Writing Letters of Recommendation

I am often asked “Will you write me a latter of recommendation?”, and I’m always pleased to hear this. It tells me that they trust me to judge their performance and character, and a little aspect of the future.

And, then, I procrastinate about actually doing it. I have no idea why, but time will pass while I cogitate about doing it, think about what I want to say, before I finally get around to doing it. This is decidedly odd, as I’m not generally a procrastinator, so there’s something here that’s different.

Every time I write a recommendation I’m reminded of some of the best military quotes from fitness reports, whether true or not, I’ve heard these:

  • completes all tasks to his utter satisfaction
  • able to perform most tasks with only moderate supervision
  • continent of urine and stool for entire shifts

and my favorite, from the Royal Navy:

  • this officer uses my ship to move his genitals from port to port, and my officers to transport them from bar to bar.

Anyway, if I promised you a letter of recommendation, I’ll get right on it. Really.

How can you make an ED more chaotic?

Remodel it, that’s how!

My ED is a busy place, with about 75, 000 visits a year, so there’s hardly a dull moment. As with most ED’s it hasn’t had one coordinated ED rebuild, so it exists as a series of added-on areas and hallway beds to manage the capacity.

Then the fun starts: the ED had enough money to remodel the busiest area of the ED, with new floors, a new central work area, etc. From the drawings it’ll give us a ton more work space using the same floor area. That’s the pleasure.

Here’s the pain: the contractor initially wanted to do about a quarter of the area at a time, and projected they’d be there through February (!). ‘Uuh, no,’ said the Powers That Be, ‘how about we give you the entire area for one month and you get it done and outta here before flu season.’ So, that’s what we’re doing.

The best quote of what it’s like is from one of my favorite nurses: “I just act like it’s a new job: I know how to do things but don’t know where anything is”, which pretty much sums it up.

The best part is that I haven’t heard any actual griping about it, which is remarkable from this collection of characters. We’re all in the same boat, and there is a payoff.

But it’s more chaotic than usual.

Buzzword of the day

Via Capsules – Meetingsnet.:

Buzzword of the day: “Buzzword of the day, courtesy of Buzzwhack.com [1]:

mercky: Pharmaceutically dubious. ‘Data from the Vioxx trials are in and the results
appear to be mercky.’

Nominated by Alan Skolnick

[1] http://www.buzzwhack.com”


Medblogs Grand Rounds 2:4

I am honored to host this week’s Grand Rounds, the weekly roundup of what’s happening in the health and medical blogosphere, going strong for over a year now.

This looks to be the first hosting by a blogger from the other side of the medical ledger (!), patient that I am. Quite right, I believe, in this new era of Citizen Journalism and Participatory Medicine, that the Informed Patient should stand up and be heard!

That said, there’s nothing like being diagnosed with a chronic disease to give you new respect for the medical profession. Thank you, doctors. Thank you, researchers. Thank you, nurses, lab technicians, pharmacists, educators, physicians assistants, interns and med students! Our lives are in your hands.

What are you waiting for? A link?

Flu bug vanquished in my house

My grandson, all of 5, was over today for dinner. During dinner much conversation about the flu shot, bird flu, etc.

After dinner, while cleaning up the dishes, he noticed a bug on the floor. He exterminated said insect, the proclaimed: “I just killed the flu bug”.

So, we’re safe here. If you can’t squash your flu bug, be safe and get a shot instead.

Daniel suit against ABEM finally dismissed

Well, Hallelujah. A suit which had the potential to completely unravel the Board Certification process was dismissed:

What is the status of the lawsuit?

The Second Circuit Court of Appeals on October 7, 2005, upheld the previous judgment of the Western District Court of New York and dismissed all claims against ABEM and other defendants in the Daniel v. ABEM case. The Court ruled further that the case may not be transferred to any other court in as much as the plaintiffs lack standing to bring antitrust claims against ABEM and other defendants, as previously ruled by the District Court, effectively ending this 15-year suit against ABEM.

This is good news for ABEM, but also for all the other Board Certifying Organizations. If you’re interested in the case, follow the above link to the ABEM page, with the facts of the case, a timeline, etc.

This has been going on for 15 years. Good riddance.

Home Improvement, Part the Second

So, yesterday the last posts were replaced which hold up the porch. It’s now quite sturdy and secure, and I hope it’s the last major maintenance it’ll need until replacement.

In response to a couple of the comments: Slope on the porch wasn’t the issue, as much as the outside 4×4’s not contacting the ground unless someone walked to the edge of the porch and ‘bounced up and down’. It was disconcerting, and I figure it’d have caused something expensive to snap eventually.

The pond fish feeder: I haven’t called yet, but I will this afternoon. And, yes, things are a bit bigger here. My pond is probably 30′ x 50′, and has mostly catfish in it. I don’t need a fish feeder, but I’m lazy and get tired of walking out there to feed them.

I know you’re all hanging on the outcome of the fish-feeder-failure, and I’ll keep you posted.

Home Improvement

Living in Fort Worth, I’ve been introduced to the idea that the ground under your house moves, seemingly all the time. This would be okay if it could just all agree which way to go, but one area goes up, another down, etc. This is how I learned about house leveling.

The good news: that area of the house is now very stable, and under a lifetime warranty, which is nice. However, when the house was raised the second story porch became amusingly springy, as in, it bounced when walked on. Tread lightly, indeed.

Today was spent removing the old supports, re-leveling the porch, and placing new beams. It’s about 80% done, but the hard supports are left to do, they’re for tomorrow.

Oh, and I installed an automatic fish feeder for my pond, but it won’t throw the food more than about 5 feet, so I get to call their customer service Monday.

Still, a good day for me, not in the hospital. Yea!

Polio Outbreak In Minnesota

via Doc around the Clock:

Four children have been infected with the virus, although none has become paralyzed. The Amish typically decline to vaccinate their children. The last large outbreak of polio occurred in numerous Amish communities in several states in 1979


Why worry about Bird Flu when we still have Polio to worry about? Eternal vigilance.

The Embed

Michael Yon:


I’ve returned to Iraq.”

The best war reporter of our generation is back with the troops.

Kermit, the Frog meets Kermit, Texas

MyWestTexas.com>West Texas town prepares for Kermit the Frog’s 50th on Friday

KERMIT — Things are hoppin’ in Kermit where on Friday residents expect to see their numbers swell by 600 percent in celebration of Kermit the Frog’s 50th birthday.

The town’s 5,466 people have been making preparations for the major celebration and Richard Abalos, a sergeant with the Kermit Police Department said as many as 30,000 visitors are expected. Among those — representatives with Walt Disney, who chose Kermit, Texas, over Kermit, Va., to begin a world tour in celebration of the frog’s 50th. Disney officials, Abalos said, have been in town helping prepare for the big party since Tuesday.

Kermit will begin the day by reading to students at a local elementary school. A giant, inflatable Kermit will next be blown up, and Kermit will next be given a key to the city’ a depiction of the famed frog on the city’s water tower will be unveiled and the official renaming of one of the city street’s will also take place.

Kermit will also crown this year’s homecoming queen, ride in the homecoming parade and participate in a pre-game pep rally.

A complete schedule can be found at Kermit Celebration Days.

And, in case you wondered,

Kermit the town is named after President Theodore Roosevelt’s son.

Okay, I have a visiting Kermit, TX story. You knew I did.

I was a teen during the Reagan years, and there were several tense times re the USSR (real commies, note). I was sitting on the throne in Kermit and heard the Civil Defense sirens go off, and thought “crud, the world ends and I’m on the toilet in Kermit, Texas”.

After a few moments and washing my hands, I went to the living room, no doubt white-faced, to face the bleak nuclear-bombed future, and everyone was completely calm. Eerily calm. Weirdly calm for people about to be incinerated by nukes.

“Did you hear the sirens” I asked, trying to get my elders to act. To do what, I had no idea, but I had to try.

“Yeah, they go off every day at noon” said my Kermit relative, both relieving and utterly humiliating me. Good news, no nuclear war, bad news, I looked like more of an idiot than a usual teen male can.

I hope everyone in Kermit has a good time, and that the visitors don’t get panicky when the sirens go off.

Oh, and Happy Birthday, Kermit the Frog!

Do you have a DNR?, she asked me

About 20 minutes into work today one of our experienced techs looked at me and, out of the blue, came out with this:

t: “Do you have a DNR”?
me: “Uuhhh, no. Why”?
t: “I had a dream last night that we were coding you, and the other ER docs were saying ‘we have to respect his wishes, he has a DNR’ and wouldn’t help, but I kept pounding on your chest”.
me: “Uhhh. Thanks, I guess. Yes, thanks. Why do you think you dreamed about me dying”?
t: “I’m not sure. I think it’s because you sang a song for the Nurses’ Day video tape, and I remember that”.
me: “Nope, no DNR. Code away”.

So, if it comes up, I’m against futility, but want the code. Maybe I shouldn’t sing on tape anymore…

More about the CAF Airsho 2005 – a wild ride

Sleepless in Midland had fun at the CAF Airshow: More about the CAF Airsho 2005 – a wild ride:

“…The plane is a WWII antique, and with the modifications it’s classified as ‘experimental.’  Because of that it’s tempting to say the plane has two strikes against it.  A person would have to be crazy to ride in it.  Insane.  Demented.  Stark raving mad.

So there we were at about a thousand feet above the ground, and the city of Midland was a blurry haze…”

Read the rest, it’s quite well written. And now I want to ride in a P-51.

Cell Phones vs Hospital Equipment: Less Interference, Still Annoying

via MedGadget: Cell Phones vs Hospital Equipment: Less Interference, Still Annoying:

“In their most recent analysis of cellular telephones and medical equipment, Mayo Clinic researchers report in the October issue of Mayo Clinic Proceedings that the cellular telephones tested did not interfere with medical devices that were more than three feet away, marking an improvement. In the current study, 44 percent of the devices recorded some interference from the cellular telephones but the vast majority of this interference should not have had any significance for the patient.”

My hospital allows cell phones pretty much everywhere, and the ED spent a lot of money to make it cell-phone friendly for our Nextel phones. I’m mostly happy with the availability and instant communication (and to not have to carry around a Motorola brick radio), but a few times I’ve stood, more or less patiently, while the patient gets off the phone. Some people don’t know how to say “I’ll call you later, goodbye’.

The other interesting thing is the number of people to whom I give the results of their tests and discharge instructions while talking to the top of their heads, so they don’t lose focus on the cell phone game they’re playing. Yea, cellphones.

Wall Street Journal on Medical Blogs, #2

Alerted by Bard-Parker, the WSJ article on medical bloggers is actually available for free, here: CollegeJournal | Find a Career Path.