Tracking Gustav

Here is the best tracking map I've come across. I like it because it shows the previous path as well as several forecast pathways (click the buttons on the right).

Good luck to those in New Orleans, get out safely while you can.

The Magnifying Glass

Note to patients:

When you bring your very own magnifying glass so the doctor can maybe see the very subtle rash with which you have been stricken, that's an indication that perhaps your condition isn't quite as much of an emergency as you thought it was.

Quote of the Day

Regarding the Sarah Palin pick for VP, some on the left are exercising extremely poor judgment by questioning her experience.

"Do we really need to put another wildly inexperienced, purely political choice into the White House," they ask?

No, we don't. We could elect McCain.
- Ace

Days of Yore

To the Honorable Judge of the 7th Judicial District of Pecos County:

Now come Jed Dawson, individually, hereinafter called Plaintiff, complaining of and about Dr. Scalpel Orsword (my great-great-great-grandfather) hereinafter called Defendant, and for cause of action would show unto the Court the following:

Mr. Jed Dawson was a patient of Defendant, having sought Defendant's professional expertise, judgment, skill, competence, advice, and treatment on or about the Fifth of September in the Year of our Lord 1868.

As a result of the negligent acts on the part of the Defendant, Mr. Jed Dawson suffered needlessly with anxiety, pain, and illness resulting in damages more fully set forth below.

On or about the Fifth of September in the Year of our Lord 1868, Plaintiff presented to the medical office of Defendant for treatment of a gunshot wound to the leg which occurred during Plaintiff's attempted escape from various Deputies of Pecos County, who were negligently pursuing Plaintiff after he was clearly minding his own business in the nearby vicinity of a stagecoach robbery.

In the course of his treatment by the Defendant, Mr. Jed Dawson claims that the Defendant was negligent in not using the newfangled chloroform anesthesia (picture credit), and instead was told to bite on a horseshoe instead of the traditional bullet as his wound was probed, resulting in the fracture of three teeth and several months of subsequent mental anguish, pain and suffering. Plaintiff claims the inability to enjoy meals, and claims that his resulting weight loss has led to ridicule and abuse by his peers in the prison.

Furthermore, the Plaintiff claims that Defendant's delay in arranging emergency buggy transport to the big city doctors in the next County caused even more pain and suffering and ultimately resulted in the unnecessary amputation of Plaintiff's leg.

Plaintiff seeks damages for the conscious pain and suffering and mental anguish that he suffered and in all likelihood will continue to suffer as a result of the negligent actions of Defendant, and compensation for the medical expenses which were incurred and which Plaintiff will continue to incur for the duration of his life.

Plaintiff respectfully prays that the Defendant be cited to appear before this Court and answer herein, and that upon a final hearing of the cause, judgment be entered for the Plaintiff against the Defendant for damages in an amount within the jurisdictional limits of the Court.

Respectfully submitted,

Thomas Huckfead, attorney for Plaintiff

Senator Ted Kennedy's Kidney Stone

"Senator Edward M. Kennedy had just left a hospital bed here when he delivered his speech to the Democratic National Convention on Monday night, after suffering a debilitating bout of kidney stones Sunday upon arriving in town, aides said.

His aides said that after Mr. Kennedy finally decided he was well enough to come to Denver over the weekend, they became alarmed when he arrived on Sunday after a long charter airplane flight, accompanied by family members, aides and doctors, and reported being in excruciating pain.

Their first concern was that the pain was somehow related to his cancer, or the chemotherapy and radiology he had undergone, and that it had been complicated by the long flight or the high altitude of the city. A visit to a local hospital Sunday night revealed it was kidney stones and was unrelated to his cancer.

Mr. Kennedy had no previous history of kidney stones, aides said."

Here's the part that interested me:

"And with less than two hours to go before he was supposed to take the stage, Mr. Kennedy — sitting unnoticed in a room at the University of Colorado Hospital — told his wife, Victoria, and doctors that he wanted to go to the Pepsi Center and deliver the speech.

He was driven there, accompanied by a doctor and paramedics, perched on a golf cart that took him inside. Mr. Kennedy, with his wife and his niece Caroline at his side, walked gingerly onto the stage, where he delivered a highly acclaimed address. Once done speaking, he returned to the Denver hospital, where he spent the night."

Props to the ER docs in Colorado for that probably stressful VIP workup. Good thing Senator Kennedy doesn't have to rely on Medicare, because the CMS certainly wouldn't have paid for the physician/paramedic escorts to the convention. I also wonder if they made him sign out AMA and then check back into the hospital. Probably not.

Regarding his speech, if he really believes that healthcare in America should be "a fundamental right for all" then I wonder how he reconciles that belief with the fundamental rights of physicians and other healthcare professionals? True rights do not require the labor of others.

Do those of us who chose healthcare as a profession have a "fundamental right" to join him on his sailboat and maybe have a little chowder afterwards? I don't drink scotch, but I'd enjoy claiming my "fundamental right" to a couple of brewskis from his cooler.

Classic Heather Locklear SNL skit

Funnier than Joe Biden (and much better looking).

The Physics of Batman

Yeah, I know, it's just a movie. But still...

Photo of the Day

Awesome.

A Sad and Frustrating Case

The chief complaint was possible sexual abuse of a child. I was just coming on shift, and neither the physician I was relieving nor the swing shifter had picked up the chart yet despite the patient's relatively long wait in the department (or room). Nobody wants these cases because they are usually sad, frustrating, and time-consuming. This one was no exception.

As I entered the room, I found a happy playful 3 year old girl accompanied by her grandmother and a few slightly older siblings and cousins. The grandmother alleged that the girl had reported that her mother's boyfriend had touched her inappropriately. The incident supposedly had occurred sometime during the previous month.

There was no evidence of external injury, so my main concerns were to make sure the girl was not in danger of further abuse and to file a report with Child Protective Services (as required by law). A careful evaluation of the victim's living situation was required, which in this case was quite complicated. It was a Friday night and fortunately we weren't too busy yet, at least when I began my assessment.

The girl's mother has custody of the patient because the father has been in jail for several months. The mother's boyfriend was the alleged assailant. Fortunately the grandmother had the name and address of the mother but no phone number. She knew only the "street name" of the boyfriend, who is called Pookie. Apparently the girl also stays at Pookie's mother's and auntie's houses sometimes, but their names and addresses were unknown. The girl is often left alone with Pookie while the mother is at work. Grandma has custody of the child every other weekend, and she also cares for several other young relatives in her home due to a dizzying variety of unfortunate family social circumstances.

That concise description perhaps fails to convey the difficulty that was required to obtain it. Though grandma may have a heart of gold, she certainly was a poor historian. After waiting on hold for 10 minutes with the CPS Abuse Hotline while I typed my notes, I gave up and entered the information via the internet. The CPS Abuse Hotline sucks.

One hour after I started my shift, I saw my second patient. Now we were busy, and it stayed that way for the rest of the night.

The Reality of ANWR

Brilliant article that puts the situation in perspective.

The Counterproductive Jerk

You can learn a lot about a person by sticking a needle into them. I've seen 8 year old kids lie perfectly still without a whimper as I inject a painful anesthetic into their lacerations, and I've seen plenty of otherwise seemingly normal grown men and women scream, flop around, and bawl for their mommies with the first tiny prick of the smallest needle available. "Are you done yet?" they will sob, shuddering. Umm, no...I have to actually inject some of the medication for it to work. Try to keep still. The vast majority of people fall somewhere in between the two extremes.

I understand that the ER can be a scary and uncomfortable place, and I always try to make the process as painless and relaxing as possible for my patients. If you seem like the excitable low-pain-tolerance type and you have a driver, I'm happy to give you some medication to make the procedure go a little smoother. I have no problem seeing a few other patients for a half hour or so until you are mentally and pharmacologically prepared for the little 27 gauge needle and the torturous lidocaine injection that in your mind must burn like Satan's pitchfork.

And after I've finished the 8 year old's laceration and you are ready to accept my trident of hell, again, please try to keep still. But if you are going to jerk anyway, at least try to jerk AWAY from the needle. Ouch, that's gonna leave a mark. At least it'll be 1.25 inches deep, so it won't show.

Batman and Joker Spoof

This guy does an awesome impersonation of both characters.

h/t HotAir

Quote of the Night

An elderly woman was brought to the ER by her husband because she seemed a little confused. She was answering my questions correctly for the most part until I asked her how long the two of them had been married.

"Fifty years," she said.

I looked at her husband, and he was shaking his head with a smirk.

"It's only been 49 years," he said. "One time she left me for a year."

The Pain in the Anus

"Hmmph," said the patient, "I thought you had forgotten about me."

Great way to start the visit, lady. "Thanks for your patience. So what can I do for you?"

She complained of rectal pain and bleeding for one week, which evidently became emergent around 3 am that morning. She had an anal fissure, mild in severity, with no active bleeding and a normal hematocrit.

After a detailed discussion of the pathophysiology and treatment of her disorder, she seemed upset. "You mean I waited all this time and you aren't even going to do anything for me? I read on the internet about all these treatments..."

Like what? You really just need to eat more vegetables, take some stool softeners and try some warm tub soaks. If that doesn't work you can follow up with the specialist for other options.

"But aren't you even going to prescribe me anything...some lotion, or maybe give me a shot? And what about this pain?"

Pain pills will just constipate you more and make the problem worse. Unless you start having softer stools more often than once a week there isn't any cream in the world that's going to help you. And we don't give botox shots in the ER, sorry.

"This is ridiculous," she fumed. "I could have just gone to the drugstore and gotten all of that stuff."

Yes it is, and you certainly could have. Good luck!

ooooooooooooooooooooooooooooooooooooooooooooooooooo

That reminds me, if you've never read the story of Bob the Anal Fissure, then you are in for a treat. Here's a teaser:

"At first Bob wasn't so bad. Occasional itch and discomfort. Nothing that I couldn't handle. A mint flavored suppository now and again seemed to do the trick.

But then about a year ago my cruel master Bob began requiring more and more from me. Itching on a scale that can only be described as "hellish" was the order of the day. I had a permanent brown stain on my index finger from trying to scratch the inside of my colon through my troubled anus.

I had lost all sense of decorum. I no longer cared what people thought. I often walk around in public with my hand down my pants, finger firmly implanted, trying to appease the evil God Bob.

In my spare time I would daydream about modifying various farm implements to deal with the overwhelming itch. I even went so far as to order a tined hand trowel.

Finally, I went to see a doctor..."

read the rest!