Ramblings of an Emergency Physician in Texas
My support for this, as well: from Alwin,
Request: Support The Katrina 3: “
The two nurses accused of euthenasia could use your support. Along with Dr. Amy Pou, Cheri Landry and Lori Budo now need to defend themselves against those charges, brought by a government swimming in federal grant money.
…
Please think about them today, and, if you are so moved, send a little something their way to help these heroes. Kevin, MD has been following the story and posts about it here.
Guess who got called for Jury Duty? Yes, I am thrilled to have been so honored.
I’m going, and I’m not going to ask for a release just because it could cost me money (it will). I served on a jury when an undergrad, and it was quite an experience. I’ve cleared most of the week on the off chance I get chosen, so I’m not cynical about my civic duty, but I’m not hoping to be chosen, either.
Frankly I figure no two sides of attorneys want me on a jury at the same time. We’ll see.
I was thinking about jury movies, and the one that best fits me is this one. Except, I’m not Henry Fonda, in body or spirit.
Update: It took all day. Not selected. I’m glad, as it was a case of alleged child molestation.
In the email, via the Internet tubes:
I’m an MSIII at AZCOM in Glendale, AZ and looking for a Texas ER/IM doc I met on recent plane flight regarding student rotations. His first name is Paul and he’s a retired jet fighter pilot who is the only doc in a 120 mile radius and he runs a 16 bed hospital. Any idea of how I could track him now that I forgot his last name?
If you have the answer, drop me an email, and I’ll forward it.
WAUKEGAN, Illinois (AP) — A coroner’s jury has declared the death of a heart attack victim who spent almost two hours in a hospital waiting room to be a homicide.
Beatrice Vance, 49, died of a heart attack, but the jury at a coroner’s inquest ruled Thursday that her death also was “a result of gross deviations from the standard of care that a reasonable person would have exercised in this situation.”
…
Vance had waited almost two hours for a doctor to see her after complaining of classic heart attack symptoms — nausea, shortness of breath and chest pains, Deputy Coroner Robert Barrett testified.
She was seen by a triage nurse about 15 minutes after she arrived, and the nurse classified her condition as “semi-emergent,” Barrett said. He said Vance’s daughter twice asked nurses after that when her mother would see a doctor.
When her name was finally called, a nurse found Vance slumped unconscious in a waiting room chair without a pulse. Barrett said. She was pronounced dead shortly afterward.
(emphasis added)
Chest pain triaged to the waiting room is really not a good idea.
The Chicago Tribune adds a little to the ‘what happened next’ question:
…
Vance was seen by a triage nurse at 10:28 p.m. According to hospital records, she complained of nausea, sweating and chest pain of a level she rated as a ’10, with one being the lowest and 10 being the highest,’ Barrett testified. ‘The triage nurse classified her condition as ‘semi-emergent,” he said.
At 12:25 a.m., an emergency room nurse went to the waiting room and called for Vance, but got no response, he said. Vance was leaning on her side on a waiting room seat, unconscious and without a pulse.
Doctors rushed her into the emergency room, administered CPR and put Vance on intravenous blood thinners, Barrett said. At about 12:55 a.m., doctors were able to generate a weak pulse. About 10 minutes later, the pulse stopped and doctors restarted CPR. Vance was pronounced dead at 2 a.m.
No decisions have been made about criminal charges, yet, according to the articles.
FindLaw has a copy of the Coroner’s Jury Verdict form.
Thanks to reader Andy for the tip.
Brain surgeons say rocket scientists aren’t all that bright
Here’s the latest from the Borowitz Report:
Rocket Scientists Not as Smart as Originally Thought
New Findings in Study Commissioned by Brain Surgeons
Rocket scientists, long considered the gold standard in intelligence among all professionals, are not nearly as smart as originally thought, according to a controversial new study published today by the American Association of Brain Surgeons.The study, which appears in the organization’s monthly publication, Popular Brain Surgery, is entitled “The Intelligence of Rocket Scientists: Myth Versus Reality,” and suggests that rocket scientists’ reputation for smartness is largely undeserved.
“It does require a superior intellect to function as a rocket scientist,” the article concedes. “Having said that, though, rocket science is not brain surgery.”
There’s more, and it’s funny.
BBC: WHO backs DDT for malaria control
The World Health Organization (WHO) has reversed a 30-year policy by endorsing the use of DDT for malaria control.
The chemical is sprayed inside houses to kill malaria-carrying mosquitoes.
DDT has been banned globally for every use except fighting disease because of its environmental impacts and fears for human health.
WHO says there is no health risk, and DDT should rank with bednets and drugs as a tool for combating malaria, which kills more than one million each year.
This is a no-brainer, and it’s horrible it took this long to release DDT for more malaria control. If a million Americans were dying of malaria a year, this would have been done two decades ago.
An update to an earlier post, thanks to Alwin.
On September 8th, CNN reported this:
PORTLAND, Oregon (AP) — A nurse returning from work discovered an intruder armed with a hammer in her home and strangled him with her bare hands, police said.
Guess what? He was a hired killer, sent to end the life of our brave nurse by her ex-husband!
Michael James Kuhnhausen Sr. first hired Edward Dalton Haffey to mop up the mess at Fantasy Adult Video.
Police say he then hired Haffey, a convicted felon with a long criminal history, to kill his wife.
Kuhnhausen, the estranged husband of the emergency room nurse who strangled an intruder in her Southeast Portland home last week, was charged early Thursday with criminal conspiracy to commit murder and attempted murder.
Detectives say Michael Kuhnhausen, 58, helped disarm the security alarm at the Southeast Alder Street home earlier in the day and let Haffey in. Haffey waited with yellow rubber gloves and a claw hammer for at least four hours until Susan Kuhnhausen arrived home from work.
(click the Oregonian logo above to read the whole story).
Read to the end for her new answering machine message.
Wow. I guess he didn’t warn his hired killer she was tough.
Via Wikipedia: 
Dorothy Ann Richards (September 1, 1933–September 13, 2006) was an American politician from Texas. She first came to national attention as the witty keynote speaker at the 1988 Democratic National Convention (detailed below). Considered the first woman elected Governor of Texas in her own right, she served in that post from 1991 to 1995; she was defeated for re-election in 1994 by George W. Bush, current President of the United States.
I never voted for her (too young, then not my candidate) but she was always entertaining to listen to.
Esophageal cancer isn’t very common, and bad when it happenss Condolences to her family.
This headline made me read the article. How in the world could wearing a helmet be ‘more dangerous’?
The answer was a little surprising: 
Cyclists who wear protective helmets are more likely to be knocked down by passing vehicles, new research from Bath University suggests.
The study found drivers tend to pass closer when overtaking cyclists wearing helmets than those who are bare-headed.
Aah, so it’s a risk from drivers that increases.
Dr Walker, a traffic psychologist from the University’s Department of Psychology, said: “This study shows that when drivers overtake a cyclist, the margin for error they leave is affected by the cyclist’s appearance.
“By leaving the cyclist less room, drivers reduce the safety margin that cyclists need to deal with obstacles in the road, such as drain covers and potholes, as well as the margin for error in their own judgements.
Read the article to see how they gathered their data, it’s interesting.
And, as both a driver and a cyclist I think the underlying premise is correct: less space is given to bike riders wearing helmets. As a driver I think of a helmet cyclist as a predictable actor, there to ride, usually quickly and in as straight a line as possible. I (now) realize I give a wider berth to the more casual rider.
And I can attest cars don’t mind getting close to me while riding, though I never ride without a helmet, so can’t say about whether I get more or less space with / without.
Unusually for me, I’ll let the BBC have the last word:
However, a spokesman for the Royal Society for the Prevention of Accidents insisted: “We wouldn’t recommend that people stop wearing helmets because of this research. Helmets have been shown to reduce the likelihood of head and brain injuries in a crash.
“[The research] highlights a gain in vulnerability of cyclists on our roads and drivers of all types need to take more care when around them.”
It’s the Fifth Anniversary of the 9-11 attacks on America and Americans. Nearly 3,000 died, and the country was changed. My condolences to those directly affected for the loss of lives on that fateful day.
My recommendation for this day: Chapter One of the 9-11 Commission Report. 
It should be required reading in every High School History class in the US. The rest is a bit of a snoozer, but the first chapter is an excellent recitation of what actually happened.
Yes we were, as a government and a society, caught flat footed on that day, and things have changed to work on that. Not enough, but some moves in the right direction.
There’s much left to do.
Please spare a prayer for those lost, and those who risk their lives for us.
(This is not meant in any way to disparage my patient. I post this so you get an inkling of the challenges facing the terrifically good-looking but otherwise ordinary Emergency Physician during a shift).
A patient presents to the ED, from an assisted living center. The Chief Complaint on the triage form says ” ? ” I’m game. Into the cubicle we go.
“Tell me the story”, I say. Blank look. Look again at the triage form. ‘Patient is deaf’ it says. Also, ‘history of schizophrenia, and CHF’. Ooh. No medication list.
Great.
So, a good PE is completed, and a lot of pantomime is done. The interpreter is called. And, a wait ensues for said interpreter, though the lab workup continues.
The interpreter comes, sleepy but competent. After a while signing with the patient, I get something unexpected: ‘this isn’t making any sense’. What do you mean? ‘I mean the answers have nothing to do with the questions, and there’s a lot of things that make no sense’.
Ask if the voices are louder than normal. ‘Yes’, and the interpreter is relieved, as now it’s all making sense, at least for them, if not for the patient. Does patient think their voices are out of control? ‘Yes’ says interpreter, clearly relieved that things make sense now.
Labs are returning, and it’s not good news. Elevated troponin could (probably does) indicate cardiac injury. ?Chest pain? is asked, and there is no answer that makes sense, per the interpreter. The EKG looks like the chest xray: wide and abnormal, but nothing that makes the clinician panic.
To say the consultants were thrilled with this admission would be an understatement, but not one griped. Amazing.
This is from a colleague. This is real Emergency Medicine:
I was dismissing a 70 year old lady with abd pain that my night doc had left for me. Her lab work, x-rays and CAT scan were normal. When I told her this, she said “I just want you to tell me why my butthole won’t open up and let my shit out.”
Direct and to the point. Nice.
PORTLAND, Oregon (AP) — A nurse returning from work discovered an intruder armed with a hammer in her home and strangled him with her bare hands, police said.
Susan Kuhnhausen, 51, ran to a neighbor’s house after the confrontation Wednesday night. Police found the body of Edward Dalton Haffey 59, a convicted felon with a long police record.
…
Haffey, about 5-foot-9 and 180 pounds, had convictions including conspiracy to commit aggravated murder, robbery, drug charges and possession of burglary tools. Neighbors said Kuhnhausen’s size — 5-foot-7 and 260 pounds — may have given her an advantage.“Everyone that I’ve talked to says ‘Hurray for Susan,’ said neighbor Annie Warnock, who called 911.
“You didn’t need to calm her. She’s an emergency room nurse. She’s used to dealing with crisis.”
I have ticked off nurses before, and wondered if they could actually kill me. Now I know.
hat tip to reader Andy
Intellinurse asked me to participate in a blog-meme (see her site for details). This is the first one I’ve done, mostly because Moof (who tagged Intellinurse) I like, and was asked nicely.
1) Are you happy/satisfied with your blog’s content and look? Look, yes. Content, never. I don’t write well enough to express myself eloquently, and it always seems lacking. Also, there’s a lot of self-censorship going on, and there are things I want to say and cannot until I’m retired. (The blog will get more interesting then).
2) Does your family know about your blog? Funny, that’s how I learned about “Interventions”. Yes, and they try to ignore it. Really, I try to leave them out of it, but it’s hard sometimes.
3) Do you feel embarrassed to let your friends know about your blog? Umm, no, though I probably should be.
4) Did blogging cause positive changes in your thoughts? Less than beer, but, yes.
5) Do you only open the blogs of those who comment on your blog or do you love to go and discover more by yourself? Uuh, no. I read about 120 blogs / news sites with RSS a day, and I’m an inveterate link-clicker. (See #2). Too much time spent in a chair staring at monitors. I hope the radiation from the screens wards off Bird Flu.
6) What does a visitor counter mean to you? I’m guessing this isn’t asking for a definition. I check it more than I should, and mostly to see if what I’m doing is connecting / getting linked (it’s not, by the way).
Do you like having one on your blog? Yes.
7) Did you try to imagine your fellow bloggers and give them real pictures? Oh, no, I don’t have anywhere near that kind of imagination, though I suppose Nurse bloggers look like pre-crazy Farrah Fawcett or Lee Majors while doc bloggers look a little more like Bogart and Hepburn.
8) Admit it. Do you think there is any real benefit in blogging? It keeps me from doing things dangerous or stupid, so, yes. And, I really think blogging gives me an outlet for topics I might not talk about, for better or worse.
9) Do you think that blogger’s society is isolated from the real world or interaction with events? No, the actual world is all these tubes on the internets. The rest is just some weird construct to keep everyone else happy.
10) Does criticism annoy you or do you feel it’s a normal thing? All geniuses are misunderstood in their own times, and I must come to terms with it. Hehe. Yes, criticism bugs me, but then I consider how incredibly wrong they are, and just laugh it off.
11) Do you fear some political blogs and avoid them? I fear the virulently hateful and willfully stupid ideas on some of them, and find I sleep better when I don’t think about them. So, yes.
12) Were you shocked by the arrest of some bloggers? No, it was time for Alwin to be brought to justice. I mean, really, how many Tinderbox plugs before we realize you’re not from this planet? E.T. Immigration had to crack down, and make an example of their leader. And Richard Winters is apparently being held in a secret prison given his posting frequency.
13) What do you think will happen to your blog after you die? Smithsonian, baby! That, or an ignominious digital flushing. Either way, the world benefits. As mine is a single-author blog it’ll die with me. Hopefully not soon.
14) What song do you like to hear? Amazing Grace. I like it out of proportion to its impact on my life. No particular arrangement, I just like to listen.
What song would you like to link to on your blog? ER Nurse Rap! Oh, wait, I already link that.
15) The next victims? MedPundit, DB’s MedRants, and Kevin, MD. We’ll see if I can induce them to participate. I doubt it, but will try, but I’m not going to try until I wake up. Dang night shifts.
That was less painful than I thought it might be. I look forward to another one in another 4 years or so.
Update: Medpundit plays!
