Just A Day, Just An Ordinary Day

New Year's Day
Seventh Circle Of Hell Hospital
0300 hours - Once upon a time

It's been a pleasant, and even abnormally q-word night. Every section of Main ER has open beds, so nobody's stressing. Homeless Hangout, AKA triage pit, is blissfully unoccupied. Someone, one of the clerks likely, has a battered boombox streaming out soft Christmas and seasonal music, in open defiance of policies. Good for her.

Then the Batphone rings.
City paramedics bringing a GSW victim in, in full arrest.
Virtually the entire staff, having nothing better to do, swings into action.
The Trauma Team is roused from their lair, and assemble too.
At 0302, in the softly jumbled glow of the flashing red and yellow lightbars on the outside wall, one of our gurneys comes in, bustled there by a beefy wave of firefighters, the smallest of them atop the victim doing chest compressions that would amply circulate King Kong.

Three nurses swarm IVs, getting both antecubitals and a hand, and saline and Ringer's go pouring in, while blood type and crossmatch, labs, blood sugar, and hemoglobin tests get drawn and run stat. In about 60 seconds, the monitor leads are attached, there's an ET tube in place, along with a foley catheter, and a femoral stick by the younger resident and med student team.

As I'm crawling through, over, and under the humanity to take over bagging, they're preparing a chest cutdown while the code progresses through the steps like a machine.

In fact, it ends up being bilateral chest cutdowns,  because blood is pouring out of this guy. He's essentially being cut in half from both sides to try and cross-clamp the aorta, trying to save his heart and brain until better work in surgery can save his life. And, failing that, it's good practice for young surgeons, since he's effectively dead anyway, despite the two three four units of O negative pouring into (and out of) his chest cavity even before he's cracked open.

The Chief Attending for Trauma calls it in about 60 seconds after that.
"This guy is done. My left and right index fingertips are touching through the entry and exit holes in his left ventricle. Non-salvageable."

Mr. Unlucky has been well and truly 10-ringed, right through the heart.

Before anybody can even peel gloves off, triage nurses bustle another delivery from the ambulance ramp, this one delivered by Homeboy Ambulance: two dudes in a Chevy saying "Our homie got shot." It's now 0308.

And judging by the amount of blood coming off and out of him, yes, he has indeed.

Contestant Number One in tonight's game of You Bet Your Life is literally pushed, still on the gurney and gutted like a fish, to one side, to give everyone a chance to pivot 180 degrees and start work on Number Two. Helpfully, they're all warmed up, and this one actually has a pulse and respirations, albeit with several more bullet holes in him than our unfortunate first contestant.

He looks good for stabilization, and the Trauma Team are excited to have someone they can actually have a chance of saving. As the arrangements for the surgical suite are being made, and he's being rigged for transport, the Batphone has gone off again. Another gunshot wound to the chest, another full arrest, inbound and 1 minute out.

At 0312 they arrive, pushing Contestant Two and his transport team aside, and wedging Contestant One, now with a sheet - rapidly becoming blood-tinged red - pulled over the body from head to toe, firmly along the far wall of the trauma bay.

Vulture's Row, the overhead observation area, now has a number of paramedics, cops, EMTs, etc., arrayed along it equal to the number of doctors and nurses working on the now third victim.

As we're doing the third version of IVs, ET tubes, central lines, foleys, blood tests, hanging O negative blood, CPR, and yet another chest cutdown, there comes the unmistakable voice of tonight's Queen Of Triage:

"There's another car on the landing all shot up, there's more gunshot victims inside, and I can still see the gunsmoke in the car!"

I stay in main trauma, while another bunch hustles outside to scoop up whatever Homeboy Ambulance Number Two has deposited on our doorstep.

Just as Contestant Number Two gets hustled out to surgery, they're calling the code on Contestant Number Three, despite his chest cut-down. No chance, and no blood left in him.
But then Contestant Number Four is wheeled in, turning out to have unfortunately stopped bullets to the abdomen and leg after they passed through her car door. Another guy in the car caught one in the arm, and is taken to a side treatment room. Most of the blood on the other occupants was from Number Four, but that's not apparent to us right away.

As most everyone shifts to the newest thing to play with, the two corpses sit along opposite walls, draining out every drop of blood, until we have time and staff to deal with the dead instead of the living. Everyone at this point is treading deliberately, as the floor is quite literally three quarters of an inch deep in the approximately six or seven gallons of blood and additional blood products which have drained all the way to the floor, and now cover the surface of the entire 20 by 35 foot trauma bay, not counting a huge liver-sized clot and numerous smaller coagulations plopped and strewn hither and yon in all the fuss. Every step makes the never-forgotten "shhhhwuck! squish! shhhhwuck! squish!" sounds of rubber-soled shoes pulled out of and placed back into the coagulating ocean of blood with which the entire bay is now carpeted.

It's 0315.

Contestant Number Four is stable, conscious and coherent, and apparently the bullets that hit her didn't hit vital organs or vessels. Fortunately there's no free fluid showing on the bedside ultrasound, and she's not in any distress except pain and shock at being in car full of people shot up by other folks.

Paramedics shuffle back to their firehouses, cops are everywhere, and we separate the belongings and blood-soaked clothing into piles for "evidence" versus "hazmat garbage", and a seemingly endless number of phone calls to coroner, relatives, and organ donation banks begins.

We begin mopping up, rather literally, filling large Roughneck trashcans full of oxygen and IV tubing, trash, and debris from three chest cutdowns, three intubations, three central lines, twelve IVs, four foley catheterizations, and four remaining units of O Negative blood from partial transfusions. Housekeeping is using the wall suction to try and tame the tsunami of blood, before they get down to the tile, and then bleach-disinfecting everything to the bloody grout. Body bags come out, tags are tied to toes and affixed to belongings, and a stream of labels are made for the pages of charts, documents, and other office work of sending someone to the Eternal Care Unit. Twice over.

It's now incredibly only 0320.

Sometime later, before sunrise signifies the impending end of shift, trauma surgery calls to let us know we're batting .500 for the night, 2 out of 4.

The two failures are now coroner's cases, bagged in white plastic zippered shrouds in refrigerators across the street, and the floor looks like none of it ever happened. The only traces left are the spreading ripples on the souls of those who were there, or friends and relatives who are just finding out about how the New Year started for those four people - none of them over thirty years old - this morning, after embarking on a New Year's Eve that certainly must have started for each of them so full of promise. Clearly, being around for the beginning of a day is no guarantee you'll see its end.

So much for the quiet New Year's Eve shift that wasn't.
I hate love hate love this job.

If Socialized Medicine Is So Bad

There's no if involved. But you don't have to take my word for it:

" At the beginning of 2012, over 281,000 patients in Norway, out of a population of five million, were awaiting treatment for some medical problem or other. Bureaucratic absurdities run rampant."

"And let’s not forget rationing. “Death panels”  are no fantasy. In a series of articles in 2010, Aftenposten reported on the decision by the Norwegian government’s health director to refuse certain treatments to certain “large patient groups” in order to curb costs. For example, “we can extend the lives of patients with heart failure by installing a heart pump…but this is a service we probably can’t offer. It’s too expensive.” The same goes for respirators in cases of emphysema or chronic bronchitis: “It could prolong the lives of patients, but it’s not something we can give to such a large group.” The elderly, likewise, are screwed: “we…spend too much money to extend the last phase of life for dying, often old, people.” Who’s to decide who receives treatment and who doesn’t? That, the health director answered, is a “political responsibility” – the job of politicians, not physicians."

Sweden: Tales From The Healthcare Crypt

"The clinics have security guards to keep patients from getting unruly as they wait hours to see a doctor. The guards also prevent new patients from entering the clinic when the waiting room is considered full. Uppsala, a city with 200,000 people, has only one specialist in mammography. Sweden's National Cancer Foundation reports that in a few years most Swedish women will not have access to mammography."

The truth about Canadian healthcare

"My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks."
"This is a country in which dogs can get a hip replacement in under a week, and in which humans can wait two to three years."

Coming soon to your doctor's office. Hope and change!

It's not like people haven't been explaining this news for thirty years. This sort of thing is only news to people who think Michael Moore makes accurate documentaries, rather than paeans to socialism on the order of Leni Reifenstahl and Sergei Eisenstein.

Now, when it's begun biting some people in the ass, they start to get it.
Welcome to Hell. Thanks for carpooling.

Dear Anonymous Troll

"Anonymous (troll) December 3, 2013 at 7:56 AM

I have a question: if subsidized health care is so bad (it is), how come it works so well in other countries?(It doesn't.) Take the Scandinavian peninsula countries for example, Sweden, Denmark, and especially Norway (who by the way have about the highest standard of living in the world)(actually, they don't), have all subsidized health care - and education btw. How come it's good for them but so abysmal for us? (It's abysmal for both; they just have a better track record of rolling over for nanny-state government.) Does it have to do with the "anti-socialism" brainwashing of Americans (they call that comparative government here) and failure to understand how this type of health care has to be organized in order to be made efficient?"(No, it's a success at understanding how this has to be organized, and recognition that it's contrary to our founding principles, our Constitution, and pretty much everything in American life and culture prior to about 1934.)

 

But out of fairness, Anny, let's check the videotape on your assertions:

 

Sweden    

Pop. 9.5M   15,765 immigrants annually

GDP 399B  35th world/26th per capita

AIDS deaths <100/yr

Denmark

Pop 5.5M    13,600 immigrants annually

GDP 213B   55th world/32d per capita

AIDS deaths < 100/yr

Norway

Pop. 5M        8,400 immigrants annually

GDP 281B    46th world/9th per capita

AIDS deaths  <100/yr

United States

Pop 317M    1,153,880 immigrants annually

GDP 15,940B   2d world/14th per capita

AIDS deaths  >17,000/yr

{So as not fry your delicate grey cells, I left out the number of Nobel prizes in chemistry, biology, and medicine respective to Scandinavia vs. the U.S., the number of patents for medical devices for Scandinavia vs. the U.S., and the fact that the total amount spent on healthcare in the U.S. annually is more than the entire federal budget for any year prior to 2004, because clearly things like medical innovation are unimportant trivia, and I'm sure you think the federal government is doing such a great job on running itself in every other way already that the best choice in healthcare is to just hand it over to them too, right?}
 

Wow, this is quite a poser.

If I understand you correctly, you're asking how we, a country that takes in more immigrants annually than Sweden, Denmark, and Norway and 150 other countries combined might have different health care needs?

 

How our nation's needs could possibly differ from the needs of three countries whose combined population is surpassed merely by the number of folks living in the greater NYC area??

 

And why a country whose non-socialist output exceeds them in total by a mere 16 times  might not be so enamored of socialism as they (and apparently you) are? (And BTW, Norway doesn't have "about the highest living in the world", they're eclipsed by Qatar, Liechtenstein, Bermuda, Macau, Luxembourg, Monaco, Singapore, and Jersey, just for your rather sparse fund of information.)

 

Or why we, caring for an AIDS population almost 60 times larger than all three Scandinavian states combined, might just maybe have some different healthcare priorities than a miniscule, mainly white protestant homogenous bunch of countries with essentially zero population growth?

 

You realize, right, that more people live in Los Angeles County than in Norway and Denmark combined?

That Norway's largest city isn't even the equivalent size of merely San Jose?
That Copenhagen and Stockholm, their largest cities, are eclipsed by Dallas and San Diego, and that our top 6 cities have more people than all three of those countries?

Or that the number of 0-14 year olds in the United States is three times larger than the combined population of the three countries you mentioned, combined??

And that none of those nations would even make the Top Ten if they were U.S. states, ranking behind California, Texas, New York, Florida, Illinois, Pennsylvania, Ohio, Georgia, Michigan, and North Carolina. That'd be Sweden; Norway and Denmark would actually be down around 22nd, just ahead of Alabama. In more ways than one.

And when you touted that sort of system, of course you knew that the average Swede pays >50% of their annual income to the government for that "free" subsidized healthcare, right? And that a Swedish-style single-payer health insurance system would cost the median income household in the U.S. $17,200 per year in new health care taxes. Please, extoll the virtues of doubling income taxes on the 46% of Americans who are actually paying any, because that'll really play well in Peoria. That'll be great news to the 91 million American unemployed at the moment, because it means folks like you, Anny, are going to get three new Mcjobs to help pony up all that cash. All for someone else's kids! Thanks, dude!

Gosh, sign me up, I can't wait to give Uncle Sam another 20% or more of my annual take-home, because I'm not eating enough PB&J and bologna sandwiches now, I can look forward to adding ketchup sandwiches to the menu! Thanks for the suggestion, Anny!
And then to contain costs, we'll cut staff and facililties, so that in a few years, procedures will be shoved down to lower and less-qualified staff, if they're performed at all, and in un-updated facilities with more antiquated equipment and technology. Welcome to U.S. Medicine 2015 1935.

If your message is that we should first helpfully eject all non-whites, and enforce a level of ethnic and social diversity - like you find in Sweden, Denmark, and Norway - that would do a Klan rally proud, you'll have to get your own blog. Good luck with that. I think they tried it in Western Europe starting around 1933.

 

We experimented with socialism in this country. But adhering to it almost caused the Pilgrims to starve to death, until they threw it out entirely, switched over to unrestrained capitalism, and were so inundated with bounty as a result that they paid off all their debts to their English sponsors, and had enough left over to hold a huge feast, and even invite their neighbors over. We call the remembrance of that "Thanksgiving". As Casey Stengel used to say, you could look it up.

The only subsidizing that's going on is at gunpoint, as healthy people are coerced under threat of growing fines to buy healthcare they don't need for exorbitant prices, in order to help cover the cost for those who get it for nothing. Try that at the interpersonal level, and see what the local District Attorney calls it.

I would have been all for government just letting anyone who wanted it sign-up for Medicare. But then, when they saw the exorbitant price they'd be asked for, and the substandard care they'd receive, if they could find a doctor worthy of the name who'd actually take that card, they'd run from government care like scalded cats. The idea would have been crib-strangled by everyone who experienced it firsthand in weeks. Pretty much the exact same response you're seeing now for HopeyDopeyCare, even from media talking heads who usually can't get their lips off his buttcheeks long enough to cover actual news.

But don't worry, I understand how socialism-philes love to chirp about "organizing things to be more efficient", because they're sooooooo good at making the trains run on time. Perhaps you could Google "Soviet health care" and get back to us. Unfortunately for your ilk, some of us also studied history, and we remember where the train tracks in your Worker's Paradise always lead: glorious barbed wire enclaves sitting beyond signs that promise all who enter, "Work Makes You Free". Right after a helpful post-train ride shower, eh? Last I looked, overt Socialism only killed - as in personally murdered, we're not even including the wartime casualty lists - about 65,000,000 people worldwide in just the last century alone, courtesy of Hitler, Stalin, Mao, Fidel, and Pol Pot. It would actually be less harmful to disseminate bubonic plague in grade schools.

So pretty much all your assumptions are wrong, the lack of familiarity with the basic differences is breathtaking in its totality, and the conclusions you draw, from the dearth of information about...well, anything you brought up, are almost totally wrong. Other than the fact there there are three Scandanavian countries named Sweden, Denmark, and Norway. Which probably puts you barely ahead of most current 12th graders in geography.
Sorry if reality stings when it smacks you where you sit. Maybe try an ice pack?

 

So seriously Sparky, as Bill Murray said to the innkeeper in Groundhog Day, "Did you really want to discuss the weather, or just make chit-chat?"

The Elephant In the Room: Partying Like It's 1986

Boys and girls, let's flash back to those thrilling days of yesteryear.
To 1986, to be specific.

Our beloved federal representatives, in the spirit of Satan Santa Claus, bestowed upon our republic (and to a great degree, most of our own professions) two acts of public munificence scarcely to be imagined (at least by anyone who can balance a checkbook).

I refer to the Immigration Reform and Control Act, and the Emergency Medical Treatment and Active Labor Act, whose passage the same year was anything but coincidental.

EMTALA was, in almost every way, the prequel to Obamacare. It mandated (without anyone anywhere paying for it) that all hospitals with emergency services had to provide them to anyone and everyone who walked in, regardless of ability to pay, citizenship status, or any other wee considerations.

Imagine, if you will, McDonald's mandated to give away free cheeseburgers to everyone who demanded one under the same (lack of) restrictions, and then come up with your best guess as to how long before they'd go bankrupt and close forever.

Except that, as a rule, hospitals are full of people who don't want to close, because they're genuinely concerned with finding a way to help people rather than shutting down forever. Because unlike a fast food restaurant, when hospitals close, people don't just miss lunch; they die.

Nonetheless, skyrocketing unreimbursed expenses under EMTALA have driven hundreds of hospitals, especially the smaller community hospitals you may remember if you're over 30, right off the financial cliff and out of business forever, along with no small number of larger facilities as well, due to the crushing burden of unreimbursed care to the indigent and illegal. (CA has lost something like 80 hospitals in the last 15 years, when last I looked, and chiefly for exactly this reason.)

Many others (Kaiser, I'm looking at you) simply curtailed or eliminated emergency services, thus ducking the law (legally). Which then made the wait for you or I to be seen at the hospital ERs remaining climb from minutes, to hours, to even days now at some inner city locations.

The huge hospitals and health care chains that remained had to find a way to make ends meet and buffer the enormous financial losses, so they began padding their bills. Your aspirin, for example, now costs $20. Mind you, it's still bought at $0.02@, but the cost to the insured helps subsidize the 999 other ones given out free (or at least unreimbursed by the recipients, or anyone else) to homeless, indigent, poor, uninsured, and illegal aliens, all by the trainload daily at every hospital impacted by the new law. Nothing in the new law gave these folks any incentive to make better life choices, nor any likelihood they'll ever have to pay for all the "free" health care that Tip O'Neill and Congress started handing out to them, as they have for almost 30 years now. After helpfully inviting 3 million folks to partake of American citizenship with IRCA the same year.

Flash forward, and let's see how those two genius moves have worked out:
Hospital emergency care impacted.
Health care cost rocketing to Jupiter.
Wait times to the moon.
Another 10-20 million folks thronging here illegally, and partaking of all the benefits of "free" health care, among other things.

So, in order to wipe out the scourge of uninsured patients and rampant runaway costs, we get EMTALA on steroids: Obamacare! (Because as we all know, if smashing your thumb with a hammer hurts, the best cure is to take a sledgehammer to your entire hand!)

By forcing millions of young healthy people who could formerly choose to do without it to get health insurance under Obamacare (under pain of IRS enforcement and hefty fines), the government, in collusion with the insurance companies, and against the interests of everyone, not least of them those millions of young healthy folks, has found a new way to pay for care for the unemployed, indigent, insane, and illegal patients, and now everyone else gets to pay for it all, forever! It's a Health Care Miracle!! (Well, except for that whole crashing 1/6th of the American economy like it were the LZ Hindenburg thing. FWIW, the hospital I formerly worked out has laid off 40% of staff across the board, in the fear certainty that reimbursement schemes will bankrupt them. Which put 1200 formerly insured and gainfully employed folks, and their families, in the unemployment line to buy...wait for it...health care from Obamacare! Genius, no?)

And more doctors leave the profession forever (25% of our ED doctors group retired last December, most of them years early, and the group has no plans to replace them anytime soon), most of the rest curtail or cease entirely accepting Medicare or any other government insurance, more hospitals close, the wait gets longer at the ones which remain, and the billing price of everything, like that $20 aspirin, is worse than gasoline: rising indefinitely, with no end in sight.

Meanwhile, your employers cancel (or will shortly) your policies, cut your hours to <29@week, or just lay you off outright. And the insurance companies sit back, as their willing shark-smiling minions at the IRS shovel you one and all into their maw, by the government's requirements that everyone buy insurance they don't need - like mandatory mammogram and maternity coverage for men - at prices they can't afford.

And giving out health insurance cards without making more doctors for those suddenly insured people to see, means that all those patients without appointments, but still having a problem, will now go...to the Emergency Department! Brilliant!

Cue government single payer in 3, 2,...

Next up: Let's bring that whole Amnesty Thing up for discussion again, so we can "solve" that problem like we "solved" the health care "crisis".

The biggest problem isn't that the Obamacare sign-up website is broken.
It's that someday, it's going to work exactly as designed.
Grab your wallets, and run for your lives.

Bellyaching

"Flaming Hot Cheetos are bad, and lead to unnecessary ER visits."

Color me shocked! Shocked I say.

In other news, water is wet, fire burns, and it gets dark after sunset.

O, if only someone had perhaps mentioned this terrible affliction.

Oh wait, I did that, as has probably every nurse doing triage or treatment in any ED that sees kids with sign-in complaints for "abdominal pain" or "possible rectal bleeding."

But don't worry motherfathers, we buy our docs rubber gloves and surgilube by the case, so if you want your child serially introduced to the TSA standard pre-boarding rituals (and evidently, the Deming, NM PD Roadside Assistance Program), keep handing junior those little bags of flaming death, and see whether or not you pay my mortgage again this month.

Once More, With Feeling

So apparently, law enforcement in the Southwest has taken to doing this on a regular basis:

Customs/Border Patrol Doing Anal/Vaginal Probes Without Warrants

Look, I'm over here by the Pacific Ocean. Maybe the Constitution is different for us here.

But evidently, in what is now the third such story in three days, law enforcement (in this case actual federal agents) took a woman from the border to a local hospital presumably to have licensed medical professionals go poking all up in her stuff.

I'm not a Constitutional scholar, but I have a not too startling suspicion that if the police aren't entitled to just stick their hands up into my body cavities anyways, any such explorations are neither actually "reasonable", nor what anyone with an IQ north of their shoe size would call so. Let alone how any judge not certifiably insane would see it.

So for anyone from say, Texas or New Mexico...WTF?

Someone with a badge comes in and asks you politely to please go poking around in Mr. Jones or Ms. Sanchez in ways you wouldn't consider without a 27-page pre-op form under normal circumstances, and yet in these cases we have doctors (and possibly assisted by nurses etc.) falling all over themselves to violate policy, procedure, standards of care, professional ethics, and state and federal law with the studied casualness of retarded sociopathic serial abusers, raised on lead paint chips and high on crack.

I repeat for emphasis:  
WTF?!?!?

I've searched diligently to find the story where law enforcement officials held medical staff at gunpoint and demanded the procedures be done, but so far that search is in vain.

Now look, I like police officers, as a rule, knowing their job is just as nasty and a wee bit more dangerous than ours, with similar clienteles. I joke with them, work with them, hell, I've even been related to them both by blood and by marriage, and I know there's both good ones and bad ones.

But these abuses aren't taking place on roadsides at 2AM with no one around or watching.

They're happening, serially, in accredited medical facilities, and performed by professional, theoretically conscientious, and undoubtedly licensed and usually board-certified medical staff. WHO SHOULD EFFING KNOW BETTER, and not to put too fine a point on it, with an average IQ advantage over the minions of law enforcement of 20-30 points most days, and an additional 4-10 years of post-secondary education.

In places that are supposed to be bastions of dignity, caring, and scrupulous professionalism, rather than modern re-creations of Dr. Mengele's konzentrationslaager infirmary.

So yet again, I repeat: if you're in any way involved in the profession of medical practice, and have participated in this, please, for the good of humanity, burn down your hospital, and then go home and kill yourself, or at the minimum, go down to the local state attorney general's office and turn state's evidence, followed by giving a full and complete public allocution of your and your colleague's crimes on live TV.

And then apologize, as you contemplate living the rest of your life as a traitor to the profession, and a pariah among decent human beings. Because we really need people like you in this profession, and probably walking the planet, like we need a dose of the clap.

And consider yourselves lucky that we don't let villagers come with torches and pitchforks and take you one and all to a well-deserved stake cookout in your honor.

Raping The Constitution - Just Another Day in Deming NM

(I'm cross-posting this, because there's way too much crossover applicability to the medical field going on here. - A.)

Caveat: Good cops are worth their body weight in gold. Bad ones can - and should - be melted down to make fishing sinkers.

"Welcome to Deming NM, where the only safe @$$holes wear badges!" - proposed sign for the Deming NM Chamber of Commerce to put up at city limits

Yes, I'm late getting to this, because everyone else is having so much fun with it.

First, the LINK.

Now, the highlights:

One Mr. Eckert, of southern New Mexico, having concluded his shopping at a local Wal-Mart last January 2nd, did a rolling not-quite-a-stop as he left the parking lot, and was immediately selected to donate to the town's tax coffers pulled over for a  moving violation by the Deming PD.
Whereupon, for this grave breach of public order and safety, he was ordered to exit the vehicle.
(WTF. Why?? For a ticket, all you need is a promise to appear, and normal observables for citing officers don't include the behavior of your ass muscles.){Update: Aha! Because their Talking Dog told them! More later.}

Whereupon, based on personal observation, and a career familiarity with proper buttocks etiquette, Officers Assclown and Dipshit decided that the driver was almost certainly clenching his cheeks to maintain an imaginary stash of illicit narcotics in his booty hideout.
Whereupon they contacted and received from a local graduate of New Mexico's finest internet law school and all-night taco stand judge a search warrant for the anus of the motorist in question.

Apparently in Luna County, NM, probable cause of no more than some jackassical officer's desire to have a peek up your ass is sufficient to set aside the entire Bill Of Rights.
There's doubtless a thumping sound coming from the vicinity of 77 graveyards as the signers of said document spin in their graves.

Our brave butt pirates in blue took him to a local Deming ER, whereupon the medical professional on duty told them not just no, but Hell NO! because performing such a procedure, warrant or no, was a violation of his professional ethics. Doctors typically bill separately from the hospital, so this guy's medical group should award him an on-the-spot 5-figure cash sum for sparing them the lawsuits and ridicule to follow, a sum that should be matched by the hospital out of sheer gratitude. And if the AMA has an Ethics prize, this unnamed doctor just won it for 2013, whether they acknowledge it or not.

Undeterred by such flawless ethical reasoning, Officers Assclown and Dipshit, assisted at some point by Officer Shitforbrains, and later joined by Hidalgo County sheriff's deputies Bumblefuck, Stumblefuck, and Bufflefuck, trundled the motorist outside the county limits (and the limits of the jurisdiction of said search warrant, nota bene) to the Gila Regional Medical Center in Silver City NM, in Hidalgo County, where the local disciples of Dr. Mengele were more than happy to use a search warrant from an alleged judge in another county as a pretext for an epic butt-fishing expedition.

As noted in the federal filing complaint and linked story, the motorist was then subjected to the following:

1. Eckert's abdominal area was x-rayed; no narcotics were found.
{Nota bene that at this point, it ceased being a search, and the torture began. - A.}
2. Doctors then performed an exam of Eckert's anus with their fingers; no narcotics were found.
3. Doctors performed a second exam of Eckert's anus with their fingers; no narcotics were found.
4. Doctors penetrated Eckert's anus to insert an enema.  Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool.  No narcotics were found.
5. Doctors penetrated Eckert's anus to insert an enema a second time.  Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool.  No narcotics were found.
{At this point chronologically, after failing to notice that the warrant itself was invalid in their locale, no one noticed that the time limit for said warrant had also expired even if it had been a valid warrant. Which it wasn't.}
6. Doctors penetrated Eckert's anus to insert an enema a third time.  Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool.  No narcotics were found.
7. Doctors then x-rayed Eckert again; no narcotics were found.
8. Doctors prepared Eckert for surgery, sedated him, and then performed a colonoscopy where a scope with a camera was inserted into Eckert's anus, rectum, colon, and large intestines.  No narcotics were found.
Throughout this ordeal, Eckert protested and never gave doctors at the Gila Regional Medical Center consent to perform any of these medical procedures.

This all took place in January 2013, and while it's a wonderful practical demonstration of Obamacare a few months early, like most of the activities of the current president, it's also a wee bit afoul of tiny details like the Bill of Rights and that pesky Constitution thingie.

My original response to that catalogue of nonsense was to a fellow online commentor who wondered why they didn't "just give him a dose of salts, and wait for the results" is as follows:

Because he has the legal right to refuse anything and everything. The only thing that can be done to anyone without their own consent in the ER is drawing blood for alcohol/drug tests, and administering emergency psych medication and strapping them down when they're actually violent and a danger to themselves or others (by which I mean swinging punches, kicking, and frothingly Hannibal Lecter bite-happy, not merely enamored with dropping F-bombs due to a lack of serotonin or social graces).

For everything else, they can tell everyone up to and including the President to "Eff off" with a mere 500 years of English Common Law and the full faith and credit of the U.S. Constitution on their side, something I regularly have to remind both cops and doctors of, but which our Legal Dept./Risk Mgmt. drones pound out in memos about 3X/yr.

Evidently somebody forgot to tell the local gauleiter, statspolizei, and the local disciples of Dr. Mengele in this instance that this sort of behavior was rather discredited post-1945.

Remember this when someone tells you the average h.s. grad doesn't need to know civics and political history for life beyond the 12th grade.

"These guys need to be locked up."

Letting the punishment fit the crime dictates that during confinement, they also be placed in restraints - by court order - and ass-raped by convicts repeatedly.
It's also funnier that way.

And for the record, every medical professional who didn't say not only "no" but "Hell no!" at the offending facility, from the lowest clerk up to the attending physician, just forfeited their licenses to practice, everything they own, and the next 10 years of their lives, at minimum.

Whether anyone admits it or not, this victim is on the short list to becoming the new co-owner of that entire hospital. This is a $20M judgement, and that's if it never gets to a jury's ears. He'd be crazy to settle for anything less than that, and if he has competent counsel, they've made that clear to him.

If it were me, I'd let them off with $5M in damages, provided they all stood in the town square for a week while any resident of the city limits was permitted to come up and kick them in the crotches as hard as they desired, once apiece.

And in all probability, Eckert was still issued a citation for the moving violation, and the medical center sent him a $6000 bill for sexually assaulting and humiliating him with glee multiple times, and showing a shockingly reckless disregard for anything we normally associate with professional ethics or common sense.
But, as countless late-night infomercials have told us, "Wait - there's MORE!"

They've done this before!

And come to find out, the original suspicion in both cases was the K-9 partner of Officer Shitforbrains: Leo the Ass-Sniffing Drug Dog!

Whose Crack Hound certification as a drug dog expired in 2011, at least a year before both incidents. Thus neither the dog, nor the probable cause, passed the smell test.

Not to mention that he doesn't know drugs from dirty underwear, and the false positives in both such notable occasions were ignored by everyone from Officer Shitforbrains to the Chief, because ass-raping both the citizenry and the Constitution in Deming and Hidalgo County is apparently so commonplace there that it doesn't even rate a yawn.

And notably, they again took their prospective butt-rapee to the same Gila Regional Medical Center in Silver City. One might notice a pattern here.

To the disciple(s) of Dr. Mengele working at that particular would-be Nazi Concentration Camp Processing Station and Sexual Assault Training Camp brilliant example of what you get when you make doctors the tools of the government at Gila RMC, particularly the really really questionable ones who should probably have been flunked before licensure, and be dissecting cattle for the local butcher shop instead of practicing medicine last seen at Auschwitz circa 1944, and best left there:
Show some self-respect, and burn down your hospital, for the good of all mankind, not least of which includes the local citizenry.
And then, please, if you personally had anything whatsoever to do with participating in the above or similar incidents, with all dispatch, go home and hang yourselves, as a mark that you have some shred of personal honor and a sense of shame.
Or turn yourselves in and become State's Evidence witnesses, and offer a full confession. It's the very least you can do, and clearly long overdue.

And one wonders just how many times this sort of outrageous conduct will have to be repeated before the Governor of New Mexico directs the State Police to step in, suspend the entire city of Deming Police and Hidalgo County Sheriff's Departments, and take over both until further notice to restore the rule of law and order, after referring both and any other such matters (and if they've done this twice, they've probably done it twenty times) to the state's Attorney General for some rather speedy and sweeping show trials in Albuquerque, ideally no later than close of business Friday.

When the U.S. Attorney for New Mexico will commence an investigation into the issuance of dodgy search warrants by judicial jackholes in and around Luna County has not been addressed, even by reporters who should know better. C'mon, counselor, this is an easy ticket to Congress or the governorship, and looks to be as hard as shooting fish in a barrel. Jump right in.

No points for guessing the winners of the 2013 Jackbooted Thugs Of The Year Award, by miles.

Nuke the site from orbit. It's the only way to be sure.

And please, for the love of all that's holy, it's long past time for SCOTUS to revisit the Fourth and Fifth Amendments relating to automobile and personal searches during traffic stops, and the admissibility of using drug dog "testimony" as probably cause for doing anything but handing out Milkbones. I pray that counsel for plaintiff uses some of the undoubted civil damages in this case to seek redress at the highest level for what has become a long train of abuses and usurpations of the Constitution, evincing a design to reduce us all under absolute despotism. Jefferson had a solution for that. What say let's nip things before we go there?

Public Service Announcement

Yesterday into this morning, I had an experience for the second time in the last 5 years:
fever, chills and body aches, coming on rapidly, which subsequently went away with no further ill effects within a day.

Being a health care professional, getting an annual flu shot has become a non-optional event, and this is thus the second time I can attest that this year's shot works, as evidenced by someone giving me one of this year's strains, my immune system kicking in, and the total disappearance of symptoms within a day.

There are two vaccines out this year: a tri-valent and a quadra-valent brew, hopefully good against three and four possible strains, respectively. (I got the tri-valent recipe.) Every year the flu virus mutates, and the CDC et al try to guess which way the prevalent strains will jump, and then concocting, for example, a vaccine that'll kill African B, Asian Q, and European X (all pulled out of thin air to illustrate the point) strains. Some years they hit nothing, some one, occasionally two, and rarely all three prevalent strains.

But I can tell you three things this morning:
1) School is in session, so it's flu season. There's nothing like millions of children sharing their cooties by sticking their fingers into each others' mouths to breed and propagate the annual epidemic when they bring it home each day.
2) At least one (or more) of this year's virus(es) are covered by this year's shot, based on my personal anecdotal evidence.
3) Flu shots work. If you're anti-vaccination, I'll talk with you when you show me Jenny McCarthy's Ph.D. in biochemistry. Otherwise you're a lunatic Luddite, and deserve a week or two's intestinal misery.

Get your flu shot.

Horrible Bosses

Why, specifically with nursing, do the most unprofessional, disorganized, dysfunctional, mildly retarded, socially inept @$$holes unfailingly become middle management? Is this Affirmative Action for jackasses, or are they hiring the handicapped because they're fun to watch, or is it just that senior management can't, in my father's memorable turn of phrase, actually and reliably "tell $#!^ from Shine-ola"? I confess to feeling uncharacteristically baffled.

Do an experiment: think of the co-workers you'd least like to work with, and the ones you'd be most inclined to fire for their shenanigans if you were King or Queen For A Day, (or for students, the ones you consider deadweight on clinical and lunchmeat during lectures), and for any position you stay in more than 5 years, keep track of how many of them become charge nurses, nurse managers, and clinical coordinators.

If you find someone who's so gratingly annoying the whole department wants to smother them with a pillow, congratulations, you've just met your future supervisor. If they want to fill the pillowcase full of IV pumps and beat them with it, you may have identified a future CNO.

I bring this up because, surprising me not a whit, yet another terminal management failure has been inflicted upon my work unit. She's a legend in her own mind, and clearly, at some point, she was allegedly a decent nurse.The problem comes in that when handed any slight amount of authority, she defaults to Genghis Khan-like management techniques, that probably didn't even work for Genghis, back in the day.

Which leads not only experienced me, but utter newbies on the staff to recognize in 0.02 seconds, that she's scared spitless because she's too insecure to shut her piehole and work with people, actually listening to them and MANAGING them, because she clearly lacks the wisdom, experience, competence, self-confidence, or basic 3rd-grade-level human coping skills to not dictatorially try to micromanage everyone like they were Barbie dolls at her tea party 24/7/365.

That style didn't even cut it in the Marine Corps among fresh recruits with room temp IQs, so it sure as hell isn't going to cut it with trained degreed professionals and experienced support staff.

I mention it because it's a wee bit off-putting.

And a corollary, which I'm sure shows up somewhere on a managerial training curriculum is that when you hire and promote the least competent people, it not only destroys morale and lowers productivity, it also demonstrates to everyone down to the janitorial level that you have your own head so far up your @$$ that you can't tell the difference between someone who's good and someone who sucks, and that you're - theoretically, at least - the very supergeniuses who sign the checks and direct the affairs of the entire facility. Which scares the hell out of we, the employed.

So somewhere in the Rules For Big Wheels, there has to be written the caveats:
1) Don't pull your pants down in front of the entire staff every day by hiring management morons
2) Try and demonstrate some basic level of bare competence unless you like the sound of laughter behind your back pretty much in perpetuity.

At this point, I've seen upwards of a dozen various management folks come through, and go out the other door. I could count the keepers on my thumbs. (And one of those two handed the promotion back to them after a year to go back to bedside care, because it was corroding his mind and destroying his soul, not to mention starting to hurt his marriage because of how it was affecting him.)

And as these personnel decisions are invariably made by the same people who make clinical decisions for the hospital, one is left to wonder how, other than bare good fortune, we don't kill people like the Black Plague going through Europe in the Middle Ages.

Diagnosis Of The Week

Thanks for stopping by, and helpfully signing in with everyone's favorite chief complaint:
tummy ache.

Sometimes, you helpfully narrow it down to a flank or a quadrant, and other times, not so much.

Which is why it's called Mystery Abdominal Pain.

Which occasions the triage nurse getting out their deerstalker cap and meerschaum, and playing Sherlock Holmes with you, crossed with a really thorough police interrogation. (Tip to family members: shaddup, and let us get the answers the patient has. We'll be happy to let you fill things in afterwards, but first things first, 'kay?)

For the anatomically vague, a brief lesson.
Chest pain is rather straightforward, there being far less "stuff" to deal with: heart, two lungs, ribs and muscles. Yes, there are other things there for more detail-oriented folks, but that's the highlights. And even then, >5 out of 10 patients with chest pain go home with a diagnosis of "atypical chest pain", which means it's probably not a heart attack, pulmonary embolism, broken ribs, aortic aneurysm, tumor, or 27 other things, and we don't know what it is, but we're relatively certain it isn't going to kill you - tonight, anyway.

Abdomens are a bit more problematic. You have a diaphragm, esophagus, stomach, liver, gall bladder, two kidneys, pancreas, spleen, two different intestines, an appendix hanging out down in the corner, and for those with the internal plumbing option, a full set of female tackle for gestating and producing offspring.

Things that'll kill you relatively soon are things like appendicitis and an ectopic pregnancy. Everything else may only make you wish you were dead. We'll be focusing on the life-threatening options first, and trying to narrow things down as we move along.

Either way, to find out, we're going to need to do a few things. Things like blood tests for standard labs, a CT and/or ultrasound, and we need your pee to make sure you aren't pregnant. For the record, the more sure you are that you "couldn't possibly be" so, without a picture of your uterus in a jar, for any female between about 5 and 50, generally just convinces us you're lying at worst, and mistaken at best, so work with us, and just give up the pee, 'kay?

This is where you can shine, and help yourself: see that computer you're reading this on? When you finish, go to your word processor, and type in your allergies, medical history (that means the things someone with "M.D." after their name has actually clinically told you you have, not the things you Googled before you came in or think you have), along with any surgeries, and a pretty good breakdown on your problem as you understand it.

Unless you had 42 abdominal surgeries in your teens, we really don't want the entire unexpurgated life history of your alimentary canal since 3rd grade, but if you do have some serious issues, by all means fill us in. Start with why you're here right now.

Then, if applicable, recall your last menstrual period, particularly if it seems to have been 8 or 9 months ago.

And if you have an IM, gastro, gyno, renal, etc. specialist(s) you see or have seen, by all means, their name and phone number.

Minus points if you deny significant history, and then we find a scar around your middle big enough to swap body parts, or even find those cute little nicks on the sides that tell us someone's been worked on by laparoscopy.

And for f***'s sake, NO, YOU CAN'T HAVE ANYTHING TO EAT OR DRINK, UNLESS IT'S
1) A COUPLE OF CHIPS OF ICE TO WET YOUR MOUTH AFTER THE OPIATE PAIN RELIEVER MAKES YOU FEEL LIKE YOU'VE BEEN SUCKING ON COTTON SOCKS, OR,
2) IF YOU'RE REALLY LUCKY, YOU CAN GUZZLE SOME OF THAT NUMMY RANDOM FRUIT-FLAVORED CT CONTRAST.

Re-read that menu above, and note that it doesn't contain double cheeseburgers, anchovy pizza, or Flaming Hot Jalapeno Cheetos, or anything else, whatsoever. Try and remember that sneaking that stuff in past us anyways is all fun and games, until your surgery is delayed because the risks of anesthesia are too great with your recent meal, so now you have to sit around and feel your appendix bursting, because the anesthesiologist isn't going to risk getting sued when you vomit during surgery, aspirate, and become a bigger brain-dead vegetable head than you were when you snuck the Monster Whopper with Fries down your gaping maw while waiting for the CT scan.

But please, do understand that if you keep pushing the point, eventually we'll realize you don't just have an abdominal problem, you also have the brain of a stegosaurus pulsing, peanut-like, somewhere inside your great empty cranial vault.

Patient Safety tip: we also frown on people laughing at sit-coms while they wait yet subsequently reporting that their pain is a "10 out of 10"; ditto if we had to wake you up to ask you how much it's troubling you. Imagine Wile E. Coyote, the boxful of knives and sharp objects, and the rock ledge he fell off of landing on your tenderest spot - if you're feeling that, and we walk in to see you doubled over, sweating, moaning, and writhing, we'll buy it. Otherwise, we'll write down your "10", then record "patient was in no distress, smiling and laughing" which is medical chartese for "horrible actor, terrible liar, and no Oscar nomination". Doubly so if you're "in pain" when we ask, but look just fine when we sneak a peek over your shoulder a minute later from the hallway (trust me, we do this a lot - thank the local drug seeking junkies); if that happens, you're so busted. Please, I beg you, don't be that guy. It's cold in Siberia, and mentally, everyone will banish you there.

If you do all this, you'll save us a lot of wasted effort, and yourself several extra wasted hours on what's liable to be a 2-4 hour process. Which, despite everyone's best intentions, still may fail to find a diagnosable condition or cause for your pain. Which doesn't mean you don't have anything, just that we can't tell you what it is, how to fix it, or when it will go away.

And a lot like the atypical chest pain patient, if we send you home, it means whatever it is isn't going to kill you imminently, even if you still think you're going to die.
The same is true for your child, and for the same reasons. When you get bored, fed up, or exasperated with the process, remember you came to us for a good reason, and we aren't kidding when we make you sign the AMA form, and list possible outcomes starting with "DEATH". We yell because we care.

But you may still need to follow up with a specialist, rather than come back here serially after refusing to do the follow up, because "the mystery pain is back". Which quote is how we'll soon lovingly refer to your return visit if you keep pulling this schtick without doing what you were told.

Live and learn.

Watch This Space

There hasn't been anything bubbling to get out, and it's been a stunningly beautiful summer outside, so I've been recharging and just playing around, which doesn't contribute to blogging much.

The Stupidity Meter at work doesn't seem to have ratcheted down any though, so I'm sure to have a thing or twelve to put up presently.

Hope anyone who drops by has had some summer vacay time as well, because sunshine really is the best disinfectant.

More to come soon.
Cheers.

There Are No Stupid Questions, Only Stupid People

From time to time, just to do an internet pulse check, I tab through my own stats to see what's bringing people here.

Sometimes it's surprising, or a I find a new blog, or I see someone has thoughtfully given me a shout out and there's a spike in page views.

And then there's today's little moment of mirth for moi.

Because one of the categories I find the most interesting is to see what keywords and searches dumped people on my little island in the Matrix.

One of this week's snort-worthy queries to the gods of Google and Bing was:
"how can you fight your ncclex score".

So if you end up here in general, or at this post because I put NCLEX in it, allow me to give you a leg up on this difficult and pressing question, especially for would-be nurses.

Here is the seldom-revealed-in-such-clarity, Top Secret:Codeword Access Sooper-Dooper Guaranteed Method to crack this deal wide open, and solve your NCLEX problem.

DON'T BE A DUMBASS. Study. Learn. Succeed.

I'm pretty sure I covered both study and test-taking strategies for your boards in the middle of 3 essays towards the new grads, a few weeks back.

So, sportsfans, in case you figure your state nursing board is going to jump back once you sic your lawyer, J. Noble Daggett on them, and cough up a passing board score because the sun was in your eyes that day, allow me to offer you a great deal on a barely used bridge right next to some beachfront property in New Mexico. Just send me your credit card number, bank account information, social security number and your ATM PIN, and I'll get right back to you.

(If that sarcasm went over your head, go back to beautician school, or perhaps consider a career in either food service or janitorial endeavors.)

You aren't going to "fight" your NCLEX score, as a rule. And in case no one ever let you in on this tip, let me let the cat out of the bag:

Your patients don't come with four handy multiple choice options tattooed on their chests.
That means you have to use Mr. Brain to come up with actual thoughts, and then behave appropriately and arrive at a rational course of action, based on what you see.

Y'know, pretty much how 99.9998% of the rest of life works.

So if you've somehow arrived at your nursing boards, and bungled them, either regroup and do better, or go home. But abandon any thought of arguing your way to a passing score if you didn't earn one. If you flunked your boards, let me be the first one to encourage you to try again. And if that amount of integrity and honesty with yourself eludes you, let me be the first one to say I'm really glad you're not a nurse, and I hope you never get to be one without undergoing a successful brain and character double transplant, if a donor match becomes available.

Because if test-taking kicks your ass, in a situation where you have oodles of time to successfully pick one of four letters on a keyboard, in an ideal test environment, the last place I want you to be placed is at a patient's bedside when some serious crap is going down. Try to remember that your kindergarten teacher lied to you, you aren't the most special snowflake, and if you can't hack the easy stuff to get this gig, you sure as shooting aren't going to be able to handle the life-and-death stuff day in and day out for twenty to forty years.

So please, either perform a Valsalva Maneuver (look it up!) until you hear a loud popping sound, and your head breaks suction from where you had it stuck, or pursue another career endeavor.

But thank you, whoever you are, for providing me the chance to mock your anonymous and unintended flash of honesty, once I found your jam-smeared fingerprints all over the NCLEX cookie jar. But please, pull your pants up from around your ankles, and decide if you're serious about this profession, or just comedy relief.

Take Pity On The Newbs

As Whitecoat's blog has reminded me, it's July.

Which, for those of you in teaching hospitals, means the new kids have been rolled out from med school and internships, and so Summertime Santa has delivered your shiny new batch of ER residents. The ones with about 5 minutes' experience, at this point.
Counting the time to get their name badges from security.

There will come a time to begin lovingly screwing with them a bit, but for now, handle them gently, like baby chicks and newborn bunnies. Everyone is new at some point. The Golden Rule applies.

I remember when I had a whole year of the ER under my belt at Seventh Circle Of Hell Hospital, when I had the unknown-to-me realization that "OMG, I know MORE than the DOCTOR!?!"

Because I experienced, on a lovely summer night one July, the dawning of comprehension of that fact courtesy of just such a larval example of the ER doc.

I'd been a nurse for most of a decade at that point, and done pre-hospital work for even longer, but my time in the big-time ER was just about at my first anniversary, so this was a new experience for me too. (Remember what I said about everyone being new at some point? There you go.)

So imagine my growing astonishment at finding a brand new ER resident, fresh out of his wrapping, as it became apparent he was staring at the patient chart in front of him, blank except for a Chief Complaint and curt but clear triage notes, evidently hoping for all the world that the very page would suddenly gain the power of speech, and exclaim to Dr. Freshmeat what in the wide world he should do.

As I ambled up to him, thinking perhaps there were some order I should note, I became aware that the entire chart was blank.

"Has the doctor seen the patient yet?" I asked.

"I'm the doctor." he said, and we introduced ourselves.

"So, first day?"

"First hour. I'm wondering what to do."

Honesty like that generally demands mercy, and he was a decent-seeming guy.

"Well Doc, usually with chest pain patients, besides the 12-lead EKG he already has, we do a stat chest x-ray, basic metabolic panel, CBC, and cardiac enzymes, repeated up to times 4, to rule out an MI." Because I'm not a genius, but after doing the same thing 500 times, I'd start to notice certain patterns...

"Great! Thanks!"

And he begins to scribble furiously in the orders block.

So figuring he's still got to actually see the guy, I move one bed down my area, just as the Head Attending, Dr. Doneitall, walks up to supervise Dr. Freshmeat, and ensure he hasn't killed anyone by 6:15PM.

"Dr. Freshmeat, tell me about your patient."
"He's got new onset chest pain, he has a negative initial 12-lead, so I'm ordering a stat chest X-ray, BMP, CBC, and serial EKGs and cardiac enzymes to rule out MI."
"Outstanding. Strong work. Carry on."

Which praise, at Seventh Circle Of Hell, from Dr. Doneitall, is the equivalent of Babe Ruth telling you you're a great baseball player. Especially to someone in his first hour in the ER.

Whereupon Dr. Freshmeat, behind Dr. Doneitall's turned back, whips around to me, throws me two thumbs up and a monstrous stage wink, and mouths "THANKS, DUDE!"

Because I just slowpitched him that hanging curve and he parked it in the bleachers. He just needed the initial nudge to help the textbook answers pop out of his forehead and flow onto the chart. Words cannot express how easy it was to work with Dr. Freshmeat the rest of his residency, and he did indeed grow into an excellent ER doc.

My other experience, growing after that night, was that I could generally run rings around the first-year residents, the second-years could keep up with me, and the third-year residents could bury me in orders in about 20 minutes that would kick my @$$ all night, and would, until they started to hone in on horses instead of zebras, and abandoned the shotgun approach to diagnostic work. It helped when they had the mentoring attendings, instead of the anal-retentive ones.

So unless they're total dicks from the get-go, cut the new kids some slack.
Keep an eye on them, shove them in the right direction from time to time, and help them to succeed, and it'll generally pay off. If not for you, for their patients for the next 30 years.

You can always screw around with them after a few months go by, just about the time they start to get a little cocky.

Diagnosis Of The Week

Your child is sick.
We know this because you've dragged the little troll here, under the general precept that "If Momma ain't happy, ain't nobody happy."

Okay, well played.

But you know what undercuts any shred of compassion we would otherwise have for someone who's visited us so often that your registration now consists of the clerk typing "F12", and your entire life history is instantly uploaded to the sign in paperwork?

It's that you brought your other 5 kids, and signed yourself in as well.

Crack medical professionals that we are, we know that the correct diagnosis is not "Mass Casualty Incident", "Attempted Mass Murder", nor even "Multiple Food Poisoning" (though your aunt's two-week old casserole has almost reached the status of agar as a culture medium in microbiology circles).

No, gentle reader, the correct diagnosis of this ailment is "Family Plan".

Now, we understand that the economy is tough, so it's hard to resist bringing your entire brood, because babysitters cost money, whereas to you, the ER is free. And we know we have better cable than you, and more video consoles. We also know it's hard to resist the free $5 universal remotes in the rooms, despite the docs having replaced them three times, and having sash-chained them to the walls, along with the free crayons we buy by the bucket, rather than see your spawn reduced to actually waiting quietly while the TV plays.

But what boggles our collective minds is that you frequently show up with both parents, grandmama, and your 7 kids, when you, we, and every person in triage can tell that there's only one sick kid among the bunch (if that, but I'm giving you the benefit of the doubt).

Allow me to be so unfeeling as to suggest that next time, 1 parent brings one kid in your 1 car, and the other stays at home with the other 11 not-sick kids. Sociologists have a name for this: they call it "parenting".

I know I'm being unfeeling, because, really, how could I possibly know at a single glance, before a single vital sign is taken, that all 17 of your offspring don't each have Dengue Fever? It could very well be exactly that, and who am I to assume otherwise? And I apologize for thinking that you brought them all because you cleverly noted that since the doctor's already in the room, why not let him do 25 full physical assessments instead of wasting his precious time with one actually minimally sick child?

Clearly, yours is the superior outlook on the proper role of the ER in your life.

So the next time your big yellow bus rolls up, and you, your spouse, his brother and sister-in-law, their 9 kids, your grandmother, and 32 of your kids tumble out of the Clowncarnucopia of Fail, I'm not going to bother to explain to you why, on a 5-level triage system, where 1 is dying, and 5 is minimally acute, you're all the only "6"s on the tracker, and the entire Western Hemisphere will be evaluated first (including the guy who signed in with lycanthropy), before I even consider shuffling you along to the clinic side.

And thanks for bringing your entire village all the way here, because nothing says reasonable health care usage like seeing the entire chorus of Les Miserables descend on my desk simultaneously, grab an entire bucket of pens and sign in forms, occupy every seat in the waiting room, and turn a busy waiting room into a school field trip for the entire district, while they run around, scream and yell, and eat half of 117 bags of Flaming Hot Cheetos, while scattering the other half of each bag all over every horizontal surface as a sacrificial offering to the Mayan God Of Faux Corn Products.

The only thing rolling in my favor is that the day they authorize a minimal $5 co-pay for your nonsense, one of these trips will wipe out your EBT card balance for the month, and you'll have to sell the Mercedes.

But until then, you're on notice: the next time you pull this crap, I'm not telling the Fast Track Doc we have a Family Plan.
One more visit from the Bratty Bunch, and I'm upgrading you to a Flash Mob.
And on my 5-point triage scale, that's a 32.
Be warned.

Raging Bull&#!^

Okay, first, read this tale over at Dr. Whitecoat's blog.

Just for reference, I may have mentioned this subject before.

And I may, perhaps, keep bringing it up until any assault on any health care provider gets you an instant non-negotiable 24-hour stay in the Graybar Motel, just like wife-beaters and drunk drivers.

One, because that's not too much to expect, and
Two, because it's f***ing the way it should be.

We have, in the referenced tale, a perfectly reasonable description of an incident that happens with tedious regularity, especially in emergency departments, but in fact, throughout healthcare, and we yawn at a situation where someone committed criminal battery on the nurse, then multiple staff members, but had to rise to actually assaulting and battering a police officer - a man with multiple backup officers right next to him, and a tazer, bulletproof vest, service pistol, and 50+ rounds of ammunition on him, as opposed to someone in cotton hospital pajamas with just an ID tag for armorplate - before anything like a certainty of a trip to jail, rather than merely being tenderly escorted onto the street, was contemplated.

How do I feel about that? Thanks for asking.
IT'S BULLSHIT!!!
My apologies if I was too subtle there.

To be fair, the story wasn't the first one Whitecoat has referenced; tales of ED violence around the country and around the world are a regular feature on his blog, because they're so easy to find, again and again and again. This one just frosted me, because of the tacit acknowledgement that "that's just the way it is".

When we, as a work unit, as a hospital, as a profession, as an entire segment of society, agree to let ourselves get kicked in the crotch daily, as though it was okay, guess what's going to happen to you and I tomorrow?

If you guessed "get kicked in the crotch again", congratulations.

Enough is enough.
Start rattling cages, and get the monkeys working for you for a change, instead of sucking up to their Press-Ganey score whores.

Or start making plans to bury your friends.
Because if you think the nutbags who keep shooting up Gun Free Zones at schools aren't going to figure out very soon it'll work at hospitals too, you're certifiably insane.

Not The Fashion Police

From time to time, as noted earlier, some folks come to my house, and one way or another, wind up strapped to a gurney, dressed in a patient gown, under close observation every minute, until we can find a nice soft room for them in the psych unit so someone with the patience of Job and the compassion of Dr. Schweitzer can sort them out, and help them get the voices out of their head.

We do an excellent job, but sometimes, there's just too many crazies, and not enough watchers.

So when you get someone settled in, rotate them off the restraints, get all the prelims done to grease the skids for their departure to our/somebody else's psych eval unit, sometimes they've become such model citizens that the need for being tied to the bed rails has long since passed, and can't be justified.

And then Mr. Murphy punches in, and that split second the minder is busy dealing with one of the unstable campers, one of the calmer ones notes the merest sliver of a chance for freedom, and bolts for it, leaving the minder with nothing to show for a last desperate effort but a handful of patient gown with no patient inside it.

When you're the one who sees someone sans obligatory hospital gown, or anything else, go flying past you, out the front door, over parked cars and parking attendants, bushes, hedges, parking meters, and fire hydrants like a gazelle on crack, it's probably better that you noted the patient is now running in nothing but a smile up the nearest freeway onramp, rather than attempting to replicate her feats of Olympic steeplechase prowess into the dead of night.

Now, I know at that hour, human response and higher brain function aren't at their peak, even when you've been on the nightshift for, seemingly, your entire adult natural life.

But when you pick up the phone, and report the incident to the local Patrolers of Highways, you expect a certain level of...well, not competence, which they have, but more like...perspicacity, which they might sometimes lack. Just a bit.

You would then be forgiven, after telling them a naked crazy woman is running down their freeway, and asking for a wee bit of assistance in corralling said waif, and returning her to the land of Milk and Geodon, when they ask in reply, "Could you give us a physical description?" and your jaw hits the floor.

But when you ask, in a voice dripping with sarcasm and pathos, heard plaintively across the entire waiting room, "Officer Notthesharpestpencilinthebox, just exactly how many naked women do you figure you're going to find running down the freeway at 3AM???" and this reduces both the security chief and your charge nurse to hysterical giggling tears for 10 minutes afterwards, it makes the entire shift almost worthwhile.