Texas IS a Country

Today’s great quote proves the title:

You can’t be a real country unless you have a beer and an airline. It helps if you have some kind of a football team, or some nuclear weapons, but at the very least you need a beer. — Frank Zappa

via Greeblie’s Blog

Busiest Day Yet

Today was the busiest day yet at my new job. I’ve been here for nearly 6 months, and today was a doozy. Our ED has the best system, frankly, for doc scheduling I can imagine (that is financially viable). Generally, there’s a new doc starting every 2-2.5 hrs, and the new, fresh doc picks up all the really ill and injured new patients; those being replaced by the new doc spend the next few hours finishing up the workups for the patients they picked up during those first two hours. The remainder of the day is spent in our fast care area, seeing the mildly ill.

I started at noon, and by 2PM I had 17 new patients, all of whom were sick. My previous record had been 16 in 2.5 hrs, so it was busy. With 5 minutes left in my first two hours, our ED was overloaded and we went on ‘Medicine Diversion’, meaning we were closed to ambulance traffic that was non-traumatic. (There’s a big political problem with going on Trauma diversion, as we’re one of two trauma centers in town). Ten minutes later we went on trauma diversion. The place filled up so quickly it was amazing.

I spent the next 4.5 hrs re-evaluating, looking at films, awaiting test results, etc, and got those patients cared for (several were very ill, and only 5 went home). Then I finally got out to the fast care area. And now I’m tired.

Still, it’s an interesting contrast to my last job, where after work I was worn out, and remarkably angry, after nearly every shift.

A New Look for the GruntDoc

After griping about Blogger for about 3 months, I finally took the plunge, and have moved up in the world. Now GruntDoc.com will be posted using MovableType , which promises to be a more robust, and more reliable, publisher of my thoughts and drivel.

There’s a learning curve with everything new, and if the pictures don’t do what they’re supposed to, give me some time (and tell me about it). MT makes that a little easier, as comments should be back, now integrated into the program instead of being an add-on. I haven’t tried it.

The one thing I will miss is a spellchecker, which for me works like a typo checker. I can spell very well, but cannot type without watching my hands, and that leads to typos that the Blogger spellchecker would catch for me.

Should be fun.

Study

CNN: “Study: Texas Leads in Executions”. Now, I read CNN’s news page (no popups, no scrolling text, the ads are generally tasteful, etc), and I have for years. They are often first with a story, and while they don’t do very well with in-depth coverage, they’re good for knowing what’s going on. But, you have to wonder how a) this is news to anyone who is conscious, and that b) somebody released this information as a ‘study’.

Leaving aside whether or not you agree with the death penalty, it’s been common knowledge that every year since the death penalty was reinstituted in the US, Texas has executed far more of its death row inmates. (Making a death row meaningful). Usually, this information is thrown in near the bottom of every execution, pending execution, etc. Therefore, their study really didn’t take all that much time to put together and come to a conclusion.

I propose other studies: Oxygen can be breathed. Water will both freeze and boil, yet can be consumed. Every human will die sometime after being born.

My fervent hope is that none of my tax dollars went into this ‘study’.

Official GruntDoc Mascot (for now)

the Official Mascot of the GruntDoc website
A terrific gift from one of my aunts for Christmas is this Disney character doll, “Doc”, from Sleeping Beauty. She added the name tag and presented it to me for Christmas. She adds that talking the Staples order clerk into actually ordering a nametag that says ‘grunt’ is problematic.

I like it, and it’s going to be added permanently to the front page of the site, as soon as I get around to it.

Update: Of course, Doc would be surprised he was in Sleeping beauty, except as an extra. His feature movie was, of course, Snow White and the Seven Dwarfs. GruntDoc regrets the error.

Nancy Caroline, MD

The first summer after High School I took an EMT class, mostly because it was a good way to fill the summer without having to get a real job. I discovered I liked the challenge and idea of prehospital care, and after a year of college, I began to work full time in an Emergency Department while taking Paramedic classes. The text was Nancy Caroline’s “Emergency Care in the Streets”, which was the standard text of the time for the emerging field of professional prehospital care. In many ways this was my first introduction to ‘real’ medicine; acid-base equations, cardiac rhythms and their diagnosis, emergency medications, etc. The book was well written and entertaining, and it spoiled me; I still expect EM texts to have the same style and sentence construction in every chapter, which is not the case (the current standard, Tintinalli, has one zillion chapter authors, and although some effort was given to uniformity of presentation, the differences in writing styles can be jarring). Moreover, it teased me, fired the imagination: if I can do this, what else could I do? She never heard of me, or of the many her text taught and touched.

I read of her death today, of cancer, at the age of 58. I will always appreciate her for turning the head of this West Texas kid toward Emergency Medicine.

Thank you, Nancy Caroline, MD.

Merry Christmas

Merry Christmas, gentle readers. Now, get away from the computer and enjoy your loved ones. I’m going to.

Flags at half-staff

Flags at State, but not Federal, buildings are at half-staff today. The Post Office said it must just be a state event, and the police dept. we called had no idea why.

Does anybody know why?

Smallpox Vaccination Update

Our hospital (over 600 beds, more than 70,000 ED visits this year) was notified that we’re to be issued about 150 doses of the smallpox vaccine for the entire hospital. We’re to decide who should get it, who wants it, then there is to be an as-yet-to-be-defined screening process to make sure we’re ok to get it.

This is not as simple a decision as it sounds. I learned, listening to an Audio-Digest tape (my favorite form of CME, listen to good speakers on interesting talks while driving to and from work) that the smallpox vaccination program is more complicated than I would have imagined. For starters, it’s not just docs and nurses who need to get vaccinated, it’s necessary to make an entire tiny, immunized, hospital. Does no good for just the docs and nurses to be immune, we’re going to need X-ray techs, respiratory therapists, dieticians, laundry, etc. So, as I see it, those getting the immunization are, in essence, volunteering to be the smallpox eval and treatment team. Otherwise, people won’t come to work if there is an outbreak.

I wonder who will come to the ED, if there is an outbreak. It’s going to be really quiet or a complete zoo, and we’re going to have to do it with a skeleton staff. I really wonder how many of the people who get the immunization will show up for work; I think it’s a given that none of the unimmunized would come to work. It’s one thing to get the immunization to protect yourself from the rash that wanders in on day one, but quite another to go back on day 3, leaving your family to fend for themselves during a plague. Assuming there would be fuel at the gas station, etc.

Another vaccination drawback, we’re going to be (potentially) contagious until the eschar (scab) from the immunization falls off (at least theoretically), and the speaker on the tape feels we shouldn’t be in patient care until that happens, which could be about two weeks. The speaker says this wasn’t a problem when we got it a long time ago, because everyone else was immune, immunodeficiency diseases were unknown. And, then there are the people with ill household members or illness themselves, who shouldn’t have the vaccine. Then there’s the mechanics of the vaccination scheduling: two weeks off is a killer for ED scheduling for one or two docs; we have nearly 20, and almost half have to work every day. Now, try taking everyone and giving them 2 weeks off. Doesn’t work. And this isn’t just for docs, it goes for everyone involved. It’s a real can of worms.

I still want the vaccination, but look forward to more answers. And maybe two weeks off.

Update: having just reviewed the excellent government (yes, our government) website www.smallpox.org, I think the two weeks away from patient contact is overblown; it does recommend a “semi-permeable dressing” over a simple dressing for health care workers. This makes me believe the program is much more likely to be successful.

Life Intervenes

Sorry for the lack of blogging, but it’s just been lazy around here (really, I have been lazy). I have been working, the superwife is working overtime getting ready for Christmas, and my son came in from college, UCLA. Tried to get him to transfer to a Texas school instead of UCLA, but he fancies himself a Cal dude, or did; after living a few months in LA, he tells me he’ll be ready to go somewhere else on graduation.

It’s nice having him home, though, and not just for all the manual labor (leaf bagging, moving huge chunks of steel, and today, installing a garage door opener). I could do all myself (except move the I-beams, they’re heavy), but it’s much more enjoyable to do it with a son.

Birthday Boy

My nephew recently had his first birthday, and as part of the celebrations a contest was held: guess the number of photos his doting mom and dad had taken of him in the first year.

Correct answer: 811. Really. A digital camera helps, as you don’t have to slow down for a developer.

And, we’re going to get your present out there, real soon. Probably not film, though.

Let’s go see Santa

Santa and grandson
The world’s cutest and smartest grandson, mine, went to see Santa yesterday, in one of those weird rituals of child raising. I still remember being petrified at going someplace strange to see a very much larger than life character who was loud and, somehow, knew everything about me.The grandson kept it all together; indeed, he brought the house down.

According to the Grandmother, eyewitness, grandson was all hammy, cheesy smiles sitting on Santa’s lap. Then the obligatory ‘what do you want for Christmas, young man?’ was asked:

grandson: “I want some books, and I want mom to clean the kitchen”.
Santa: “You want books, and, what?”
grandson: “I want books, and for mom to clean the kitchen”.

From the mouths of babes……

And, I’m getting him some books.

Company Party

When in the service, I would frequently attend “Officer’s Calls”, which we called ‘Forced Fun’. The boss wants all his officers to show up and act like a big happy family, so we did. It didn’t take long, we usually always grouped into the same groups who worked together, and so it was not something we would have done on our own, but was not really punishment, either.

I thought of this the other day while at the Company Christmas Party, with my wife. We had a good time, ate some completely unrecognizable food (red gels over all the lights make all the food unrecognizable; odd how much taste is visual), and grouped off with people we knew and were happy with. The Trey and Kay dance floor show was worth the trip itself (thanks, guys!). There was one of those IF IT’S LOUD IT MUST BE GOOD bands playing music absolutely nobody in our room full of mid 30’s plus people could relate to, and then we went home. We had a better time than it sounds like, and as an expression of appreciation to their Independent Contractors it was really nice.

Looking forward to next years’ company fun!

Electrical Revenge

Ever see sparks fly out of a breaker? It’s really neat, and would be enjoyable entertainment if it wasn’t attached to your own house. The electrician arrived today to expel the electrical demons (see prior post), and while he had the cover off, the main, 200 amp panel breaker acted up, and reproduced the symptoms that caused the call. Viola! A diagnosis!

Interestingly, the cure is a new panel, and not just a breaker swap, due to the damage to the busbar. Tomorrow, we’re to be without power for 6 – 8 hours while a new panel is installed. And thank heavens for the home warranty! $45.00 is cheap for this repair.

Update: yesterday, the panel swap was performed, and since then the electricity, which I always take for granted, has worked great. It was punishingly cold, but it took only about 5 hours. The inside of the panel looks great; the electrician was a pro, and was thorough and complete without wasting time. The outside of the panel doesn’t line up very well, and I’m going to tinker with it.

KC135 Fuselage Pressure Test Explosion

What happens when a fuselage reaches its pressure limit? I know you’re unable to sleep without the answer, so here it is.

via Sgt. Stryker