This is spurred by our wonderful (looking, as well as posting) RadGirl..Hope you do fine, Babe..But did you guys know???
That medical bills are not counted against your CREDIT rating/scores?! Bet you didn't! They don't even appear! And to follow that to the (ill)logical end..By our laws, as long as your doctor wants you admitted and taken care of, ED or PCP, the hospital HAS to do so!
Bottom line, just pay your DOCTOR'S bill and you'll always be OK..
F**K the hospital bill!! They can threaten, etc, but can't really do a damn thing and they HAVE to take care of you again and again no matter what your bill is!
And, Anon From the North, who says CA's health care sucks?! That's a great way to take care of that problem, but I just don't think it would work in the USoffreeA as 911 pointed out..Happy New Year!!
Wednesday, December 26, 2007
The Naked, the Fat and the Dead
Here’s some free advice: Don’t get so fucking fat that when you die, your family has to deal with your ginormous whale-carcass.
One of my local pathology colleagues had a gastric bypass patient die today – he was 45 years old and 780 pounds. I think his BMI was, like, a trillion.
Listen, I have nothing against fat people. First of all, fat chicks love to have sex, and are good at it, because they are so grateful for the attention. Second, fat people get sick and die more often, which is great for business. Third, and most important, fat people are great to make fun of.
Here’s the problem with the morbidly (mortally?) obese: there is nowhere to put your fat ass when you die. This dude was rejected by multiple funeral homes because (and I’m not kidding) he risked exploding their crematory furnace. You see, fat is flammable; if you have witnessed a grease fire, you know what I mean. The family was too poor to pay for the double cemetery plot and the extra manpower required for burial and transport. The dude would not even fit into the refrigerators in the morgue – they had to wall off half the room in plastic and pump refrigerated air into a jury-rigged plastic bubble.
They are calling the local zoo to see if they have animal crematoriums. If this doesn’t work, they are going to end up having to cut this guy into pieces and burn him up a bit at a time. Again, not kidding.
So, listen up fatties: put down the extra large Mr. Pibb and step away from that Hardee’s Monster Thickburger. Your family will thank you when you are dead.
Oh yeah, Merry Christmas.
One of my local pathology colleagues had a gastric bypass patient die today – he was 45 years old and 780 pounds. I think his BMI was, like, a trillion.
Listen, I have nothing against fat people. First of all, fat chicks love to have sex, and are good at it, because they are so grateful for the attention. Second, fat people get sick and die more often, which is great for business. Third, and most important, fat people are great to make fun of.
Here’s the problem with the morbidly (mortally?) obese: there is nowhere to put your fat ass when you die. This dude was rejected by multiple funeral homes because (and I’m not kidding) he risked exploding their crematory furnace. You see, fat is flammable; if you have witnessed a grease fire, you know what I mean. The family was too poor to pay for the double cemetery plot and the extra manpower required for burial and transport. The dude would not even fit into the refrigerators in the morgue – they had to wall off half the room in plastic and pump refrigerated air into a jury-rigged plastic bubble.
They are calling the local zoo to see if they have animal crematoriums. If this doesn’t work, they are going to end up having to cut this guy into pieces and burn him up a bit at a time. Again, not kidding.
So, listen up fatties: put down the extra large Mr. Pibb and step away from that Hardee’s Monster Thickburger. Your family will thank you when you are dead.
Oh yeah, Merry Christmas.
Saturday, December 22, 2007
Hello Taxpayers! (incident number 3087)
Spoke to a friend today who happens to be a nephrologist. He is currently taking care of a Bangladeshi woman who flew directly here to Podunkville after a physician in Bangladesh told her she would need dialysis but could not get it there. Turns out she has relatives here in the den of Satan... the imperialist/capitalist empire known as America.
I happened to be looking over his shoulder as he was on the internet and he was reviewing a strange looking document which was written in broken English. It was the patient's medical record from her home country.
This nice gal does indeed have renal failure, and needs to start hemodialysis. She did manage to scrape together the money to get here, but can not pay her medical bills now that she has arrived. Turns out that in the course of her evaluation she was found to have severe coronary artery disease and will need a simple multiple coronary artery bypass graft among other things. She's going to live here now and get all the medical care she needs. I think it's great. We will definitely help her out. The only problem is for you, the taxpaying public. Open your hearts people! (your wallets have already been opened by federal law).
Merry Christmas and Happy Kwanza-Rama-Hannukan. Thank you again, American public
I happened to be looking over his shoulder as he was on the internet and he was reviewing a strange looking document which was written in broken English. It was the patient's medical record from her home country.
This nice gal does indeed have renal failure, and needs to start hemodialysis. She did manage to scrape together the money to get here, but can not pay her medical bills now that she has arrived. Turns out that in the course of her evaluation she was found to have severe coronary artery disease and will need a simple multiple coronary artery bypass graft among other things. She's going to live here now and get all the medical care she needs. I think it's great. We will definitely help her out. The only problem is for you, the taxpaying public. Open your hearts people! (your wallets have already been opened by federal law).
Merry Christmas and Happy Kwanza-Rama-Hannukan. Thank you again, American public
Friday, December 21, 2007
My Crystal Ball Rocks
Dear Readers,
I have posted before on the fact that we are running out of specialists, especially here in podunkville. I opined in previous posts, that this problem will only get worse as less and less people decide to put themselves through the 6-10 years of minimum wage 120 hour week hell that is surgical residency. Here's a little article sent to all us car-crash physicians. Sucks to be right all the time.
U.S. hospital EDs increasingly unable to find specialists.
In a front-page story, the Washington Post (12/21, A1, Lee) reports, "Hospital emergency departments (EDs) across the United States, already struggling with overcrowding and growing patient loads, are increasingly unable to find specialists to help treat seriously injured and ill patients," say some medical experts. According to one "nationwide survey by the American College of Emergency Physicians in 2005, the most recent available," among the "1,328 emergency department directors who responded, 73 percent said they had a problem with inadequate on-call coverage by specialists, including neurosurgeons, orthopedic surgeons and obstetrician/gynecologists." Centers for Disease Control and Prevention (CDC) statistics indicate that the "annual number of visits to emergency departments rose 18 percent, to 110 million, from 1994 to 2004." However, "the number of hospitals operating 24-hour" EDs "fell by 12 percent" during that time. Experts say that the "shortage of specialists is the result of a fear of malpractice lawsuits, a reluctance to go without pay when seeing uninsured patients, and a growing intolerance for the disruption in their personal lives and private practices."
I have posted before on the fact that we are running out of specialists, especially here in podunkville. I opined in previous posts, that this problem will only get worse as less and less people decide to put themselves through the 6-10 years of minimum wage 120 hour week hell that is surgical residency. Here's a little article sent to all us car-crash physicians. Sucks to be right all the time.
U.S. hospital EDs increasingly unable to find specialists.
In a front-page story, the Washington Post (12/21, A1, Lee) reports, "Hospital emergency departments (EDs) across the United States, already struggling with overcrowding and growing patient loads, are increasingly unable to find specialists to help treat seriously injured and ill patients," say some medical experts. According to one "nationwide survey by the American College of Emergency Physicians in 2005, the most recent available," among the "1,328 emergency department directors who responded, 73 percent said they had a problem with inadequate on-call coverage by specialists, including neurosurgeons, orthopedic surgeons and obstetrician/gynecologists." Centers for Disease Control and Prevention (CDC) statistics indicate that the "annual number of visits to emergency departments rose 18 percent, to 110 million, from 1994 to 2004." However, "the number of hospitals operating 24-hour" EDs "fell by 12 percent" during that time. Experts say that the "shortage of specialists is the result of a fear of malpractice lawsuits, a reluctance to go without pay when seeing uninsured patients, and a growing intolerance for the disruption in their personal lives and private practices."
Wednesday, December 19, 2007
Santa came early!!!
for me...I just got my ABEM re-cert score back and passed! I wonder if I'll be alive to re-cert a fourth time? How old is the oldest living, really practicing, ED doc any of you know? Not in an Ivory Tower setting, but really in the trenches??
Saturday, December 15, 2007
My Favorite Patient
A few weeks ago, I had a 50ish year old lady brought to the ED by her daughter. The chief complaint was "confusion". Mom had been confused for days. Significant medical history was denied, no medications.
History was not helpful, exam revealed a very confused somnolent patient, but was otherwise unhelpful.
The standard workup including CT scan was negative, but there was one interesting lab test. The Urine Drug Screen was almost pan-positive.
Amphetamines: POS
Benzodiazepines: POS
Opiates: POS
Barbiturates: POS
Cannabis: NEG
I went back to the room to ask more questions and talk to the daughter. I handed the multiply positive drug screen to the daughter and said "maybe this explains her confusion" Turns out that drug abuse had been a significant history with the patient, but they didn't tell me that part.
She woke her mother up and said "Mama, have you been doing drugs again (or "druds" if you're pretending to be a doctor...see other posts)?" The mother woke up and said......(this is my favorite part)...... "not unless they've been putting it in my weed"!
For the non-medical folks....of course the only negative part of her drug screen was the weed...the only part she admitted to! I thought it was hysterical! That case made my night all worthwhile.
History was not helpful, exam revealed a very confused somnolent patient, but was otherwise unhelpful.
The standard workup including CT scan was negative, but there was one interesting lab test. The Urine Drug Screen was almost pan-positive.
Amphetamines: POS
Benzodiazepines: POS
Opiates: POS
Barbiturates: POS
Cannabis: NEG
I went back to the room to ask more questions and talk to the daughter. I handed the multiply positive drug screen to the daughter and said "maybe this explains her confusion" Turns out that drug abuse had been a significant history with the patient, but they didn't tell me that part.
She woke her mother up and said "Mama, have you been doing drugs again (or "druds" if you're pretending to be a doctor...see other posts)?" The mother woke up and said......(this is my favorite part)...... "not unless they've been putting it in my weed"!
For the non-medical folks....of course the only negative part of her drug screen was the weed...the only part she admitted to! I thought it was hysterical! That case made my night all worthwhile.
Pardon Our Absence
Evidently folks are mad that we haven't been posting too much. Sorry. Between looking for my new job which does involve the circus (and trapeze stuff), we have all been uncommonly busy.
Etotheipi is 'getting stabilized on his medicines' and is out of the lock-down unit.
Schrodinger's Cat is involved in back to back semi-pro bowling tournaments and is working on a killer 'stache.
ERDOC85 could not be reached but his attorney assures us he will be back soon and may appear on the ticket in Iowa so we wish him well.
Oldfart is still recuperating from the electricity they juiced him with a couple of weeks ago but has maintained his sunny disposition throughout.
More soon.
Etotheipi is 'getting stabilized on his medicines' and is out of the lock-down unit.
Schrodinger's Cat is involved in back to back semi-pro bowling tournaments and is working on a killer 'stache.
ERDOC85 could not be reached but his attorney assures us he will be back soon and may appear on the ticket in Iowa so we wish him well.
Oldfart is still recuperating from the electricity they juiced him with a couple of weeks ago but has maintained his sunny disposition throughout.
More soon.
Monday, December 10, 2007
Livestrong?
Banal? I guess that's a good word for it. Comically commonplace? Certainly not ironic in the classic sense. Pitiful may be the best word for it.
73 year old smoker with COPD. Came in to my ER by ambulance near intubation, huffing and puffing, and getting only a few words out. Clothes and breath reeking of cigarette smoke.
Me: "Don't talk sir, breathe... "
Patient: *squeak*
Nebs and IV started with oxygen. Full code. I go in to complete the exam and spy a little yellow latex bracelet on his wrist... right under the IV line the paramedics started... "LIVESTRONG".
(insert appropriate sentence here about Lance Armstrong, irony, 'not getting it', being pitifully unaware, magical thinking, cognitive dissonance etc...., but please, spare me the 'evil tobacco company' rhetoric)
73 year old smoker with COPD. Came in to my ER by ambulance near intubation, huffing and puffing, and getting only a few words out. Clothes and breath reeking of cigarette smoke.
Me: "Don't talk sir, breathe... "
Patient: *squeak*
Nebs and IV started with oxygen. Full code. I go in to complete the exam and spy a little yellow latex bracelet on his wrist... right under the IV line the paramedics started... "LIVESTRONG".
(insert appropriate sentence here about Lance Armstrong, irony, 'not getting it', being pitifully unaware, magical thinking, cognitive dissonance etc...., but please, spare me the 'evil tobacco company' rhetoric)
Thursday, December 06, 2007
Dirtballs Get Sick Too
One of my colleagues took care of a "trap" patient the other night. A "trap patient" sets up the doc and ER staff for failure by looking and acting like a dirtball, but is, inconveniently, tremendously ill (boy who cried wolf etc...).
This patient had been seen in our facility a few times, and at other surrounding ERs within the past ten days. She is 26 years old. Her angry, multiply tattooed, smelly, drunk boyfriend had the paperwork to prove it. He waved said paperwork in our faces while letting us know with various grunts, groans, and hand gestures that he thought we were all stupid. The patient 'hurt everywhere' and 'needed pain medicine' and she was cold. She was a drug-seeker and the nurses told us so. They even set her back in a fast-track bed and told my friend, "Get her out of here... She was just here last night!"
My friend was all set to do just that but he took a look then showed me the chart while raising one eyebrow. He was concerned that the patient's heart rate was 120 and that the patient had a fever and that the patient's blood pressure was a bit low. My buddy worked this young gal up, AGAIN, and took a good ration of shit from the nurses for it too.
Well, the labs started coming back. White count 21,000, not pregnant, ESR ("sed rate") 75... and some other stuff. Normal Xray. Normal CT of the abdomen from an outside facility three days prior. Nothing making sense (but sepsis or connective tissue disease jumping up on the list above "dirtball" now).
The patient herself was absolutely no help. She denied any and all risk factors for transmissible disease, denied drug use, denied high risk sex, all that stuff. That sed rate though, that white count, those vitals... she WAS sick. She DID "hurt all over" and she HAD BEEN a drug seeker. The admitting physician gave my pal a rash of shit for dropping a "weak admission" on him.
Flash forward two days. Little miss puzzle has been transferred from our facility to the Mecca... for a possible aortic valve replacement. Turns out she nearly died soon after admission. Turns out, well, just one time, she used IV drugs. Turns out she had endocarditis with a big goomba on her aortic valve and tons of nasty bacteria coursing through her blood. Turns out she may also have HIV and maybe Hepatitis C too. Turns out she really was a dirtball, and a liar, and a very sick gal who may still die.
Dirtballs get sick too.
This patient had been seen in our facility a few times, and at other surrounding ERs within the past ten days. She is 26 years old. Her angry, multiply tattooed, smelly, drunk boyfriend had the paperwork to prove it. He waved said paperwork in our faces while letting us know with various grunts, groans, and hand gestures that he thought we were all stupid. The patient 'hurt everywhere' and 'needed pain medicine' and she was cold. She was a drug-seeker and the nurses told us so. They even set her back in a fast-track bed and told my friend, "Get her out of here... She was just here last night!"
My friend was all set to do just that but he took a look then showed me the chart while raising one eyebrow. He was concerned that the patient's heart rate was 120 and that the patient had a fever and that the patient's blood pressure was a bit low. My buddy worked this young gal up, AGAIN, and took a good ration of shit from the nurses for it too.
Well, the labs started coming back. White count 21,000, not pregnant, ESR ("sed rate") 75... and some other stuff. Normal Xray. Normal CT of the abdomen from an outside facility three days prior. Nothing making sense (but sepsis or connective tissue disease jumping up on the list above "dirtball" now).
The patient herself was absolutely no help. She denied any and all risk factors for transmissible disease, denied drug use, denied high risk sex, all that stuff. That sed rate though, that white count, those vitals... she WAS sick. She DID "hurt all over" and she HAD BEEN a drug seeker. The admitting physician gave my pal a rash of shit for dropping a "weak admission" on him.
Flash forward two days. Little miss puzzle has been transferred from our facility to the Mecca... for a possible aortic valve replacement. Turns out she nearly died soon after admission. Turns out, well, just one time, she used IV drugs. Turns out she had endocarditis with a big goomba on her aortic valve and tons of nasty bacteria coursing through her blood. Turns out she may also have HIV and maybe Hepatitis C too. Turns out she really was a dirtball, and a liar, and a very sick gal who may still die.
Dirtballs get sick too.
Monday, December 03, 2007
Sunday, December 02, 2007
It finally happened...
Our worst nightmare. I ended up in my own ED! Saturday after Thanksgiving went in for an afternoon shift and about 4PM went into PAF. Has happened maybe 4 times in 10 years and has always gone away with rest. So I finish the shift out and go take something to sleep. Had to get up for at 10AM Sunday for new shift(great clock rythym there)Still felt it. By the time I walked into the Hospital I felt like shit.
One of my buds(nurse) made me go to a room and did an ECG..130-140 AF, bp a little crappy..
So one of my partners comes in and shames me into signing in, gives me some diltiazem and I slow down but don't convert..Finally after a few hours a couple a cardiologists show up to give me shit and I convince them to cardiovert me. Had to direct my own concious sedation to start, then ask my charge nurse to go get a real doctor in case something happened(my partners)
I get zapped not once, but 4 times(I think) the last 2 with 360 and the last one apparently with a Cardiologist putting a paddle over the pad to get enough pressure to get thru my chest(for those who don't know me, I'm ex-athlete, 6'7" 290)
Man that really gets you sore! Felt like I'd done 5000 benchpresses. My damn chest hair hurt for 3 days! The nurses all felt bad for doing it to me, but at least it converted and I'm still in NSR.
Overall, I wouldn't recommend it...But if they send me a PG, I'll give us high scores!!
One of my buds(nurse) made me go to a room and did an ECG..130-140 AF, bp a little crappy..
So one of my partners comes in and shames me into signing in, gives me some diltiazem and I slow down but don't convert..Finally after a few hours a couple a cardiologists show up to give me shit and I convince them to cardiovert me. Had to direct my own concious sedation to start, then ask my charge nurse to go get a real doctor in case something happened(my partners)
I get zapped not once, but 4 times(I think) the last 2 with 360 and the last one apparently with a Cardiologist putting a paddle over the pad to get enough pressure to get thru my chest(for those who don't know me, I'm ex-athlete, 6'7" 290)
Man that really gets you sore! Felt like I'd done 5000 benchpresses. My damn chest hair hurt for 3 days! The nurses all felt bad for doing it to me, but at least it converted and I'm still in NSR.
Overall, I wouldn't recommend it...But if they send me a PG, I'll give us high scores!!
Saturday, December 01, 2007
A Stranger in a Strange Land
I just returned from an interview. I am trying to find my way out of of the E.R. buzz saw. There is a place with a preponderance of eerily happy, heterosexual, tall, geeky white people with excellent dentition. It is called Utah.
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