a cartoon junkie. Perhaps you already knew this?

Yeah, I know. I can hear your scoffs, snickers, jabs, and guffaws from here. Here's our conversation

SUCKHEAD (You): But aren't you a doctor? I mean aren't you mature than that?
ME: Have you read my entries? Seriously I talk about poop in over 60% of my entries.
SH: But shouldn't you just, you know, stop watching them?
ME: I've tried, it's my addiction. I enjoy pretty much anything animated.
SH: How is that a weakness?
ME: If anything is animated, I'll pretty much watch it. Heck, I've made it through episodes of Captain Planet. I have a somewhat encyclopedic knowledge of any 80's cartoon, and I can't get this info out! I want to replace this knowledge with something useful, but all I see is Ma Beagle from Duck Tales! It's not my fault
SH: Well, how can you make this into a good thing?

Well, I'm glad you asked, Suckhead. I have decided to enlighten you to a few of the best online cartoons that are currently rummaging around in this big wide internet of ours. I realize there are THOUSANDS of fantastic internet cartoons out there. I have sifted through thousands to find a few gems. Be warned, all of these are worth their weight in solid animation gold... Here are a few of my favorites.

Enjoy:

Possibly my #1 pick (There she is, by Sambakza)

The Waterlollies (Fantastic Animation)

(**NEW EDIT**)
I can't believe I didn't put Homestar on this entry
in the first place. For those of you who have never
been to Homestarrunner.com, you're welcome.

Charlie the Unicorn (So dumb it's hilarious)

BadgersBadgersBadgersBadgers
(So catchy You'll wish you hadn't seen it)

The Ultimate Showdown (bad animation =OK in my book
as long as the song is fun)

So many more, it's hard to stop here. Maybe I'll just go watch Magical Trevor. Any great internet cartoons that were left out?

Don't you hate it when...

Wed, 28 Oct 2009 00:07:12 GMT

Don't you hate it when you wake up, look at the clock, and realize that your alarm didn't go off. Not only that, but you were sure, extra sure in fact, that you set it the night before. So then you rush through your morning routine knowing full well that there will surely be a white-hot corny-chunk containing shit-storm waiting for you once you get to work and their is nothing that you can do about it.

In addition to this. Don't you hate it when your car is low on gas. You remember thinking to yourself: "hey I have plenty of time now to fill it up, but I really just want to get home to relax, but I have to be sure to get up early to fill it up or I might be late for work, or even worse, run out of gas and be REALLY late." Unfortunately, you forgot about that and did not fill the car up so now you have to get gas anyways. So you pull over and try to pump gas quickly as if the 7 seconds you save by quickly shoving the handle in your car will really make a difference. But then as you try to do the same in removing it you forgot that a little leftover piss of gasoline is always waiting in the end of the handle which flies though the air and covers your pants, shirt, face, and hands with just enough of a misting to give you the aroma of Captain Wanker the Moron who can't pump gas without getting it all freakin' over himself.

And don't you hate it as well when you are already rushing so you did not have any time to get a real breakfast. You were smart enough to grab a can of Mt. Dew out of the fridge and a nutra-grain bar but that was about it. You were OK with this being your breakfast until some douchebag slams on his brakes at a barely yellow light that you had already committed to going through so you had to either a) perform amazing evasive maneuvers using only your crotch since both your hands are already occupied with the aforementioned breakfast OR b) slam on your breaks. But, after slamming on your breaks just after opening the Dew you spilled a healthy portion of the unhealthy yellow caffiene all over your shirt. Then, maintaining your last ounce of sanity you look over to the side of the road only to see some random dead animal that makes you feel bad for getting so pissed about the little things that have happened to you.

You do? You do hate it when that happens?

Bad days happen, get over it and get back to work.

Fortunately for me, I made all that crap up, today rocked.

Rough Run

Tue, 20 Oct 2009 05:30:15 GMT

Dale Carnegie taught a course on "How to Stop Worrying and Start Living." Must of this information is contained in his very small Golden Book. I currently own the golden book which has many uplifting insights on how to live your life in a positive and optimistic way.

I do consider myself an optimist, despite many other peoples recommendations.

One of the nuggets of wisdom on how to reduce worrying is to try to keep everything in perspective. Try to back up and take in the big picture and overcome worry. He states: "What's the worst that can happen." Out of all of the very excellent advice in this book, I think this one small part was not meant for ER doctors.

In the last 3 days, I have had to pronounce 5 people dead. Nothing was done wrong. People die. It is still sad.

5 dead in 3 days... That sucks. Worse then that. That crazy-kung-fu-mega blows!

Nothing makes that easier. It is always hard. Talking with the families and breaking terrible news always crushes me. Doing it several times over and over just absolutely drains me. In the ER I have to function extremely fast and react instantly to changing dynamics. Emotions must be put on the back burner since I am caring for many patients at the same time; that being said, after everything is done for the day, sometimes it all catches up with me. I feel terrible, even though I know I did everything I could and no one could have saved these patients.

So, I sit and contemplate and hope the next day is better. It is also tough to bounce back after that and be happy and energetic to see the cute 4 year old with the sniffles.

Sometimes it feels like I'm just putting a band-aid on everything and just trying to buy time.

OK, enough whining, time to go back to work.

Invincible Bacon

Thu, 15 Oct 2009 01:29:57 GMT

I peeked out into the hall to see that the line for the flu shot had grown to epic proportions. I continued to diligently see patients in the fast track department with ailments ranging from: Cold with Fever, Fever with Cough, Cough with Chills, Cold with Runny nose... etc. Excitement, thy name is fast track.

Then I went back to check on the line. Some lady was handing out pamphlets to fill out while waiting in line. I asked if I could have one so I could fill it out while I worked. She looked at me in my scrubs and said:

"You work in the ER?"

"Uh-huh" I responded,

"Come with me," she said.

She then took me past about 30 other people to the front of the line where a nice lady asked me if I had asthma or was allergic to anything (no and no). Then I snorted down a vial of anti-H1N1-goo. Mmm, bacony.

Now I am an unstoppable force to be reckoned with. Live attenuated virus down my snout makes me immune, Boo-yah! Just to prove my immunity I licked the snot off of the next 10 kids I saw. Take THAT, immune system!

Considering the fact that I'm a provider in an ER, I figure I'll likely see more flu than pretty much anyone else I can think of. So far, no side effects from the vaccine, I'll keep you up to date, but I'm really not concerned.

In a fun side note, cutie-pants Samantha got her 6 month vaccines yesterday as well. I felt so bad. Mostly because right before she got the vaccine she was giggling and looking up at me with a huge smile on her face. Then *POW POW POW POW* four shots in the thighs. Poor thing. But shes back to her happy as a clam personality today, and she seems to still love daddy cause she's giggling like crazy (normal for her). Not only that, but I can still bring home the bacon without bringing home the swine.

Yes, you SHOULD fear Fiber One bars

Fri, 09 Oct 2009 02:28:49 GMT

First of all, I really did not plan to destroy her day. It was neither my intention nor my desire to have another human to suffer so horrendously due to my inadequacies. However, we all sometimes fall short of the mark. I digress...

It started as a typical day at work. Drove in, had my Coke for breakfast as I drove in. Also, on the way in, I snacked on a couple Fiber One bars. Don't get me wrong, these things are actually quite tasty. Not only that, but I think they have something like 281548% of your daily requirement of Fiber. Perhaps I back up a little here.

I am a very regular guy. I don't mean that in the "I'm Mr. average Joe and I fit in well in the crowd." No. Not at all. I don't go for the fit in average. By regular, I mean that I poop regularly. Heck, I'm extra regular. In fact, I think I crap on average about 2.7 times a day. Everyday. Not little wimpy micro-spurts either, we're talking king sized Baby Ruth's 3 times a day. Mmm, Baby Ruth (actually more of a Snickers man myself... but I digress a second time)

So, I had my 2 fiber one bars. Most people should have more fiber in their diet. I am not most people. I should eat more of Cap'n Brickos Mega-Constipating Cheezie flavored Hummus... if it existed. But yes, I had 2 fiber one bars. It took about 3 hours, but then I felt it. You know it. You've felt it. Try and deny... you have had The Urge at work. To go. Oh yeah.

Fortunately my primary super power (as previously mentioned multiple times) is incredible bowel control. So, I could overcome the power of The Urge by sheer mental and sphincter power alone. That being said, I could still feel the fiber bars brewing inside for several hours. I knew I had a massive amount of gas forming, but I kept busy with work, and I won the battle. I made it out of work. This is where the fun starts.

I walked to the parking garage. For some crazy, horrible, and semi-hillarious reason, I could not get the 4 gallons of gas in my colon to pass while I walked outside towards the parking garage. Then, I pressed the elevator button to take it to the 4th floor, since every morning I feel capable to walk down the 4 flights but I'll kick someone in the crotch before I'll walk back up them.

I get on the elevator. My dark nemesis, The Urge, returns. Fortunately, I am going UP on the elevator and there is ab-so-lutely no chance anyone else will be getting on since who would want to go up from a floor above the ground floor? Seriously? What are the chances?

I release. No, that does not do it justice. I produced a level of atrocious Anus-Swamp Vapor that could melt steel. It came out as a vapor but I am sure was more caustic than pepper spray. Even my eyes started watering a bit. The sheer volume of it even surprised me. It literally filled the entire elevatore with its presence. I think if it would have been any larger I think the fart would have had it's own conciousness and may even have willed itself into existance as a sentient supervillian, it was that amazingly bad. Yeah, just vicious.

I then went up one level, suffering in my self made stink-coffin, but finally relieved to be rid of the monster that had been lurking in my colon for hours.

Then the unthinkable happened. The elevator stopped at the first floor.

A nice looking lady in a business suit got on the elevator. In a split second I had to make a decision. And, using all the fast paced skills of a trained ER physician, I pounced on the best decision in that milisecond.

I left the elevator.

I watched the door close. I sat outside the elevator for a second, slightly worried that I may have just killed an innocent woman, but relieved that I did not have to ride up in an elevator and try to pretend that the whole area did not just reek to all hell from my disemboweled evil I had just created.

I then walked up the 3 flights to my car and went home.

Please, random lady in elevator in the parking garage, if you are reading this, you have my sincerest apologies. I meant no harm. I blame fiber one.

Sigh, the older I get, the more sure I am that fart jokes are the only thing that will keep us all sane...

The fall of man

Mon, 05 Oct 2009 02:07:26 GMT

This is Dr. Slicy dictating...

Chief complaint: Fall

HPI:
This is an elderly white male who per EMS had fallen earlier this evening. This apparently happened just outside of the "King's Bar." Witnesses on scene stated he had complained of severe pain after "a great fall" though has difficulty siting exactly where his pain is, stating "it hurts everywhere." Of note, the patient is extremely morbidly obese. He had been sitting on a tall wall where this happened for unknown reasons. After he collided with the ground he has poor recollection of events, however witnesses stated that several men came out of the bar and attempted to get him back together, though they were unsuccessful. The witnesses also mentioned that the men from the bar also had some equine assistance in this manner as well, though I am suspicious for intoxication vs. poor recollection pertaining to this.

PMH: negative PSH: negative Social: denies alcohol/drug use

Physical Exam:
General: Extremely morbidly obese man lacking several key components of his body

ED Course:
Unfortunately, despite the effort of the men and possibly equine assistance, this person had obvious signs of death and despite our best efforts, he was pronounced scrambled dead shortly after arrival.

...A friend of mine thought it would be funny if I put a Nursery Rhyme into dictation form.

The beautiful lack of logic (and other reasons not to blog without sleep)

Fri, 25 Sep 2009 02:28:43 GMT

The incredible lack of logic makes kids hilarious. I'm jealous. I want to be able to do this crap and get away with it as well.

My friend has a little 4 year old, or maybe 5, or possibly 3, I'm not good with kids, since mines only 5 months.

He's old enough to talk and walk, so good enough. I'll call my friend Mega-milk, since he drinks that crap.

Child: "Dad! Dad! Daaaaaad!"
Megamilk: "Just a minute,"
Child: "DAAAAAAD!"
Megamilk: (sigh), Yes?
Child: "IT'S TIME TO R-R-R-ROCK AND ROLL!" (and then the child runs off screaming).

There was no music. There was no mention of rock and roll nor of anything even tangentially related to his statement. He had never done this before. Why? Why do this? No idea, but it ruled.

My buddy in residency? Yeah, he was Batman for 5 months. That was his name. Not Dad. Not Father. Not anything related to parenting. Just Batman. Such as:

"Batman can I have Cherios for breakfast?"
"Batman can I watch cartoons this morning?"
"Batman I don't want to go to bed yet"

No reason. He just called him Batman for 5 months. No reason. No exception. He was Batman.

Don't you wish you could do that and get away with it?

I do.

Is it crazy to envy the insane?

Man, time for bed.

106, really?

Thu, 10 Sep 2009 01:43:56 GMT

A friend of mine asked if I ever got scared at work, which I responded that I did pretty much everyday. However, when you know the patients very intimately, it becomes a bit more terrifying.

Here's a few examples where I did not get too scared. Sometimes in the ER you have to take the story of your patients with a grain of salt. During exciting moments, people tend to lose track of time and space. This must be expected, and is completely understandable.

Your child had a seizure? OK, sure, please explain what you saw, perhaps it was a seizure, perhaps not. Oh, your child was waving her hand at one of her friends and she waved her hand really fast for a minute while giggling? Yes, my suspicion is that it might not have been a seizure after all.

You had multiple episodes of vomiting all day? OK, how many? None? Oh, you were nauseous today after drinking yesterday? OK, well, what did you take to help for your nausea? Vodka? Really? Vodka? How did that work out for you? Oh, the vodka did not seem to settle your stomach, weird, well, lets see if we can help.

I realize this makes me sound condescending, which it certainly would be if I were making these stories up and they were not true...

However, more recently I did have a scary occurrence with a set of parents. The parents were my brother and sister in law and the patient was my niece. They said she had a high fever. In the ER a "high" fever can mean anything from a fever of 99.1 to much higher. However, when my sister in law took my nieces temperature and the thermometer read 106, this caused a bit of concern. I'm not sure the precise temperature at which the brain turns into a warm bag of oatmeal, but 106 is enough to scare me.

I did what any trained doctor would do, I wet myself. Then changed my shorts. After changing said shorts we rechecked the temperature again. They had a skin thermometer (you put in on the forehead then drag it to the temple, I'm not sure how accurate it really is, but 106 give or take a degree still is toasty) Still high. Fortunately, after finding out the dosing they had been using for her fever it was discovered that she actually could have a significantly larger dose of Tylenol and Motrin. Despite her very high temp, she really looked quite good and did not have that many symptoms. To make a long story short, her temperature came down and she perked up and looked great a short time later. She did great and made a full recovery as most kids do, mostly miffed that mom and dad kept her from doing all the crazy things a little kid wants to do when they are sick but don't realize it.

On a separate note, I tried to find a good image on google images for a fever, and then I found this awesome pic of a fire-breathing giant robot baby. I love google images.

This is how hot her fever was...

Still, 106. That's hot. Anyone seen a temp higher?

The Future of Medicine in the US

Tue, 25 Aug 2009 03:04:59 GMT

A typical night shift in the ER (details changed to protect me from the HIPAA-police).

A hallway full of people with varying levels of alcohol, each with similar colorful phrases to yell at the nurses, mostly rhyming with "trucking stitch."

Several young children brought in for fevers. Tonight, all of them went home with diagnosis varying from viral illness, to upper respiratory illness, to otitis media. My intervention with all of them was limited to Motrin.

Then, in a flash, the night became much scarier, when the Priority one phone rang. I rushed over to answer it and plugged my other ear to listen for the story from the EMS. Apparently a ninety-two year old man had been found at the nursing home unconscious. By unconscious, I mean not breathing and also without a heartbeat. In medical terms, this is described as "bad."

Per the EMS, whenever this happens the nursing staff there are required to start CPR and notify EMS. This struck me as quite odd, since usually (especially at nursing homes) patients often have advanced directives as to whether or not they are to be resuscitated or not. My suspicion is that this information may have not been 100% accurate, but in the ER, working with incomplete information is the norm.

The EMS did a fantastic job. They intubated (put a breathing tube) into the patient, started an IV, and began CPR. The man remained unresponsive and unconscious, but his heart beat and blood pressure did return as well. They also had limited information. How long was this man down? What past medical problems? What medications does he take? In such situations they do not have time to take a full history, they start CPR and bring the patient to us.

In transit, the gentleman coded again, meaning his heart stopped beating (again) and his blood pressure decreased to zero. His breathing stopped as well, but he was already intubated, thus the EMS were already breathing for him. Again they gave more epinephrine, atropine, and other strong medications, and again the patients heart began beating.

The patient came into the ER trauma bay and the staff immediately began attaching wires, IV line, and all of the apparatus so that we could evaluate him. Our knowledge of the patient was obviously the same as the EMS. On arrival he had a very weak, thready pulse. I called to our ICU physician and described the case while the nurses continued to attach devices.

The nurses continuously monitored the patient and found his heart had stopped yet again. We re-started CPR a third time, continuing with chest compressions, more STRONG IV medications, as well as defibrillating the gentleman when his cardiac rhythm showed Ventricular Tachycardia. We continued to try to "save" this man for quite a while. I did a bedside ultrasound on him, when I looked at his heart, it had no movement at all. He was finally pronounced dead.

Here comes the hard question. Was it better that we tried everything in our power to attempt to save this 92 year-old gentleman, or would it have been better to let him die peacefully in his sleep?

I do not attempt to know the answer to this question. I have seen some very spry 92 year olds, as well as some people that are in their 60's that have end stage dementia, that no nothing of their surroundings and just live only because they have IV sites that keep them alive.

I have seen how destructive and invasive CPR can be, and how rarely it is effective. That being said, I have seen people brought back from the brink of death. Rarely. Very rarely.

I know more than one EMS worker who actually has a tattoo on their chest that reads DNR, which means "Do Not Rescusitate." An interesting decision from an individual who often is required to rescusitate many patients.

Currently, in the US I am required to do everything in my power to save anyone and everyone that walks through the doors of my ER. In cases like this, I must definately try my best to save the patients life, until I have found that my efforts are futile. Personally, I find such interactions frustrating.

Every person must draw their own line. If this patient had a clear order for a "Do Not Rescusitate" maybe he would have died peacefully in his sleep. Maybe that's the answer, or at least part of the answer. Every person in the US has to fill out an order what they want done if they require CPR every 10 years.

I don't know what the answer is, nor what the future of US medicine holds, but I think it all starts with asking the right questions.

For me, these are some of the right questions:

How much should individuals be accountable for their own health? Overweight, Smokers, Alcoholics, Drug-users vs. healthy, active?

What age determines you to be elderly, or is it how healthy you are? Should you be declared a DNR once your health has deteriorated past a certain likelihood of meaningful recovery?

Will it take a nationwide shift in our approach to medicine as a whole to change for the better, or can the current system continue indefinately?