Interlude

I feel more rants bubbling up from my bezoar-distended stomach, so, as an amuse-bouche, I serve to you today the following. First, from Monkey-Girl's blog, a good question. Second, from my favorite sports blog, comedy based on the question. And third, a music-video, which, I think, encompasses our whole god-dammed raison d'etre (movie quote) here at MDOD. Enjoy!

Is That a Bezoar in Your Pocket...?

Insane people are cool. Who else would systematically pull out their hair, eat it, and end up with that thing (pictured above) lodged in their stomach? And all for MY entertainment.

That thing is called a trichobezoar. Tricho = hair. Bezoar = nasty mass of indigestible stuff. We get these with reasonable frequency in the pathology lab. The one you see above, you may have noted, is cast in the shape of a stomach. Those who eat their hair are said to suffer the from the so-called “Rapunzel syndrome”. I’m trying to figure out a catchy name for those who eat their own pubic hair.

Hair is not the only material we get. I have seen phytobezoars (plants), plasticbagobezoars, paperclipobezoars and CornNut®obezoars (OK, I made that last one up – shockingly, the other ones I did not).

This came up recently on a scalp biopsy from a young woman with patchy baldness. “Well, of course”, you are probably thinking, “could be telogen effluvium, alopecia areata, like ya know, wha-eva’”. Well, I diagnosed trichotrillomania, or, for the non-medical types, freakshow-who-pulls-out-her-own-hair. Maybe I’m being too critical. Maybe Head-and-Shoulders tastes like fucking maple syrup. So I apologize for the offense I have caused. Go ahead and eat that plastic shopping bag from Wal-Mart. Who am I to judge.

The Little Boy We All Know and Hate

Enuff bashing the lawyers, insurance and shit..Something fun.

OK, I've wanted to post this for a long time. Some of you are going to hate me(BFD!)and the docs, nurses and EMT's are going to LOVE IT..

I (and each and every one of you) have wished for this opportunity all of my career.

Grandma brings in Jr, about 10 yrs old, by 911!! for a PSYCHIATRIC EVALUATION because he's threatening her and she's scared of him. We all know this story..
The difference is Grandma(mom's a crack ho') seems like a very nice woman who just is at wits end with this little POS and Jr is well groomed, no tats, no ear ring, belt on his pants, no crooked ball cap. And he's clearly just being a BRAT. We have a little conversation and Jr decides to try and bite me..
Grandma says she can go get his Uncle(where's Dad?) who he, Jr, relates too..I say by all means please go get Uncle to help me with this complex medical case.

Granda leaves and I grab both of Jr's arms and put them over his head, put my hand over his mouth so my eardrums stay intact and tactifully tell him if he doesn't shut up I will turn him over my knee and BUST HIS ASS ALL UP! And if he tries to bite me or anyone else I will FHU! I have his address and know where he lives and if Grandma ever calls 911 again because he's being a brat, I will return and he will never live to repeat the 5th grade..

God, it felt good. Jr quiets down very quickly, Grandma and Uncle "Joe" come back in and I tell them Jr and I have reached an understanding. If he ever causes Grandma trouble again, I give her my card and tell her to call me. And Jr is right there, and, of course sees this.
I leave.

And as they are walking out, Grandma says thank you. She asks Jr what he has to say and the little dude comes over and gives me a HUG! It may have been better than a thoracotomy surviving!

Go ahead and call CPS, you liberal MF's, I don't care. Maybe there's one less gang banger in the making and I sure saved a hell of a lot of $$$$..

New Medical Condition - GRINCHISM

You may recognize this face if you watched the most recent Survivor series from Micronesia. This unfortunate young woman, who somehow managed to make it to the final four, has Grinchism. This disease was first describe by Dr. Seuss in 1972. The criteria for diagnosis are quite simple, but must be met completely to be considered 'true' Grinchism...

1. You must look exactly like the Grinch.

2. You must be an absolute raving, crazy, BITCH.

Sadly, this disease is incurable. Wish her luck.

M.D.O.D. Scavenger Hunt

Dear Readers,

You have heard many of us say that medicine is not a business and that patients are not customers. Let's try a little exercise here. I really am interested in what you have to tell me. Just for fun, call up your local hospital and ask the following...

1. How much is an EKG in the ER?

2. How much is a set of cardiac markers in the ER?

3. How much is a chest XRAY in the ER?

Make a couple of calls on different days. One time say you are uninsured and are concerned about your bill and the tests above are what you have been told you will need and you want to be able to pay. Another time, tell them you have medicaid, another time tell them you have kick-ass private insurance with gold-plated benefits through the railroad or IBM or some shit like that. Let me know what you find out.

I suspect you will not be able to get this information at all. If you are able to get the information I bet you get different answers based on your level of insuredness (if that's a word), which will prove my point. In a business you know the price before you buy. In a cost-shifting game the price is hidden because some pay none and others pay a lot. Have fun!

Не волнуйтесь по поводу мужчина скрывался за занавесом. он с правительством и находится здесь, чтобы помочь вам.


EDITOR'S NOTE: THE HAPPY HOSPITALIST IS DOING SIMILAR WORK HERE SO LET'S GET THIS INFO TOGETHER. 911DOC

Resubscribe Please! (sticky post)

Dear readers, we changed our email feed program to feedblitz a few weeks ago. If you want updates please do sign up again in the box to the right. And just so I can make money off of charlatans... "JCAHO, JCAHO, Complimentary and Alternative Medicine, Fibromyalgia Cure, Chronic Fatigue Syndrome Cure, remedies doctor's don't want you to know about, HIPAA compliance software, homeopathic cure". Do me a favor and click on these ads as they robotically show up on the site. These folks are fantastic and we stand behind their rite to advertise idiocy and snake oil! Mo-money bizzle.

Incomprehensible Grief

As a parent, can you imagine anything that could remotely come close to the grief of losing a child? This photo shows parents saying 'goodbye' to their child killed Monday in the earthquake centered in Sichuan Province, China.

There is no time to prepare...no chance to say goodbye.

Lofty's family has been particularly saddened by this disaster because we adopted a little girl from Sichuan Province a few years ago. Her hometown of Deyang has been decimated. We pray for her birthparents and the wonderful people we met who care for the children in the orphanage in Deyang.

Our little girl is six years old...smart, funny, beautiful, and so full of life. We are blessed to have, apparently, been lucky enough to have saved her life twice.

Consider helping here at Network for Good.

Lofty

All Your Medical News Right Here

Hate to blow our own horn but we've been saying this stuff for a couple of years now and the Wall Street Journal is late to the party.

Check Here too, and here, and here, and here, and here, and here, and here, and here, and here, and here, and other places, and, finally, here, oh, and here too.

M.D.O.D., we're cynical about medicine and the politicians and entitled teat-suckers that have destroyed it, and you should be too.

Consults Circa EMTALA

PHYSICIAN TO PHYSICIAN CONSULT PRIOR TO EMTALA

Dr. A: Hey Bill, I've got a patient down here that has a lung mass. She has no insurance and no job and is quite distressed. She needs a biopsy and maybe surgery and chemo. Can you help?

Dr. B: Well jeez doc, my schedule is full for the next few days, but maybe I can work her in between appointments on Friday. Tell her not to worry, I'll see her in my office. I'm sure we can get her plugged in.

Dr. A: Thanks Bill, she really feels badly about not being able to pay you much and her husband says they can pay some over time... They are really nice folks and will try their best.

Dr. B: Yeah, okay, probably won't see a dime but let's get her in. I'll ask the oncology folks to get involved too. Jim will jump on this. Maybe we can fix her.

Dr. A: Thanks so much. See you at dinner on Saturday, got a few days off coming up.

Dr. B: See you then.


PHYSICIAN TO PHYSICIAN CONSULT POST-EMTALA


Dr. A: Hey Bill, I've got a patient down here that has a lung mass. She has no insurance and no job and is quite angry. Had to wait three hours to be seen and all. She needs a biopsy and maybe surgery and chemo. Can you help?

Dr. B: What, am I on call for the ER?

Dr. A: That's what it says on the schedule.

Dr. B: You guys are killing me. That's four patients over the weekend that will cancel my clinics on Tuesday. You guys just cost me over five grand from paying patients.

Dr. A: Yeah, us too. Thirty people waiting to be seen. Twenty walk-outs today. Eighteen ambulances and four of them reasonable calls. This woman was actually diagnosed with a lung mass last year but never followed up. Still smokes. Came in tonight because she's been coughing up blood. Says she 'can't afford to see a doctor so she came here.

Dr. B: Fucking incredible! What does she think that the ER is free?

Dr. A: It is free to her. She will never pay for any of this, says she's disabled. Drove herself in, has a cell phone that she's been talking on half the time I've been in the room. Seems quite unconcerned except for the wait. Says her lawyer said to come here and that we have to treat her.

Dr. B: Do we?

Dr. A: Yes.

Dr. B: Lawyer?

Dr. A: Yeah, she's suing the poor sap who took her chest film a year ago. Says he didn't explain the consequences of the XRAY findings to her adequately... says she didn't understand this was dangerous. Went to the lawyer before coming here.

Dr. B: Holy shit, now I really don't want to take care of her! Hey can't you transfer her to the General?

Dr. A: No, EMTALA prohibits it.

Dr. B: But she can't sue the city hospital but she can sue the hell out of me! Can't you get Dr. C to take this one?

Dr. A: No, his privileges are suspended for not signing his charts on time.

Dr. B: Suspended for not signing charts?

Dr. A: Yes.

Dr. B: Well, come to think of it, I haven't signed my charts in a while. Maybe I can get suspended too?

Dr. A: Worked for him.

Dr. B: Can we get oncology to consult?

Dr. A: They aren't on call tonight?

Dr. B: Well will they help out after the biopsy?

Dr. A: Don't know, you will have to ask them, we only heave oncology ten days out of the month.

Dr. B: Fuck this! I knew I should have gone to business school. I can't wait till I retire. Just so you know, I'm seriously considering dropping my privileges and doing all outpatient stuff, surgery center, the whole bit.

Dr. A: Join the club. Sorry.

The Heroes and the Vultures

Helicopter transport is dangerous. Read about these fallen heroes, and then read about the vultures.