Sunday, March 30, 2014

PSA: Trolling

Astute observers, or now anyone, will note the appearance of a new box to the right., entitled "Comments"-->

It will intimidate something less than 1% of anyone who reads this or any other blog, or comments thereon, based solely on my own research.
The terminally stupid less than 1% who most need it will completely ignore it.

I blog for my entertainment, and a sanity release valve. That it elicits anything from a laugh to an "amen" from others is icing on the cupcake. That it may occasionally cause someone to disagree surprises me not a whit.

But if you haven't got the balls to identify yourself, even with an Internet alias (seriously, did you really think my parents named me "Aesop"??), and a trackback to yourself, but still think you can run in here, crap the floor, scoop it up, and fling it on the walls or at me with all the glee of a spider monkey on crack, think again.

If something I write twists your tail, have at it. I rarely lose a debate on the merits, but feel free to have a go, if you can stay on topic, rather than go all ad hominem. I recognize on most of what I write here, I'm handicapped by only having nearly twenty years' experience doing what I do and seeing about a paltry million patients, out of eight billion people on the planet, so it's inevitable that somewhere someone may have learned something beyond my ken. I'm not omniscient.

But when someone chooses to start with rudeness and insulting comments, any possible intellectual validity has just been sacrificed. So has my toleration or patience. Any screed that follows will thus be shipped out with all the warm and tender feeling of Ripley sending the titular foe out the airlock of the Nostromo's lifeboat in Alien, and with all possible dispatch. Take bets on this.

When you start out by being rude and/or insulting, and as a bonus are demonstrably retarded and ignorant, you may possibly hear the word "Fore!" just before the #3 iron arcingly descends into your ass and sends it straight down the fairway of Life.

In all the known universe, this is the one corner of it where I am entitled to wave my magic wand and send refugee flunkouts from Etiquette School where they belong, with a pull of the handle of the Internet's flush tank.

Happily, in a year, I doubt I've had to do that even five times. I'd be even happier not to improve those stats, but not to the point of foregoing the pleasure when the need arises.

I fire abusive patients and eject jackassed visitors all the time in the real world; if you came here from under a bridge, I will return you there faster than you got here, and you won't even elicit a tiny internet virtual tear. It may come as some shock to learn I, like 500,000 of my ER colleagues, tolerate none of anyone's bullshit whatsoever.

If five minutes reading what I write here hasn't made my glee at using the "delete" option apparent, "Go ahead, make my day." 

And of course, if I'm bored, I reserve the right to make you an example, because even steak knives need sharpening from time to time, and sometimes I appreciate you volunteering to be the cadaver for today's anatomy lesson.

The 99+% of you to whom this note doesn't apply, go back to having a pleasant day.

Saturday, March 29, 2014

PSA: Preparedness

Last night I was typing away, and felt a sharp jolt for about a second around 8 PM. Went to the USGS "Did You Feel It?" website, self-reported my experience, noted it was a small earthquake a couple of miles from where I was sitting, and went back to web surfing.
A little more than an hour later, I spent the better part of 30 seconds under the same desk while the place got its ass kicked by the 5.1 that followed, again just a bare few miles away from where I'm sitting when I'm home. And I wondered if I had a handy set of clean undershorts.

Today it's mainly been just a drill, and the results were, thank a merciful God, extremely minor in the grand scheme.

The upsides are that the roof and walls are fine, the stuff I keep on hand was sufficient, and even a far worse shake would have likely been something I could've handled. (Still need more clean undershorts though.)

The downsides are that I really, really hate this stuff, because you never know a moderate small quake is either of those things until it finally stops (and thirty seconds of rocking and rumbling under furniture is a long time to wonder about that, believe me), because the little ones and the big ones start out exactly the same. The big ones just keep building and going on until you're pretty certain you're in deep doodoo. Ask me how I know.

So for last night, my issue was unfortunate proximity to ground zero.
That, and dozens of random noticeable aftershocks, including the 9:02 AM one that provided today's wake up alarm. That's all normal, and they'll continue with diminishing frequency into the next week. (And having gone through 2 bigger ones, which IMHO gives one a mild but permanent case of TSD, not PTSD, because it's never "Post-" until you die, in this case.)

The cat isn't liking things any better, having tried to climb into me during last night's festivities, adopting the spot beneath the chair I'm in now as her default Safety Zone with each follow-up shake, and generally regarding the entire world with suspicion with each additional aftershock.

So wherever you are, and whatever the regional problem is likely to be when the word "disaster" is mentioned - tornado, hurricane, earthquake, floods, severe winter storms, or what have you - do please take the time to do some proper prior planning, set back food, water, car supplies, and so on, and generally make all the preparations you reasonably can so that when things get suddenly crappy, you're part of the solution, and not part of the problem.

Added: And BTW, that happygas they've been propagating about "72 hours" on your own is utter rose fertilizer. 72 hours isn't a disaster, it's a minor inconvenience, like Woodstock. Make your plans for successfully navigating a period of 30 days without outside resupply of the major necessities of life, and then beef it upwards over time until you're ready for a problem of multiple months. All 72 hours buys you is the certainty of living in a FEMA shelter on Day Four, which is an abysmally poor prospect. 

And don't forget a change of shorts.

Song Of The Day: AC/DC You Shook Me All Night Long

Saturday, March 22, 2014

An Embarassment Of Riches

It's television pilot season in Califrutopia.
Which means that several networks and studios will spend millions of dollars and tens of thousands of man hours to create a host of programs which, thank a merciful deity, you'll never ever see, in order to cull the stack down to a manageable number, of which all but one or two, based on historical precedent, will suck, and probably hugely.

This matters to me about as much as the weather on Jupiter, because in the meantime, I get a lot of days as a decently-remunerated and medically licensed babysitter, and the checks all clear. How many in a lot? This week has been 14 days long, so far. And just about the time I could get used to it, it will be gone, and I'll be back in the salt mines. But until then, I just got to give my bank account a transfusion that should cure the recent anemia, but a side effect of multiple 12 hour days separated by 3-5 hour nights off is that I'm sleepy, cranky, and several of the other dwarfs, none of whose names I can recall at the moment. (Bitchy? Meany? Clumsy? Stupey?...whatever)

(Bonus Game for those in school, or back there again: psychoanalyze the Seven Dwarfs based on direct clinical observation of the DVD/BD, turn it into a paper, ace your psych presentation.)

That's not a whine (It's not! It's not! It's not!); I knew the gig was tough when I signed up.
But it means my usual fund of bile has been eating craft service, is a little gassy, and putting on a couple of pounds, and would really rather face-test the thread count in my pillowcase than saddle up for any rhetorical jihads or jousting the slumbering herds of pigs in our profession. At least for now.

My profound apologies, but that means anybody stopping by will have to entertain themselves for a bit longer while I nap. True to form, there are some very old obscure magazines laying about for you to read. This will probably cease all too soon in a week or three, then I can recert about half a dozen cards and classes to prove that I'm still nursey enough to market myself to greener pastures, as if they actually exist.

After a few weeks of Hollywood's amateur drama queens, I'm not looking forward to returning to the professional circuit. The catering there sucks, everybody is Scarlett O'Hara, and I can't fire them.

Submitted for your approval: What say we all pass the word, and on April 1st, apropos of the day, we all submit reviews on our most horrible patients, direct to hospital management and the Press-Ganey knuckleheads, and roundly bitch them out for the worst offenders?
In a perfect world, this catches on like Talk Like A Pirate Day, and the patient ratings for the entire country, complete with the best individual write-ups, get posted online. Anonymously, of course.

See you when I've thoroughly inspected the inside of my eyelids, and can open them spontaneously without using my hands. And hey, look, I just wrote an entire post about not being able to write an entire post. Sleepy, soooo sleepy... 

Monday, March 10, 2014

Rite Of Passage

For those of you with self- or preferred scheduling, those of us with more time on the job judge the rest of you worthy of basic respect when you exhibit the common sense sufficient to schedule yourself for the switch to DST in the spring, resulting in an 11-hour shift, but somehow seem to miss the 13-hour Bataan Death March shift in the fall.

Unless you share that you're a masochist, and other TMI gems about your personal predilections.

Saturday, March 1, 2014

Prehospital Pop Quiz

Q.: When is the 60 y.o. male with sudden onset 9/10 acute crushing epigastric pain and nausea, with a Hx of HTN and high cholesterol not having a classic M.I.?

A.: I don't give a damn, he's still getting the paramedic taxi to the ER stat, and a full cardiac workup until a board-certified ER doc in consultation with another board-certified cardiologist gives him the all-clear. Neither of which would be me and my Portable Ultra-Mini Field Hospital of Wonder.

Which they did, grudgingly, but only some dozens of hours later, after a highly suspicious day of full cardiac evals, and only after admission for acute pancreatitis secondary to a stone-blocked pancreatic duct.

Ain't nobody dying in my lap; your patient, guys. And thanks for the speedy response and great care.

For the record, I much prefer working surrounded by a full ER, rather than merely curious bystanders. But it's nice to know I can still take the act on the road. Especially when the patient relays personal "thanks" several days later, because he still can.